Last updated February 21, 2019 by Lisa Richards, CNC   Reviewed by Zia Sherrell, MPH.

Should You Take Probiotics With Antibiotics?

Can you take probiotics and antibiotics together?

Probiotic and antibiotic are two words that sound similar, but they’re worlds apart. “Biotic” signifies lifelike, a word derived from the Greek biotiko. Antibiotic signifies ‘against life’ and probiotic signifies ‘for life’.

All ecosystems consist of two parts; the biotic entities, which are the living organisms, and their physical environment. Each element in the ecosystem can impact on the others, and they are interdependent for survival.

Your body is an ecosystem too. Every part of you is teeming with micro-organisms, especially your digestive system where there are an incredible 100 trillion bacterial cells, more than ten times the amount of human cells. This is what we call the microbiome. (1)

When you are healthy, you and your microbiome live together in harmony, with each one existing in perfect balance.

There are always harmful bacteria, viruses, and fungi that live on and within you. Most of the time, they exist in small quantities and do not cause disease. Your immune system keeps them in check.

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Complications arise when these microorganisms multiply beyond their normal parameters, and they begin to cause disease. When this happens, antibiotics may be necessary. These medicines play a vitally important role in maintaining health, but they have their downsides too.

Antibiotics are essential for medicine and human health. They are one of the most significant discoveries in medicine, but they also cause health issues. That’s where supplements like probiotics can help. (2)

Let’s start by taking a closer look at antibiotics – what they are, what they do, and what side effects accompany them.

What Are Antibiotics?

According to the Microbiology Society, an antibiotic is a substance that either kills bacteria or prevents it from growing and replicating. (3)

The mechanisms they use to do this differ, depending on the antibiotic. Some affect the bacterial cell walls, others the essential enzymes. Antibiotics can be broad-spectrum, acting on a wide range of bacteria, or narrow-spectrum, targeting a specific type of bacteria.

Antibiotics can also destroy some parasites, but not viruses or fungi. Doctors use antivirals and antifungal medications to eradicate these microbes.

Bacteria can cause critical diseases like cholera and tuberculosis and less serious conditions like an infected cut or minor infection in the body. Antibiotics are adept at killing these bad bacteria, but they also obliterate the good bacteria that are beneficial to your health.

Antibiotics are found in nature, such as penicillin, or they can be synthetic. Microbes generate antibiotics to wipe out the other bacteria that surrounds them so that they have less competition for food. Scientists can even cultivate antibiotic-producing bacteria in the laboratory, and in turn formulate medicine from them.

What Are The Side-Effects Of Antibiotics?

Evidently, society needs antibiotics; their use has prevented millions of deaths since their discovery in 1928 by Alexander Fleming. (4)

But this wonder drug is not perfect. Yes, it can solve some health problems, but it can cause others.

Their Influence On The Gut Microbiome

Antibiotics kill both pathogenic and desirable bacteria, leading to an imbalance to the gut microbiome. As the bad bacteria and yeast begin to outnumber the beneficial bacteria, this is known as dysbiosis. It can lead to antibiotic-associated diarrhea, infection-induced diarrhea, imbalances like Candida overgrowth, and even irritable bowel syndrome (IBS). (5)

Antibiotics cause a decrease in the diversity of good bacteria found in the human microbiome. When you stop taking antibiotics, your microbiome will begin to recover, but it may take years. In fact, it may never be exactly as it once was. (6)

The amount of harm that antibiotics can do to your gut microbiome depends on several factors; the duration of regimen, whether you are using one antibiotic or more, the chemical action of the antibiotic, and the dosage. Some antibiotics are very potent, others are not as damaging to the human microbiome, but all have been implicated in the following conditions (7):

