Taking antibiotics? Or have you taken antibiotics recently?
You might be surprised to learn how antibiotics can interact with your gut flora, and how you can support a healthy microbiome during antibiotic use.
Recent research has shown that taking a course of antibiotics may alter the good balance of your gut flora.2
This is why some health practitioners now educate and encourage patients about the benefits of taking a probiotic along with their antibiotic.
But won’t an antibiotic just “kill” the probiotic strains in the gut?
And if not, when is the best time to take probiotics with antibiotics?
We’ve put together the ultimate guide to keeping your gut microbiome in good shape when taking antibiotics, and why it is so important to choose the right probiotic for the job.
There are some good reasons to take a probiotic with an antibiotic. Scientific studies have shown that probiotics can support and maintain the gut microbiome when taken alongside antibiotics, as well as restoring beneficial gut flora after antibiotic use and reducing the side effects of unhealthy gut microflora.3,4
Antibiotics are designed to protect us from pathogenic, or bad, bacteria. Prescribed to prevent and treat infections caused by pathogens and other microbes, antibiotics are extremely effective for treating a bacterial infection and returning us to good health. Some antibiotics are highly specialised and only effective against certain bacteria, while others are broad-spectrum.
During antibiotic treatment, the good balance of our gut bacteria can be altered. Our body requires a healthy balance of gut bacteria to function properly, supporting healthy gastrointestinal function and immune system function.
One way to support our gut bacteria balance during antibiotic use is to take a probiotic at the same time.
The word 'pro-biotic' means 'for life'.
Probiotics are live, beneficial microbes that are used to support the composition and function of gut microbiota.5 These microbes are present in fermented foods such as kimchi, yoghurt, sauerkraut, and kefir. They can also be taken as supplements.
Probiotics can help to restore and maintain the composition of the gut microbiome and introduce beneficial functions to the gut environment, helping to reduce or prevent gut inflammation and other intestinal issues.6 In fact, a survey found that 98% of gastroenterologists believe that probiotics have a role in the treatment of gastrointestinal conditions.7
They also support the health and activity of the immune system.
One of the major benefits of taking probiotics is their ability to reduce diarrhoea that may occur when the natural balance of gut bacteria is disturbed, causing harmful bacteria to multiply beyond their normal numbers.8
One study found that when children were given certain probiotic strains alongside antibiotics, the number of children who experienced diarrhoea was significantly reduced.11
The researchers explained that probiotics help to maintain and restore the natural balance of bacteria in the intestinal tract during antibiotic use.
Other research has concluded that adding probiotics to antibiotic interventions helps to preserve the diversity of gut microbiota, and can also ameliorate the changes to gut microbial composition caused by antibiotics.12
What’s more, the World Health Organisation (WHO) has stated that probiotics will be our second most important immune defence system if antibiotics ever become ineffective as a result of antibiotic resistance.13
As you might already know, your gut bacteria play an important role in healthy digestion - but there’s a lot more to it than that. These trillions of tiny microbes work by fermenting specific dietary fibre in the food you eat, which allows them to produce a range of substances and nutrients that your body needs to function properly.14 These substances include three major short-chain fatty acids (SCFA) called acetate, propionate, and butyrate.
Butyrate is the main energy source for the cells that line the intestines, and also helps the body to process glucose for energy. SCFA have many other important benefits, including maintaining the strength and integrity of the gut mucosal barrier; supporting your immune cells, protecting your body from pathogens, managing the inflammatory response, maintaining heart health, and protecting brain cells.15 Some evidence also indicates that certain SCFAs may help protect the liver and reduce the risk of obesity, heart disease, and diabetes.16
Essentially, your overall health and wellbeing is supported when you have a good quality and quantity of friendly gut bacteria. They protect your body from germs, viruses, and chronic diseases. The greater and more diverse your bacteria, the better they are able to support your health.
Over the past decade, several studies have shown that changes to your gut microbiome can take several months to return to a healthy balance.
A 2022 study involving adults who had taken antibiotics found that it took around two months for their gut bacteria to return to a “pre-antibiotic” state.
Taking a probiotic with an antibiotic can help to prevent the loss of your good bacteria.
