Probiotic Supplementation with Amoxicillin-Clavulanate
Saccharomyces boulardii or Lactobacillus acidophilus should be co-administered with amoxicillin-clavulanate to reduce antibiotic-associated diarrhea and mitigate microbiota disruption.
Recommended Probiotic Strains
The most effective probiotics for patients taking amoxicillin-clavulanate are:
Saccharomyces boulardii CNCM I-745: This is the first-choice probiotic based on the strongest evidence for reducing antibiotic-associated diarrhea and preventing dysbiosis 1, 2.
Lactobacillus acidophilus: Specifically L. acidophilus ATCC 700396, which significantly reduces gastrointestinal side effects and yeast superinfections when taken with amoxicillin-clavulanate 3.
Combination therapy: L. acidophilus ATCC 700396 plus Bifidobacterium lactis ATCC SD5220 maintains stable Lactobacillus counts and facilitates faster restoration of normal microbiota 4.
Clinical Evidence Supporting Use
Saccharomyces boulardii demonstrated the most robust benefits in a randomized controlled trial where subjects receiving S. boulardii with amoxicillin-clavulanate experienced fewer adverse events, better tolerance, less pronounced microbiota shifts (including reduced Escherichia overgrowth), and lower antibiotic-associated diarrhea scores compared to antibiotic alone 1.
Lactobacillus acidophilus showed significant clinical benefit in a prospective randomized trial where 89% of patients reported infection resolution, with concomitant L. acidophilus therapy associated with significant decreases in gastrointestinal complaints and yeast superinfection 3.
Meta-analyses confirm that probiotics reduce the risk of antibiotic-associated diarrhea when co-administered with antibiotics, with Lactobacillus GG, S. boulardii, and probiotic mixtures being most effective 2.
Dosing and Administration
Start probiotics simultaneously with the first dose of amoxicillin-clavulanate 1.
Continue for the full antibiotic course plus an additional 7 days after antibiotic completion to facilitate microbiota restoration 1, 4.
Timing: Administer probiotics at least 2 hours apart from antibiotic doses to maximize probiotic viability.
Microbiota Protection Mechanism
Amoxicillin-clavulanate causes significant microbiota disruption including reduced Roseburia prevalence and increased Escherichia, Parabacteroides, and Enterobacter 1. These alterations persist for at least 2 weeks after antibiotic cessation 1. Probiotic co-administration mitigates these shifts and accelerates return to baseline microbiota composition 1, 4.
Safety Considerations
Probiotics are generally safe but should be used with caution in patients with compromised immune systems, compromised intestinal mucosal integrity, or central venous catheters 2. For immunocompetent patients taking amoxicillin-clavulanate, probiotics pose minimal risk and provide substantial benefit.
Clinical Context
In pediatric populations with respiratory tract infections, probiotics are commonly co-prescribed with amoxicillin-clavulanate, with S. boulardii, Bacillus clausii, and lactic acid bacillus being most frequently used 5. Clinicians recognize the gastrointestinal side effects of amoxicillin-clavulanate and the preventive benefits of probiotics 5.