From the Guidelines
It is recommended to stagger your intake of probiotics and antibiotics, taking them at least 2-3 hours apart, to minimize the potential negative impact of antibiotics on the beneficial bacteria in probiotics. This approach is based on the latest evidence from the American Gastroenterological Association (AGA) clinical practice guidelines on the role of probiotics in the management of gastrointestinal disorders 1. The guidelines suggest that certain strains of probiotics, such as Saccharomyces boulardii, may be beneficial in preventing antibiotic-associated diarrhea and Clostridioides difficile infection.
When taking antibiotics, it is essential to follow the prescribed dosage and schedule, and then take your probiotic at a different time to maximize its effectiveness. For example, if you take an antibiotic at 8 AM and 8 PM, you might take your probiotic around noon and before bedtime. Some key points to consider when taking probiotics with antibiotics include:
- Take your antibiotic exactly as prescribed by your healthcare provider
- Take your probiotic at least 2-3 hours before or after your antibiotic dose
- Continue taking the probiotic throughout your antibiotic treatment and for 1-2 weeks afterward to help restore your gut microbiome
- Choose a probiotic that contains strains like Lactobacillus or Bifidobacterium, which have been shown to be effective in restoring gut flora
The AGA technical review on the role of probiotics in the management of gastrointestinal disorders also highlights the importance of selecting the right probiotic strain and combination, as some strains may be more effective than others in preventing antibiotic-associated diarrhea and C. difficile infection 1. However, the overall certainty of evidence for the use of probiotics in this context is considered low due to the heterogeneity of the studies and the risk of bias.
In terms of specific probiotic strains, the AGA suggests the use of S. boulardii, or the 2-strain combination of L. acidophilus CL1285 and L. casei LBC80R, or the 3-strain combination of L. acidophilus, L. delbrueckii subsp. bulgaricus, and B. bifidum, or the 4-strain combination of L. acidophilus, L. delbrueckii subsp. bulgaricus, B. bifidum, and S. salivarius subsp. thermophilus for the prevention of C. difficile infection 1. Ultimately, the decision to take a probiotic with an antibiotic should be made in consultation with a healthcare provider, taking into account individual patient factors and the potential risks and benefits.
From the Research
Probiotic and Antibiotic Intake
- The decision to take a probiotic at the same time as an antibiotic or to stagger their intake depends on various factors, including the type of probiotic and antibiotic, as well as individual health conditions 2, 3.
- Studies have shown that taking probiotics with antibiotics can help reduce the risk of antibiotic-associated diarrhea (AAD) 3, 4, 5.
- A meta-analysis of 25 randomized controlled trials found that probiotics, particularly Lactobacillus GG, Saccharomyces boulardii, and probiotic mixtures, were effective in preventing AAD when coadministered with antibiotics 3.
- Another study found that taking probiotics with antibiotics reduced the incidence, duration, and severity of AAD, which can contribute to better adherence to antibiotic prescriptions and reduce the evolution of resistance 4.
Timing of Probiotic Intake
- Research suggests that taking probiotics with a meal or 30 minutes before a meal can enhance their survival during gastrointestinal transit 6.
- A study using an in vitro model of the human upper gastrointestinal tract found that survival of probiotic microbes was best when given with a meal or 30 minutes before a meal, particularly when the meal contained some fats 6.
- However, the optimal timing of probiotic intake in relation to antibiotic use is not clearly established, and more research is needed to determine the best approach 2, 3, 4, 5.
Considerations for Probiotic and Antibiotic Use
- Probiotics are generally considered safe, but they should be used with caution in patients with compromised immune systems or intestinal mucosa, and in the presence of a central venous catheter 3.
- It is essential to choose a probiotic that is specifically selected to not contribute to the spread of antibiotic resistance and does not carry transferable antibiotic resistance 4.
- Patients should consult with their healthcare provider before taking probiotics with antibiotics to determine the best course of treatment for their individual needs 2, 3, 4, 5.