From the Guidelines
The best time to use probiotics when preventing antibiotic-associated diarrhea is to start taking them at the same time you begin your antibiotic treatment and continue for at least one week after completing the antibiotic course, as supported by recent studies such as 1 and 1. When taking probiotics to prevent antibiotic-associated diarrhea, it is essential to take them at least 2 hours before or after your antibiotic dose to prevent the antibiotic from killing the beneficial bacteria in the probiotic. Some effective probiotic options include:
- Saccharomyces boulardii (typical dose 250-500 mg twice daily)
- Lactobacillus rhamnosus GG (at least 10 billion CFU daily)
- Multi-strain products containing various Lactobacillus and Bifidobacterium species Probiotics work by maintaining a healthy balance of gut bacteria that antibiotics can disrupt, as discussed in 1. Antibiotics kill both harmful and beneficial bacteria in your intestines, which can lead to diarrhea in about 20-30% of patients. Probiotics help restore this balance by introducing beneficial microorganisms that compete with harmful bacteria, strengthen the intestinal barrier, and modulate the immune system. If you develop severe or persistent diarrhea while on antibiotics, especially with fever or blood in stool, contact your healthcare provider immediately as this could indicate a more serious condition like Clostridioides difficile infection, as mentioned in 1. It is crucial to note that while probiotics can be beneficial, they may not completely prevent antibiotic-associated diarrhea, and their effectiveness can vary depending on the specific probiotic strain and individual patient factors, as highlighted in 1 and 1.
From the Research
Best Time to Use Probiotics
To prevent diarrhea due to actively taking an antibiotic, the best time to use probiotics is:
- Upon initiation of antibiotic treatment or within 48 hours, as suggested by 2
- From the first dose of antibiotics until 14 days after the last antibiotic dose, as evaluated in 3
Effective Probiotic Strains
The following probiotic strains have shown efficacy in preventing antibiotic-associated diarrhea:
- Saccharomyces boulardii CNCM I-745, as confirmed by 2, 4
- Lactobacillus rhamnosus GG, as confirmed by 2, 5, 6
- Other strains such as Lactobacillus acidophilus, Bifidobacterium longum, and Enterococcus faecium have also shown promise, as mentioned in 5
Administration and Efficacy
- The administration of probiotics can help prevent or resolve the consequences of antibiotic-associated dysbiosis, such as diarrhea, and promote the resilience of the gut microbiota, as stated in 2
- The use of probiotics has been shown to reduce the risk of antibiotic-associated diarrhea in both children and adults, as demonstrated in 3, 6, 4