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Understanding Antibiotics and Their Impact on Gut Health

Antibiotics play a vital role in treating infectious diseases. They are used to kill or prevent the growth of harmful bacteria, helping to treat bacterial infections. However, taking a course in antibiotics can negatively affect your gut microbiome. 

The gut microbiome consists of trillions of bacteria and fungi that live in the human digestive tract, called microorganisms or microbes. The microbiome plays a vital role in digesting fiber while dictating how the body reacts to infection, just to name a few. The gut ecosystem is essential for human health. A more diverse microbiome is considered to be beneficial for overall health. 

Unfortunately, antibiotics do not discriminate between harmful and beneficial microbes.  

While antibiotics can be very effective at treating bacterial infections, they also kill the good bacteria in the gut, leading to an imbalance in the gut microbiome. This can negatively affect your immune system, metabolic activity, and overall health.

In addition, by upsetting the balance between harmful microbes and beneficial gut bacteria, antibiotic intervention can cause antibiotic-associated diarrhea. This is usually mild and resolves in a day or two. 

However, sometimes antibiotic treatment causes an overgrowth of pathogenic bacteria, such as a toxin-producing bacterium called Clostridium difficile (C. difficile or C. diff). A Clostridium difficile infection can cause severe antibiotic-associated diarrhea that can lead to colitis (inflammation of the colon). 

In addition to uncomfortable gastrointestinal side effects such as nausea, vomiting, and diarrhea, vaginal thrush is another unwanted adverse effect of antibiotic treatment.

Appropriate use of antibiotics can also reduce the risk of microbiome disruption. This means you should only use antibiotics prescribed for you, never use leftover antibiotics, and always finish the entire course of antibiotics. Antibiotics should not be used to treat viral infections like the common cold or yeast infections. Not only is this harmful to your gut microbiome, but inappropriate use of antibiotics can lead to antibiotic resistance, a global health threat.

The Role of Probiotics in Maintaining a Balanced Gut Microbiome

Probiotics are live microorganisms consisting of helpful, beneficial, or healthy bacteria and yeast. They are available over the counter as dietary supplements both online and at local pharmacies. You can also obtain probiotics from fermented foods such as yogurt, miso, sauerkraut (the unpasteurized type), pickles, tempeh, and kefir. Taking probiotics alongside antibiotics may help to maintain a healthy balance in your gut flora. Learn more about the positive effects of probiotics.

The Science Behind Probiotics and Antibiotics Co-Administration

How Antibiotic Treatment Affects the Gut Microbiome

Taking antibiotics disrupts the complex ecosystems of the gut microbiome. This is because antibiotics work to eradicate harmful bacteria that cause skin, ear, and urinary tract infections. However, antibiotics do not discriminate between harmful and beneficial bacteria. This leads to a decrease in the number of microbes in the digestive tract and also a decline in human gut microbial diversity.

Beneficial Bacteria: The Protective Role of Probiotic Supplements

Probiotics are foods or dietary supplements that contain live microorganisms. They help to improve or maintain the good bacteria in the body. Taking a probiotic supplement at the same time as antibiotic use may help maintain or restore a healthy balance in your gut microbiome between good and bad bacteria. It can also support overall gut health. In addition, taking a probiotic alongside antibiotics can lower your risk of serious antibiotic-associated diarrhea caused by C. difficile infections. 

Adding probiotics to Helicobacter pylori (H. pylori) eradication therapy has been found to improve treatment outcomes and reduce side effects. It is believed that colonization of specific probiotics can help maintain the gut microbiome during H. pylori infection and antibiotic therapy.  

In some populations, there is a high level of antibiotic resistance to two antibiotics (clarithromycin and metronidazole) that are used in triple therapy for Helicobacter pylori infections. A non-randomized clinical trial found that H. pylori patients who were given Saccharomyces boulardii (S. boulardii) have lower antibiotic resistance genes. However, more studies are necessary to establish the role of S. boulardii in treating H. Pylori among patients with antibiotic resistance. Find out: How Does an H. Pylori Breath Test Work?

