Wednesday, January 25, 2023

Should You Take Probiotics During Or After Antibiotics

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How Probiotics Help With Antibiotics

Should You Take Probiotics After A Round Of Antibiotics? | Ask Eric Bakker

Antibiotics are commonly prescribed drugs that inhibit or kill the growth of micro-organisms in the body. They are used either:

  • as a primary intervention to treat bacterial infection or
  • to prevent infection .
  • While antibiotics are highly effective, they can also lead to a number of unpleasant side effects. One of these side effects is the death of a large amount of good bacteria, causing a bacterial imbalance in your gut. This, in turn, causes several common anti-biotic side effects such as diarrhoea and nausea. Other side effects also include intestinal discomfort and flatulence. This is simply because, along with killing harmful bacteria , antibiotics also destroy many of the important, beneficial micro-organisms that make up the intestinal flora and help digestion and good health.

    Probiotics Before With Or After Antibiotics

    As mentioned above antibiotics do not have a clear-cut line between beneficial and pathogenic bacteria. They kill without discrimination and would therefore be important to know how to take probiotics with antibiotics.

    This is applies to those who are on amoxicillin, tetracycline, doxycycline and penicillin and those who have finished their antibiotic course.

    So, when is taking probiotics with antibiotics recommended? How long should wait before or after antibiotics?

    Pharmacists and physicians normally recommend probiotics with antibiotics to regulate the intestinal normal flora. This strategy also prevents diarrhea induced by drugs as a result of predomination by Clostridium officinale. Here are some guidelines on how to go about it.

  • It is recommended that you take your antibiotics then wait for 1 to 2 hours after which you can have your probiotics. It is more preferable to ask your pharmacists based on the manufacturer, when it is best to take that particular brand. 1 to 2 hours is averagely safe for most probiotics in the market as during this time, antibiotics will have passed through the body.
  • There are strains in probiotics that should not be taken with antifungals and one of them is Saccharomyces boulardii. It is however, stable in acidic environments and can thence be taken at any time. At the same time, owing to the fact it a yeast and not bacteria, the live micro-organisms will not be killed.
  • What is the best brand of probiotics to take with antibiotics?

    Lastly A Few Words On Probiotic Strain

    The Ruscio article ends with:

    Its not necessary to find the one right probiotic strain for your specific health condition. Thats because all probiotics have a similar synergistic effect of balancing the gut microbiota, modulating the immune system and reducing inflammation.

    This really surprised me, as it plainly contradicts all of the research to date.

    Its true that for a few purposes, differences between strains may not matter as much. But in a great deal of cases, strain specificity is extremely important.

    Ive highlighted this before, but here are just a few examples to illustrate my point:

    • Lactobacillus rhamnosus GG has shown some promise in randomized, placebo-controlled trials of mild-to-moderate ulcerative colitis, but has been linked to nausea, vomiting, epigastric pain, and other adverse events in Crohns disease.
    • Lactobacillus plantarum 299v has been shown to reduce IBS symptoms in a number of trials, while Lactobacillus plantarum MF1298 has been shown to worsen IBS symptoms.

    In fact, a 2018 systematic review and meta-analysis concluded:

    Strong evidence was found supporting the hypothesis that the efficacy of probiotics is both strain-specific and disease-specific. The clinical relevance of these findings indicates that health-care providers need to take these two factors into consideration when recommending the appropriate probiotic for their patient.

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    Is There A Case Against Taking Probiotics With Antibiotics

    Ive seen some internet articles that warn people against taking probiotics to help with recovery from antibiotic therapy. Where is this advice coming from?

    One study questions the value of taking probiotics and antibiotics together . In this study of 21 patients, eight patients received probiotic therapy, seven patients received no treatment, and six patients received a fecal transplant. Researchers found that probiotics were less effective for antibiotic recovery than no treatment at all. The fecal transplant brought near-complete recovery in a matter of days.

