How Probiotics and Antibiotics Can Work Together

How Probiotics and Antibiotics Can Work Together

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Katie Stone - Naturopath

Written By:

Katie Stone - Naturopath
Dr. Nare Simonyan - PhD Pharmaceutical Science

Medical Reviewer:

Dr. Nare Simonyan - PhD Pharmaceutical Science
Kari Asadorian - BSN, RN

Edited By:

Kari Asadorian - BSN, RN
Last updated:
Probiotics and Antibiotics | MTHFR | Methyl-Life® Supplements Source: YouTube.com

What are antibiotics?

Antibiotics are a type of medication designed to kill bacteria and/or stop them from multiplying.1

They are generally prescribed to treat bacterial infections that cannot be treated with other medications.

Antibiotics work by targeting bacterial functions that are essential for survival or reproduction, such as interfering with their DNA replication, protein synthesis, cell wall functions, or folate metabolism.2

What are probiotics?

Probiotics are beneficial bacteria or yeast that can support the balance and function of your gut microbiota. When taken in supplement form, probiotics may provide a range of health benefits, including support for digestion, immune function, and mental wellbeing.3.

Probiotics work by interacting with and stimulating the growth of other beneficial bacteria while ‘crowding out’ harmful bacteria. They also support a healthy immune response to invading pathogens and produce antimicrobial compounds to prevent them from growing.4

Postbiotics are microbial metabolites, such as short-chain fatty acids (SCFAs), that provide direct benefits to overall health by reducing inflammation and improving insulin sensitivity, immune function, gut barrier integrity, and regulating the immune response.5

How do antibiotics affect gut health?

Broad‐spectrum antibiotics are the most commonly prescribed form as they target a wide range of bacterial species. These antibiotics cannot differentiate between ‘good’ and ‘bad’ bacteria, so they kill both. This can lead to an imbalance in the quantity and quality of your gut bacteria, as fewer beneficial microbes make it easier for harmful species to grow and proliferate. For example, antibiotic eradication of beneficial bacteria in the gut allows Clostridium difficile (C. diff) to flourish, often resulting in antibiotic-associated diarrhea and other gastrointestinal symptoms.6

AAD (antibiotic-associated diarrhea) occurs in 5%–35% of people who take antibiotics, depending on the type of antibiotics, the patient’s health, and their exposure to other bacteria.7

Taking probiotics with antibiotics

Taking probiotics alongside antibiotic treatment has been shown to help counteract antibiotic effects in several ways, including:

  • Producing antimicrobial compounds that suppress the growth of harmful microbes8
  • Competing for receptors and binding sites with pathogenic microbes on the gut lining9
  • Strengthening the integrity of the gut barrier, which helps to prevent the invasion of harmful bacteria and subsequent inflammatory responses10
  • Fermenting prebiotics (non-digestible fiber) to support the activity and growth of more beneficial microbes (mainly Bifidobacterium spp. and Lactobacillus spp.) in the gut


A 2021 systematic review also found that taking probiotics alongside antibiotics reduced AAD in adults by 37%, with higher doses providing greater benefits.11 The minimum recommended dose is 10 billion CFU per day. Another review demonstrated the greatest effects were seen with Bifidobacterium licheniformis, B. longum and B. subtilis, while other species including L. acidophilus, L. casei and S. boulardii are also found to be effective.12 Saccharomyces boulardii is a type of probiotic yeast that is resistant to most antibiotics and highly effective in preventing AAD, as well as other gastrointestinal symptoms.13

How to take probiotics with antibiotics

Check that your probiotic product has been designed for antibiotic use. Some species are better suited to resisting antibiotics than others. The delivery system of the probiotic capsules will also play a part. For example, spore-based probiotics are highly resistant to antibiotics as they are not released until they reach the intestinal tract, where they can begin colonizing. 

It’s usually best to take your probiotic at least two hours away from your antibiotic.

How probiotics and antibiotics can work together

Key takeaways

  • Icon Antibiotics are medications designed to kill infectious bacteria, but they also kill beneficial gut microbes.
  • Icon Probiotics are beneficial bacteria that can be taken in supplement form to restore gut health.
  • Icon Taking probiotics alongside antibiotics has been shown to help reduce the harmful effects of antibiotics.

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How probiotics and antibiotics can work together

Frequently Asked Questions about probiotics and antibiotics

Can you take probiotics with antibiotics?

Yes, some types of probiotics can be taken alongside antibiotics, and are often recommended to help protect against the side effects of the antibiotics. Look for a probiotic product designed to work with antibiotics, such as Saccharomyces boulardii or spore-forming Bacillus species.

Why don’t doctors prescribe probiotics with antibiotics?