Human Gut Microbial Diversity: Clinical Evidence Supporting Simultaneous Use of Antibiotics and Probiotics

A Coachrane review of 23 studies assessing the efficacy and safety of probiotics for the prevention of pediatric antibiotic-associated diarrhea 

A systematic review and meta-analysis of 23 randomized controlled trials with nearly 4,000 participants found that the incidence of pediatric antibiotic-associated diarrhea was 8% in children taking antibiotics with probiotics compared to 19% in children who didn’t take probiotics with antibiotics. 

Authors of this systematic review concluded that there was a protective effect of using probiotics in the prevention of antibiotic-associated diarrhea.

While none of the studies reported serious side effects from the probiotics in healthy children, serious adverse effects have been reported in severely debilitated or immunocompromised children. Notably, this review also points out that, among other probiotics being studied, Lactobacillus rhamnosus or Saccharomyces boulardii at 5 to 40 billion colony-forming units (CFU)/day may be the most appropriate due to their safety and efficacy profiles. The authors also endorsed that future trials would be necessary and beneficial. In the meantime, probiotic use should be avoided in pediatric populations.  

Scientists from Weizmann Institute of Science in Israel and other institutions found that probiotics are associated with a delay in recovery of the gut microbiome

A 2018 study found that taking probiotics with antibiotics for 4 weeks delays the return of the gut microbiome to normal. In fact, it took six months for the gut microbiome to return to normalcy for participants who received probiotic treatment. This was noted in people who took an 11-strain probiotic supplement containing a variety of beneficial bacteria. The study authors concluded that the introduction of new bacteria and yeast strains into the gut microbiota prevented it from returning to normal in the usual timeframe. 

In contrast, people who didn’t receive probiotics had a faster return to normal of the gut microbiome. However, it is possible that different combinations of antibiotics and probiotics may be beneficial.

Timing Matters: Best Practices for Taking Probiotics and Antibiotics

Recommendations on Probiotic and Antibiotic Timing

In terms of the timing of probiotics with antibiotic therapy:

• Start taking probiotics the same day you start a course of antibiotics.

• To prevent interactions, avoid taking antibiotics and probiotics at exactly the same time. Instead, take antibiotics and probiotics at least 2 hours apart.

• Probiotics work best if you take them on an empty stomach once or twice a day. 

• Continue taking probiotics for several weeks after finishing a course of antibiotics.

Maximizing the Benefits of Probiotics During Antibiotic Treatment

To get the maximum benefits of probiotics with antibiotics, choose:

• High-quality probiotic supplements from reputed manufacturers 

• Probiotics that are specially formulated for use alongside antibiotics

• Supplements containing a probiotic strain such as Lactobacillus rhamnosus, Bifidobacterium sp., or Saccharomyces boulardii

• Probiotic supplements that provide 5 to 40 billion colony-forming units (CFU)/day (these are considered the ideal microbiological quality and therapeutic dose)

Potential Concerns and Side Effects

Antibiotic-Associated Diarrhea

Studies have shown that probiotics have a protective effect when used alongside antibiotics. They reduce the risk of antibiotic-associated diarrhea by more than half. Probiotic strains such as Lactobacillus rhamnosus GG and Saccharomyces boulardii may be more effective than other probiotic strains in this regard. Furthermore, the use of probiotics with antibiotics appears to be generally safe for most healthy people. You should not give probiotics to your kids without discussing it with a pediatrician first. 

Risks of Combining Certain Probiotics with Antibiotics

There are no head-to-head comparisons in medical microbiology research between different combinations of probiotic strains and specific antibiotics. Caution is therefore advised against the widespread use of probiotics with antibiotics. Children and people with a weakened immune system or chronic health conditions should check with their healthcare provider before taking probiotics alongside antibiotic therapy.

Side Effects and How to Mitigate Them

Common side effects of probiotics include:

• Nausea

• Flatulence (gas)

• Abdominal bloating

• Abdominal pain

• Vomiting

• Constipation

• Changes in taste

• Decreased appetite

• Increased phlegm 

• Chest discomfort 

It is best to start with a low dose of probiotics and slowly increase to the recommended dose over a period of several weeks. This will give your body time to adjust to the probiotic supplement. 

If you continue to have gas, bloating, or other side effects of probiotics after a few weeks, stop taking the supplement and consult your healthcare provider. Find out the best probiotics for men and women.