    However, when you are looking for health insights from research, its important to follow the overall trends rather than focus narrowly on one study. So, if we compare the evidence for taking probiotics after antibiotic treatment:

    A large-scale meta-analysis of 63 research trials showed that subjects had 48% less antibiotic-associated diarrhea after taking probiotics [11

    Trusted SourcePubMedGo to source].

    Its clear that the one small study doesnt stand up against a much larger meta-analysis of 63 studies. This is the reason a meta-analysis is the gold standard for research.

    Bottom line: Be careful about science-based claims you read on the internet. Marketers often cherry-pick studies to support their position.

    What Is Antibiotic Resistance

    Should you Take Probiotics with Antibiotics?

    Theres no doubt that antibiotics have a crucial place in modern medicine, but their use does come with some significant downsides.

    The overuse and misuse of antibiotics have led to antibiotic resistance, which is when bacteria become resistant to antibiotics.

    This trait can be passed on from bacteria to bacteria even among different species! which leads to even more resistance.

    Heres how it works:

    • Lets say you have a population of harmful bacteria causing problems some of these are naturally resistant to antibiotics.
    • Antibiotics kill both the good and bad bacteria in your body, but the naturally antibiotic-resistant bacteria stand strong.
    • Without all the antibiotic-susceptible bacteria taking up space, the resistant bacteria have room to multiply and they pass their resistance on to other bacteria.
    • These super bugs no longer respond to certain antibiotics, leading to longer, more intense, and sometimes untreatable infections.

    Every time we take antibiotics, more resistant bacteria have the opportunity to flourish and some even become resistant to several different antibiotics, turning them into dangerous pathogens.

    This is where taking probiotics with antibiotics can make a critical difference in your health.

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    Do Antibiotics Kill Probiotics

    Unfortunately, only a few probiotic strains have been shown to survive when taken directly alongside antibiotics. As all antibiotic medication will have some kind of negative impact on the gut microbiome, its really important to choose the right strains of probiotics when taking this type of medication. You want strains that have not only been researched to survive when directly taken alongside antibiotics, but to also demonstrate that they exert benefits.

    The extensive research behind the three previously mentioned Lactobacillus strains sets them apart from many probiotic supplements on the market today and makes them a suitable choice for anyone who wishes to take natural bacteria during their course of antibiotics. Furthermore, Lactobacillus acidophilus Rosell-52, Lactobacillus rhamnosus Rosell-11 and Bifidobacterium lactis Lafti B94 have been tested and shown in-vitro to survive stomach acidity and bile salts.

    How Do Antibiotics Influence The Gut

    In ancient days, bacteria were only viewed as disease-causing microorganisms, which led to the invention of antibiotics.

    Yes, they saved millions of lives, but something else was going unnoticed: The good gut bacteria plus their amazing health benefits and the damage each antibiotic prescription was causing.

    But with many different studies today, the medical community is now aware of the harmful effects of antibiotics on gut flora.

    Your gut environment consists of a trillion bacteria, fungi, and yeast, all commonly referred to as the microbiome. While some of these organisms can be harmful, others are extremely beneficial to your digestive health, immune system, mental health, and heart health.

    But consuming antibiotics kill both the good and bad bacteria. This leads to a disruption in normal gut function, breaking the protective gut barrier and leaving you susceptible to infections.

    In extreme cases, you might end up with Candida overgrowth, irritable bowel syndrome, acne, malabsorption, depression, anxiety, brain fog, and autoimmune diseases. But you dont have to wait for your body to reach this breaking point.

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    Best Probiotics For Long

    Its a good idea to look for research on the best probiotics when taking antibiotics long term if you are on longer courses of medication. If you need to take long term antibiotics, you may wish to consider choosing a supplement that contains Lactobacillus acidophilus NCFM®. A supplement that contains this particular strain has been demonstrated in a randomised controlled trial to minimise disturbance to the composition of the gut microbiome when taken alongside antibiotics14. This can be useful when antibiotics are being taken for longer than two weeks. However, it is recommended to take this probiotic strain 2 hours away from an antibiotic, rather than at the exact same time.

