Should You Take a Probiotic With an Antibiotic?

06/13/2023 | 5 min. read

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Alexander Fleming’s discovery of penicillin is recognized as one of the greatest medical breakthroughs of all time, and rightfully so. Antibiotics have saved hundreds of millions of lives from infectious diseases that were once our leading causes of death.

But antibiotics have a dark side. Although they target disease-causing bacteria, they also indiscriminately inhibit or kill beneficial bacteria—and they are particularly hard on the gut microbiome: the trillions of bacteria and other microorganisms that live in the intestines and play an important role in human health.

In addition to causing diarrhea, nausea, and other drug side effects, antibiotic-related damage to the gut microbiome is linked with a whole slew of chronic health problems. That’s why, if you ever have to take an antibiotic, it is essential that you also take a probiotic.

Why Are Probiotics Important During a Course of Antibiotics?

Probiotics are live strains of beneficial microbes that help support, replenish, and diversify the gut microbiome. Proven benefits of taking a probiotic supplement in conjunction with an antibiotic include:

  • Reducing antibiotic side effects. If you’ve ever taken an antibiotic, you may know that diarrhea is an especially common side effect. A meta-analysis of 63 randomized controlled trials found that probiotics reduced antibiotic-associated diarrhea by 48%.
  • Preventing dysbiosis. Dysbiosis, or imbalances in the gut microbiome, is another adverse effect of antibiotics. This includes both the suppression of beneficial bacteria as well as the overgrowth of harmful microbes such as Clostridium difficile, which can cause life-threatening diarrhea. Multiple studies show that probiotics can prevent dysbiosis.
  • Preserving bacterial diversity. A systematic review of 29 studies concluded, “Addition of probiotics to antibiotic interventions seems to preserve alpha diversity and ameliorate the changes of gut microbial composition caused by antibiotic interventions.”
  • Making antibiotics more effective. Probiotics exert antimicrobial effects as they pass through the intestinal tract and help modulate the gut’s immune system. One study showed that individuals taking metronidazole (Flagyl) for SIBO and concurrently taking the probiotic yeast Saccharomyces boulardii had double the success rate compared to those taking the antibiotic by itself.

When Is the Best Time to Take a Probiotic When Taking Antibiotics?

Make a point to purchase and start taking a good probiotic supplement the same day you begin a course of antibiotics. If this isn’t possible, start the supplement as soon as you can.

Wait at least two hours after taking the antibiotic before taking your probiotic. This helps ensure that the beneficial bacteria aren’t killed or inhibited by the drug.

How Long After an Antibiotic Course Should You Take a Probiotic?

A single course of a broad-spectrum antibiotic can cause changes in the gut microbiome that can take months to restore and return to normal. Therefore, I suggest taking a probiotic for a minimum of six months after completing an antibiotic.

Better yet, make probiotics a part of your daily supplement regimen. The gut microbiome is constantly under assault from poor dietary habits, alcohol, environmental toxins, stress, and other medications that negatively impact microbial diversity, such as birth control pills, acid-blocking meds, and NSAIDS.

Antibiotics aside, probiotics are needed more than ever in this day and age to support a healthy microbiome.

What Are the Best Probiotic Strains to Take With Antibiotics?

Several different probiotics have been used in clinical trials, and many strains have been shown to be protective against the adverse effects of antibiotics.

Given that there’s no one strain superior to all others, here’s what I recommend you look for in a good probiotic supplement:

  • Multiple microbial strains. Most probiotic supplements include various strains of Lactobacillus and Bifidobacterium. For broader protection, I also recommend S. boulardii as well as soil-based organisms. Make sure the specific strains are listed on the label and the product contains several billion colony forming units (CFUs).
  • Delivery system and packaging. Remember that probiotics are living organisms that must be formulated in an appropriate delivery system and packaged properly to ensure viability. A good product will also include an expiration or use-by date.

Beyond that, go with a reputable company with good manufacturing processes, quality assurance, 100% product guarantees, etc.

Are There Any Alternatives to Probiotic Supplements?

Yogurt, kefir, miso, tempeh, kimchi, kombucha, and other homemade or unpasteurized fermented foods are abundant in probiotic microorganisms, and fiber-rich vegetables, nuts, beans, whole grains, etc., support their growth.

Unfortunately, most of the fermented foods sold in supermarkets are pasteurized, so the beneficial bacteria have been destroyed. (Yogurt and other products labeled “made with live and active cultures” are exceptions.)

As you can imagine, it is difficult to get enough protective probiotics from diet alone. Even if you could, note that some people cannot tolerate fermented and/or high-fiber foods. For example, certain fermented foods can aggravate symptoms of small intestine bacterial overgrowth (SIBO).

That is why probiotic supplements are the way to go—especially when your goal is to counter the adverse effects of antibiotics.

Are There Any Drawbacks to Probiotics?

Probiotics can cause gas and bloating in sensitive individuals, but this usually disappears over time as the gut adjusts to them. Some probiotic supplements contain lactose or other potential allergens, so read labels carefully if you have allergies. A few probiotic strains increase the body’s production of histamine and should be avoided by anyone with histamine intolerance.

There have been rare reports implicating bacteria or yeast in probiotics with infections in individuals who have pre-existing conditions, such as compromised immunity, recent surgery, prolonged hospitalization, or venous catheters. Although this risk is exceptionally low, patients with serious health challenges should discuss this with their healthcare providers before taking probiotics.

Recap: Safe and Effective

The overwhelming consensus is that probiotics are safe, well-tolerated, and have positive effects not only while taking antibiotics but also on overall gut health, immunity, inflammation, weight, mood, and more.

Dr. Drew Sinatra

Meet Dr. Drew Sinatra

Dr. Drew Sinatra is a board-certified naturopathic doctor and self-described “health detective” with a passion for promoting natural healing, wellness, and improving quality of life by addressing the root cause of illness in patients of all ages. His vibrant practice focuses on treating the whole person (mind, body, and spirit) and finding missed connections between symptoms and health issues that are often overlooked by conventional medicine.

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