Choosing the Right Probiotics to Take with Antibiotics

The Importance of Probiotic Strains: Lactobacillus, Bifidobacterium, and Others

One or more of the following probiotic strains are usually present in supplements: Lactobacillus rhamnosus, Lactobacillus acidophilus, Bifidobacterium species, Saccharomyces species, Bacillus species, Lactococcus species, Clostridium butyricum, Leuconostoc mesenteroides cremoris, and Streptococcus species.

Some studies have found that Lactobacillus rhamnosus and/or Saccharomyces boulardii at doses of 5 to 40 billion CFU/day are the most appropriate choice for use with antibiotic therapy. 

Consider Fermented Foods as Natural Probiotic Sources

Foods such as yogurt, sauerkraut, pickles, kefir, kombucha, miso, kimchi, tempeh, certain cheeses, and sourdough bread are natural sources of probiotics. 

Other fermented beverages and foods such as beer, wine, and canned or baked foods do not contain probiotics because the manufacturing process inactivates the bacteria. 

Some people find the smell and taste of fermented foods unpalatable. However, the odor, flavor, and texture of yogurt is generally appealing, which is why it is the go-to probiotic for many people (look for “live active cultures” on the label). The number of bacteria and the probiotic strain vary by brand. 

Expert Recommendations and Clinical Trials Insight

Experts recommend reserving probiotic supplements for when they are prescribed by a healthcare provider to treat a specific condition. 

Research has shown that probiotics replenish healthy bacteria in the gut and are beneficial to take alongside antibiotics. They can lower the risk of antibiotic-associated adverse effects. 

However, some studies have shown that taking probiotics with antibiotics can delay the return of the gut microbiome to normal. Additionally, there is a lack of research on the specific combinations of probiotics and prescribed antibiotics that are beneficial. 

Lastly, probiotic supplements sold over the counter are not subject to FDA oversight like prescription medications. It is especially important to check with your healthcare provider before giving probiotics to a child or taking probiotics if you have a weakened immune system or chronic health conditions.

Conclusion: Balancing Antibiotic Use with Probiotic Intake for Gut Health

Benefits of Probiotic and Antibiotic Co-Administration

Probiotics contain beneficial bacteria such as Lactobacillus, Bifidobacterium, and Saccharomyces. These live microorganisms can reinforce the gut microbiome during antibiotic treatment. Therefore, probiotics can help to restore the imbalance in the gastrointestinal tract caused by antibiotics.

Safeguarding Your Microbiome During and After Antibiotic Use

Probiotics help to restore any imbalances in your gut microbiota to a healthy state. Taking probiotics during or after a course of antibiotics may lower your risk of antibiotic-associated side effects such as antibiotic-associated diarrhea. However, it is best to check with your healthcare provider before taking a probiotic supplement when they prescribe antibiotics. You can, however, consider eating more probiotic foods, such as yogurt, to reestablish a healthy gut microbiome.

Some people take a daily probiotic supplement for general wellness. Talk to your doctor about doing this if you struggle with gut health issues. Probiotic supplements are generally safe and can be taken long-term if they are helpful. However, people with chronic health conditions or a weakened immune system should consult their doctor before taking any supplements.

Frequently Asked Questions

What happens if you take probiotics and antibiotics at the same time?

If you take probiotics and antibiotics at the same time, they could interact and make the antibiotic less effective in treating your bacterial infection.

How many hours before antibiotics should you take probiotics?

You should take probiotics at least 2 hours before antibiotics. Probiotic supplements work best on an empty stomach. 

What medications should not be taken with probiotics?

Do not take antimicrobials such as antibiotics or antifungals at exactly the same time as probiotics (take them at least 2 hours apart). Also, check with your doctor before taking probiotics with immunosuppressant medications such as corticosteroids (prednisone, others). Find out: “Is Antimicrobial Resistance (AMR) the Next Pandemic?”

Can you take 3 different probiotics at the same time?

You can take 3 different probiotics at the same time if they contain different probiotic strains. Alternatively, you could take one multi-strain probiotic supplement for overall gut health. Learn more about how to heal your gut.