    What Are The Best Probiotics To Take After Antibiotics

    Taking Probiotics with Antibiotics or Anti-microbial Herbs

    Even if you have taken a probiotic designed to be taken alongside your antibiotic medication, it is always a good idea to take a good daily probiotic after antibiotics for at least a month or so to replenish the gut microflora. Scientists are not really sure exactly how long it will take to rebuild the gut flora after antibiotics it will depend on several different factors such as the individual gut microbiome, the length of the course, the strength of medication, diet and lifestyle etc. So, what are the best probiotics after antibiotics? Well, studies show taking a probiotic supplement that contains the strains Lactobacillus acidophilus NCFM and Bifidobacterium lactis Bi-07® after antibiotics may help to stabilise Lactobacillus populations in the gut13. The Lactobacillus genus of friendly bacteria helps to crowd out the bad guys and keep our gut environment healthy.

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    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 .

    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.

    Addressing Some Specific Claims

    A few things before I dive in:

    • First, my goal here is not to try to take anyone down. I simply want to focus on the evidence. Dr Ruscio has a great deal of clinical experience helping people with gut issues, and just because I disagree with him on the evidence here does not mean that he doesnt produce plenty of valuable content related to gut health. I have referred to his site many times and hope that we can have an open and respectful discussion about this research.
    • Second, I am always willing to consider new evidence, even if it directly contradicts what Ive said before. Ive been quite transparent about major paradigm shifts in the past related to the optimal stool testing methodologies and whether SIBO breath tests are all they are cracked up to be. At the same time, Im equally willing to defend my position if I believe the evidence still supports it.

    With that said, lets look at the major claims in the Ruscio article:

    1) Probiotics make antibiotics more effective

    Rather than canceling each other out, research shows that taking probiotics and antibiotics together is more effective than taking antibiotics alone. This is absolutely true in some instances. Probiotics, especially strains of Saccharomyces var. boulardii, have been shown to improve eradication rates of H. pylori. They may also be effective for eradicating Blastocystis.

    There is also research to show that probiotics and antibiotics are more effective together for SIBO and other gut infections , , .

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    Antibiotics And Gut Health

    There is no doubt that antibiotics have an essential role to play in modern medicine in preventing and curing bacterial infections. Thanks to antibiotics, bacterial infections are no longer the most common cause of death in the modern world1. However, in recent times it has become increasingly recognised that antibiotics negatively affect our gut microbiome2.

    The gut microbiome is a complex ecosystem of trillions of microbes that live together in harmony in our gastrointestinal tract. These microbes have far reaching effects on human health, enhancing digestion, immunity, skin health and energy3,4,5. A balance is required between beneficial microbes and more harmful microbes that naturally colonise the gut. This balance can be disturbed by various lifestyle factors including low-fibre diet, travel and infection, among others.

    So, what happens to our gut microbiome when we take an antibiotic? Unfortunately, taking antibiotics can be detrimental to our gut health. Whilst effective in killing bad bacteria antibiotics are essentially non-selective and can also deplete the beneficial bacteria residing in the gut. This is thought to contribute to the development of diarrhoea, constipation and/or vaginal thrush when taking an antibiotic. In certain cases, this disruption to our gut microbiome can result in an overgrowth of unwanted, pathogenic bacteria such as Clostridium difficile.

    People taking antibiotics may experience6:

    Benefits Of Taking Probiotics During And After Taking Antibiotics

    Should You Be Taking Probiotics with Antibiotics?

    Up to 39% of people experience diarrhea while taking antibiotics. And while your bathroom habits may not be something you want to discuss, thats a number thats hard to ignore!