  • Candidiasis
    Studies have reported for decades that patients can suffer from candidiasis following a course of antibiotics, especially those who have a less than ideal level of immunity such as patients undergoing chemotherapy, low birth-rate babies, and the elderly. (8)Antibiotics create an opportunity that allows Candida to aggressively colonize the gut, and they also depress the immune defense mechanisms that your body needs to tackle it.
  • Diarrhea
    Scientists recognized decades ago that the harmful bacteria Clostridium difficile has the opportunity to multiply in the digestive tract after a course of antibiotics. (9)C.difficile is a nasty pathogen that can cause life-threatening diarrhea and organ failure. In some cases, the patient may need their entire colon removed. (10)
  • IBS
    This common disorder causes pain and bloating in the abdomen, cramping, diarrhea, and constipation. Research indicates that in some sufferers of IBS, there are elevated numbers of bacteria in the digestive tract, referred to as small intestinal bacterial overgrowth (SIBO).If there is an overgrowth of bacteria in the intestine that is causing symptoms, surely the best treatment regimen would be to use antibiotics? In some cases, this will exhibit a temporarily successful outcome; however, some doctors now believe that using antibiotics to treat the bacterial overgrowth will result in a chronic condition and regular relapses. (11)
  • Weight management
    Animal feedstuffs regularly contain antibiotics in order to increase weight gain in livestock; this is achieved by altering the gut microbiome. The use of antibiotics ensures that these animals don’t suffer from any form of sub-clinical infection that could lead to weight loss.There is a well-established correlation between the use of antibiotics early on in childhood and excessive weight gain. Studies indicate that if the mother takes antibiotics, the unborn child can be predisposed to being overweight.

    The use of antibiotics dramatically alters the gut microbiome. The gut microbiome of babies is dependent on what was acquired before birth from the mother and is also affected by breast milk. Scientists now recognize that a child’s metabolism is modulated by the intestinal microbiome.(12)

  • Mental health
    It might seem incredible, but your microbiome influences your mood and your mental health. Recent research is now referring to this phenomenon as the gut-brain axis and has shown that the human microbiome is responsible for conditions such as depression, autism, and neurodegenerative disease. (13)Think about how you feel when you are about to take a test or when you are waiting for some important news. Your digestive system suffers, and you may experience cramps, pain, and diarrhea. It now seems that these effects work both ways, with your emotions affecting your gut and your gut microbiome affecting your mental state.

    Japanese researchers looked at mice who were specially bred to be microbe-free and lived in a completely sterile environment. They had double the level of the stress hormone cortisol vs. normal mice who otherwise identical, save for their microbiome. (14)

    It is believed that the gut-brain axis works through several mechanisms: the vagus nerve which connects the brain with the digestive system; through short-chain fatty acids which affect the whole body and are produced by bacteria; and through the immune system which has also been implicated in mental health.

    A healthy microbiome should be diverse, but in individuals suffering from depression the range of microorganisms can be much narrower than would be expected. (15)

    It is not thought that depression is due solely the makeup of your gut microbiome, but there is a clear connection that is not yet fully understood.

Their Influence On Vaginal Microflora

Just like the gut, a healthy vagina has a microbiome that is filled with good bacteria and needs to be balanced for health.

Good bacteria like Lactobacilli in the vagina prevent pathogenic bacteria and yeasts from causing infections. These infections include bacterial vaginosis, Candida yeast infections, urinary tract infections, and even some sexually transmissible diseases (16).

The microbiome of the vagina is also responsible for maintaining the correct pH, a part of your immune system which also prevents a proliferation of bad bacteria.

What Are Probiotics?

Probiotics are microorganisms, including live bacteria and yeast, that can help you to improve your health when ingested in large enough quantities.

You might have heard them called good or helpful bacteria, which is in contrast to disease or infection-causing bacteria, which are undesirable. Probiotics can decrease the number of pathogenic bacteria and increase the desirable bacteria.

Probiotics work by helping your body’s bacteria to remain in balance or to restore harmony following an illness, stress, poor diet, or a course of antibiotics. Keep in mind that you may be consuming antibiotics inadvertently from the food that you eat, e.g. from eggs, dairy, and meat. Even without taking antibiotic pills, your gut microbiome can be suffering and out of balance.