Probiotics are a simple and convenient way to maintain gut flora diversity and the integrity of the gut barrier, an important element of our gastrointestinal health. Probiotics also “crowd out” potentially harmful bacteria by competing with them for nutrients and preventing them from growing or spreading.
In addition, probiotics support the health and strength of the gut lining, which is needed to block harmful bacteria and viruses from entering the body.
Not all probiotic strains are effective when taking antibiotics. Only certain strains have been clinically researched to support healthy gut flora during antibiotic use, without impacting the antibiotic treatment.
Saccharomyces boulardii is a strain of beneficial yeast that not only survives in the gut during antibiotic treatment, but also helps to preserve the microbiota from undesirable bacteria and promotes the growth of healthy bacteria.22 S. boulardii is also shown in clinical studies to be effective for those suffering diarrhea, across both children and adults.23
Bifidobacterium animalis ssp. lactis BB-12® is a probiotic bacteria that has also been shown to maintain gut microbiota and prevent the increase of potentially harmful bacteria when taken during and after antibiotic use.24 Both S. boulardii and BB-12 help to increase populations of beneficial species and the support conditions for a healthy gut environment.
There is no evidence that probiotics ‘fight’ antibiotics or reduce their effects in treating an infection. Many health professionals advise their patients to take a probiotic along with their antibiotic to reduce the negative effects on their gut health.
Some probiotic strains cannot survive if taken during antibiotic treatment, so it’s important to choose a product that is clinically proven to work while taking antibiotics. So far, research has shown that Saccharomyces boulardii and Bifidobacterium animalis ssp. lactis BB-12® are two strains that can withstand antibiotic treatment.
Always read the dosage information on your product first. Some probiotics need to be taken at least two hours away from your antibiotic, while others can be taken at the same time.
You should also check that the product specifically states whether it can be taken alongside an antibiotic.
Probiotics are available over-the-counter, so doctors don’t have to prescribe them. However, be sure to ask your doctor if a probiotic is suitable for you when they have prescribed antibiotics.
You can find probiotics at a health store or pharmacy. Ask the pharmacist to recommend probiotic supplements specifically researched to be suitable for antibiotic use.
If you’ve been prescribed a course of antibiotics to treat an infection, be proactive. Talk to your health practitioner about whether you should be taking a probiotic supplement during or after your treatment. You should also ask if it’s okay for you to take probiotics that contain the strains clinically proven to survive antibiotic treatment, such as Saccharomyces boulardii and Bifidobacterium animalis ssp. lactis BB-12.
As explained above, taking a probiotic after a course of antibiotics can help to restore and maintain the gut bacteria that may have been lost to the antibiotic treatment.26 Probiotics can also support the integrity of the gut barrier and help to maintain healthy immune function.
Looking after your gut microbiome should be a priority at any age. These billions of tiny microbes that live in your gastrointestinal tract have a major impact on almost every bodily function: your immune system, digestion, mind, mood, blood sugar levels, metabolism, skin health, and much more.
01 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7491661/
02 https://www.cell.com/cell-reports/fulltext/S2211-1247(22)00401-6
03 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9240980/
04 https://pubmed.ncbi.nlm.nih.gov/30193113/
05 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3539293
06 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3539293
07 https://pubmed.ncbi.nlm.nih.gov/20216432/
08 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5745464
09 https://pubmed.ncbi.nlm.nih.gov/9892789/
10 https://www.cochrane.org/CD004827/IBD_probiotics-prevention-antibiotic-associated-diarrhea-children
11 https://www.cochrane.org/CD004827/IBD_probiotics-prevention-antibiotic-associated-diarrhea-children
12 https://pubmed.ncbi.nlm.nih.gov/36382780/
13 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9240980/
14 https://www.bmj.com/content/361/bmj.k2179
15 https://pubmed.ncbi.nlm.nih.gov/36140990
16 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9240980/
17 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7732679/
18 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7732679/
19 https://pubmed.ncbi.nlm.nih.gov/33198506
20 https://www.cell.com/cell-reports/fulltext/S2211-1247(22)00401-6
21 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10436532/
22 https://pubmed.ncbi.nlm.nih.gov/26216624/
23 https://pubmed.ncbi.nlm.nih.gov/34444974/
24 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7732679/
25 https://pubmed.ncbi.nlm.nih.gov/37203836/
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