    Taking probiotics along with antibiotics can help prevent diarrhea. In fact, its been studied and proven to do so. If thats not enough incentive to add probiotics to your diet, consider these benefits as well:

    • Antibiotics often leave you with stomach upset, GI distress, and diarrhea. Probiotics help prevent or reduce these uncomfortable symptoms.
    • Your guts not the only part of your body that has a delicate bacterial balance! Probiotics can support all areas of your body that depend on health bacteria including the mouth, skin, vagina, and more!
    • Probiotics help prevent post-antibiotic yeast infections for females.
    • Your intestines are extra stressed when taking antibiotics antibiotics are powerful! You may develop inflammation and irritation in your gut. Probiotics help prevent those side effects from escalating into long-term problems.
    • Because antibiotics can harm your microbiome, they can also temporarily depress your immune system. Probiotics support healthy immune function by rebalancing the gut.
    • If you experience stomach problems after antibiotics, youre not alone! Many people experience nausea due to antibiotics. The best way to avoid nausea with antibiotics is to take them with a full meal if possible. The second best way is to boost your healthy bacteria with some probiotics.

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    How To Restore Healthy Gut Flora

    Probiotics are generally safe, and sometimes even recommended to take during a course of antibiotics, except for hospitalised patients and people with compromised immune systems. They are especially helpful afterward to support the recovery of your gut microbiome.

    TIP There is no such thing as a clean gut diet your gut naturally cleans itself. However, you can help your gut bacteria keep you healthy with a plant-rich prebiotic diet.

    Taking Probiotics With Antibiotics

    Many people experience nausea, diarrhoea, tummy upsets, bloating, and even vomiting when taking antibiotics. Some doctors recommend taking a probiotic supplement at the same time to help with these digestive side effects.

    Even after taking antibiotics, you can boost your own beneficial bacteria with probiotic foods and supplements. They contain microbes that maintain your gut environment and help regulate your microbiome, keeping opportunistic pathogens at bay and beneficial ones thriving.

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    Side Effects Of Antibiotics

    This sudden proliferation of bad bacteria and accompanying loss of the health-promoting good guys lead to a variety of antibiotic side effects, such as diarrhea, fungal and yeast infections, and inflammation all of which can open the door to a wide variety of serious health issues.

    Thats because by weakening your bodys probiotic makeup, antibiotic use also weakens your immune defenses.

    A staggering 80 percent of your immune system resides in your gut where your probiotic bacteria work to regulate nearly every aspect of your immune function.

    This also explains why its common for antibiotic use to lead to recurrent infections , and why many people find themselves in a downward spiral of sickness, a vicious cycle thats hard to break.

    One side effect of repeated antibiotic administration is a Clostridium difficileinfection. C. difficile is an opportunistic pathogen that thrives in the carbohydrate-rich environment of a gut cleared of its good microbes .

    C. difficile is a potentially fatal microbe that secretes toxins that lead to diarrhea, fever, and colon inflammation.

    Even though Fleming himself warned us of the dangers of antibiotic overuse, were only recently connecting these dots and beginning to make changes to both our paradigm and our habits and the reason is twofold.

    Side Effects Of Probiotics

    Why you should take probiotics after antibiotics

    The common side effect of probiotics is increased digestive discomfort, such as bloating or gas. This is typically short-lived and resolves in a few days of regularly consuming probiotic supplements or probiotic foods.

    More serious side effects are possible, but extremely rare. The bacteria or yeast that is consumed as a probiotic supplement can enter the bloodstream and cause infection. Those who are at increased risk of infection include immunocompromised patients, premature infants, those with short bowel syndrome, anyone with central venous catheters, and patients with cardiac valve disease.

    It is, of course, important to discuss any supplementation with your healthcare provider.

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    A more practical strategy to aid recovery is to provide the good bacteria in your gut with their preferred source of nutrition: fiber. Fibrous compounds pass undigested through the small intestine and into the colon, where they act as fuel for bacterial fermentation.

    So if youre taking antibiotics or have recently finished a course, make sure you eat plenty of vegetables, fruit and whole grains. Your gut bacteria will thank you for it.

    Lito Papanicolas is an infectious diseases specialist and PhD candidate at the South Australian Health & Medical Research Institute. Geraint Rogers is a professor and director of microbiome research at the South Australian Health & Medical Research Institute.

    Republished under a Creative Commons license from The Conversation.

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