Probiotics are usually bacteria, but there is one probiotic yeast. Saccharomyces boulardiihas been found to be quite effective at preventing and aiding gastrointestinal disorders. (17)

Can Probiotics Reduce The Negative Effects Of Antibiotics?

The short answer is ‘yes.’ There has been considerable research directed at finding methods of preventing the side effects from antibiotic use. Probiotics have been found to be successful in mitigating the adverse effects of antibiotics.

Antibiotic-associated diarrhea (AAD) is a common event following antibiotic treatment. Probiotic use of any type was found to significantly reduce the incidence of AAD when compared to alternative treatments or placebo in the pediatric population.  In Clostridium difficile-specific AAD, both children and adults showed a massive 64% reduction in the risk of diarrhea when they also took probiotics. (18)

Clinical trials have shown that probiotic use reduces the chance of recurring infections with Helicobacter pylori, a nasty bacterium that causes stomach ulcers. A reduction in allergies and urinary tract infections and bacterial vaginosis were also found. There was also an easing of the symptoms of inflammatory bowel disease. (19)

Taking probiotics will lessen the likelihood of suffering from diarrhea or other side-effects while you are taking the course of antibiotics. It will help your microbiome to recover once you have completed the course. The faster your microbiome is to return to the normal stasis, the less likely you are to suffer any of the issues caused by dysbiosis of the gut or vagina.

What To Look For In A Probiotic

There is an increasing number of probiotics available on the market. It is vital to select a quality product to get the most health benefits. When choosing a high quality probiotic, you should look for the following 3 characteristics:

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1. Bacterial strains

Like the human microbiome, a suitable probiotic should contain a range of different bacterial strains. Here are some of the best probiotic bacteria for gut health.

  • Lactobacillus plantarum
    A bacterium that protects your gut lining and is an excellent candidate for fighting harmful microorganisms including Escherichia coli and Candida albicans. This probiotic is so hardy that some strains can even be taken at the same time as antibiotics without being killed. (20)
  • Lactobacillus paracasei
    L. paracasei is a potent weapon against E. coli, Candida albicans, and the bacteria that cause periodontal disease.
  • Lactobacillus acidophilus
    Candida cannot proliferate in the presence of L. acidophilus.This is perhaps the most effective probiotic strain you can use against Candida, due to the hydrogen peroxide and lactic acid that it excretes.

2. Colony Forming Units (CFU)

You need to ensure that your probiotic has not only the correct strains of bacteria but that it is strong enough to make a positive difference. To find out the strength of a probiotic, look for the CFU which shows you the level of live and active bacteria that the probiotic contains. You want to see there are at least 10 billion CFUs to be worthwhile. (21)

3. Delivery System

What’s the point in spending money on a probiotic if it doesn’t get its bacteria where they’re needed? Probiotics in regular vegetable capsule shave been shown to deliver around 4% of their bacteria past stomach acid. Look for a probiotic that uses BIO-tract, which can deliver more than 60% of the good bacteria to your gut.

The Bottom Line

Without a doubt, antibiotics are an essential part of healthcare. Most of us are going to need to take them at some point in our lives. Make sure that you only take them when absolutely necessary, and remember that they might come with significant side effects.

If you genuinely need to take antibiotics, you shouldn’t avoid taking them because of fear of the harm they can do to your microbiome. Probiotics are proven to alleviate many of the problems that antibiotics can cause in the majority of people.

Consider adding probiotics to your medicine cabinet to protect yourself and your microbiome from harm, in case you are prescribed antibiotics in the future.

Balance ONE ProbioticWe recommend the Balance ONE Probiotic. It uses BIO-tract technology to deliver 15 times as many probiotic bacteria to your gut, compared to regular probiotics.

It contains 15 billion CFUs of bacteria, 12 probiotic strains in including L. plantarum, and no unnecessary ingredients that might harm your gut.

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