Many individuals wonder if they can take probiotics alongside antibiotics. Antibiotics, while effective against bacterial infections, can cause side effects by impacting the body’s natural bacterial balance. Understanding how these two substances interact is important for maintaining overall health and minimizing discomfort. This article explores the relationship between antibiotics and probiotics, offering guidance on their combined use.
Antibiotics and Probiotics Explained
Antibiotics are medications that kill or inhibit harmful bacteria causing infections. They work by various mechanisms, such as disrupting bacterial cell walls or interfering with protein synthesis, which prevents bacteria from multiplying. However, antibiotics are often non-discriminatory, affecting both harmful bacteria and the beneficial bacteria naturally residing in the body, particularly in the gut.
Probiotics are live microorganisms that, when administered in adequate amounts, confer a health benefit on the host. These beneficial microbes, often bacteria or yeasts, contribute to the natural microbial community within the body, known as the microbiome. Common sources include fermented foods like yogurt, kefir, sauerkraut, and kimchi, as well as dietary supplements.
The Rationale for Co-Administration
Antibiotics can disrupt the balance of the gut microbiome, leading to dysbiosis, where the ratio of beneficial to harmful microbes shifts. This imbalance can result in various gastrointestinal side effects. One common effect is antibiotic-associated diarrhea (AAD), which can affect up to 35% of people taking antibiotics.
Other digestive upsets, such as bloating, cramping, and general discomfort, can also occur due to this microbial disruption. Probiotics are considered for co-administration with antibiotics to help mitigate these adverse effects. By introducing additional beneficial bacteria, probiotics can help support the restoration of gut balance, potentially reducing these gastrointestinal issues.
Guidance for Concurrent Use
When taking probiotics with antibiotics, timing is an important factor to maximize effectiveness. It is recommended to separate the probiotic dose from the antibiotic dose by at least 2 to 3 hours. This separation helps prevent the antibiotic from immediately killing the probiotic bacteria, allowing them a better chance to survive and reach the gut.
Selecting specific probiotic strains is important, as not all strains are equally effective or resistant to antibiotics. Strains with strong evidence for use alongside antibiotics include Lactobacillus rhamnosus GG (LGG) and Saccharomyces boulardii, a beneficial yeast naturally resistant to antibiotics. Other strains like Lactobacillus acidophilus, Bifidobacterium lactis, and Bifidobacterium bifidum have also shown promise.
The recommended daily dosage, measured in colony-forming units (CFUs), ranges from 5 billion to 40 billion CFUs per day, depending on individual needs and gut disruption severity. For mild disturbances or short courses, 5 to 10 billion CFUs may suffice. For antibiotic-associated diarrhea, 10 to 20 billion CFUs are often recommended. Higher doses (20 to 40 billion CFUs) may benefit prolonged antibiotic therapy or individuals with a history of severe gastrointestinal issues.
It is advised to start taking probiotics on the same day as the antibiotic and continue throughout the entire antibiotic course, and for at least two weeks afterward to support gut recovery. Incorporating probiotic-rich foods like yogurt, kefir, and fermented vegetables can also complement supplementation.
Evidence and Important Considerations
Current scientific understanding supports the safety of co-administering probiotics with antibiotics for most healthy individuals. Research indicates that probiotics can reduce the incidence of antibiotic-associated diarrhea (AAD) by approximately 50% in both children and adults. They may also help lower the chance of developing Clostridioides difficile infection, a more severe form of antibiotic-induced diarrhea.
It is important to recognize that probiotic effectiveness can be strain-specific, meaning not all probiotics are beneficial for all conditions. While safe, there are potential risks for certain vulnerable populations. Immunocompromised individuals, those with a central venous catheter, or premature infants have a small risk of developing infections from probiotics. Powdered probiotic formulations, in particular, have been associated with a higher risk of central line infections in intensive care unit (ICU) patients.
Consulting a healthcare professional before starting any new supplement, especially when on medication, is always recommended. Probiotics are not a substitute for prescribed antibiotics, which are necessary to treat bacterial infections effectively. They are intended to help manage side effects and support gut health during antibiotic treatment.