Probiotics don’t require a prescription. They can be bought online or over the counter. Many doctors do encourage their patients to take probiotics alongside their antibiotics.

When should you have probiotics with antibiotics?

If you have been prescribed a course of antibiotics to treat a bacterial infection, it’s important to take probiotics at the same time to help prevent possible side effects of the antibiotics (such as diarrhea and digestive upset). Look for a probiotic supplement that can be taken alongside antibiotic treatment (this should be stated on the label) and continue taking the probiotic for at least a week after your antibiotic course is finished.

How many hours should you wait between antibiotics and probiotics?

It’s usually advisable to take your probiotic at least two hours away from your antibiotic.

References

  1. Esraa M Halawa, Mohamed Fadel, Mohammed W Al-Rabia, Ali Behairy, Nehal A Nouh, Mohamed Abdo, Rada Olga, Liana Fericean, Ahmed M Atwa, Mohammad El-Nablaway, Ahmed Abdeen; "Antibiotic action and resistance: updated review of mechanisms, spread, influencing factors, and alternative approaches for combating resistance"; Frontiers in pharmacology; 2024 Jan

    https://pmc.ncbi.nlm.nih.gov/articles/PMC10820715/

  2. Kushneet Kaur Sodhi, Chandra Kant Singh; "Recent development in the sustainable remediation of antibiotics: A review"; Total Environment Research Themes; 2022 Dec

    https://www.sciencedirect.com/science/article/pii/S2772809922000089?via%3Dihub

  3. Harsh Bodke, Sangita Jogdand; "Role of Probiotics in Human Health"; Cureus; 2022 Nov

    https://pmc.ncbi.nlm.nih.gov/articles/PMC9733784/

  4. Chiara Mazziotta, Mauro Tognon, Fernanda Martini, Elena Torreggiani, John Charles Rotondo; "Probiotics Mechanism of Action on Immune Cells and Beneficial Effects on Human Health"; Cells; 2023 Jan

    https://pmc.ncbi.nlm.nih.gov/articles/PMC9818925/

  5. Ross Pelton; "Postbiotic Metabolites: How Probiotics Regulate Health"; Integrative medicine; 2020 Feb

    https://pmc.ncbi.nlm.nih.gov/articles/PMC7238912

  6. Dhrati V Patangia, Cornelius Anthony Ryan, Eugene Dempsey, Reynolds Paul Ross, Catherine Stanton; "Impact of antibiotics on the human microbiome and consequences for host health"; Microbiology Open; 2022 Jan

    https://pmc.ncbi.nlm.nih.gov/articles/PMC8756738/

  7. Eileen F O'Shea, Paul D Cotter, Catherine Stanton, R Paul Ross, Colin Hill; "Production of bioactive substances by intestinal bacteria as a basis for explaining probiotic mechanisms: bacteriocins and conjugated linoleic acid"; International journal of food microbiology; 2012 Jan

    https://pubmed.ncbi.nlm.nih.gov/18811240/

  8. Lynne V McFarland; "Antibiotic-associated diarrhea: epidemiology, trends and treatment"; Future microbiology; 2008 Oct

    https://pubmed.ncbi.nlm.nih.gov/21742394/

  9. M C Collado, J Meriluoto, S Salminen; "Role of commercial probiotic strains against human pathogen adhesion to intestinal mucus"; Letters in applied microbiology; 2007 Oct

    https://pubmed.ncbi.nlm.nih.gov/17897389/

  10. Beom Jae Lee, Young-Tae Bak; "Irritable bowel syndrome, gut microbiota and probiotics"; Journal of neurogastroenterology and motility; 2011 Jul

    https://pubmed.ncbi.nlm.nih.gov/21860817/

  11. Clare Goodman, Georgia Keating, Ekavi Georgousopoulou, Charlotte Hespe, Kate Levett; "Probiotics for the prevention of antibiotic-associated diarrhoea: a systematic review and meta-analysis"; BMJ Open; 2021

    https://bmjopen.bmj.com/content/11/8/e043054

  12. McFarland LV; "Antibiotic-Associated diarrhea: epidemiology, trends and treatment."; Future Microbiology; 2008

    https://bmjopen.bmj.com/content/11/8/e043054#ref-7

  13. Thomas A. Parrino; "Review: Saccharomyces boulardii reduces risk for antibiotic-associated diarrhea"; ACP Journal Club; 2006 Mar

    https://doi.org/10.7326/acpjc-2006-144-2-045

Katie Stone - Naturopath

About the Author

Katie is a qualified Naturopath (BNatMed) and freelance writer from New Zealand. She specializes in all things health and wellness, particularly dietary supplements and nutrition. Katie is also a dedicated runner and has completed more half-marathons than she can count!

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