Do Antibiotics Kill Probiotics? (Here’s Why Don’t Doctors Prescribe!)

Generally, it is believed that antibiotics and probiotics are agonists and can not co-exist. 

However, the relationship between antibiotics and probiotics isn’t as straightforward as it seems. 

Here are some key points that will allow you insight into their love-hate dynamics.

Adding to the complexity, certain antibiotics are more detrimental to the beneficial bacteria than others. Still, some of our gut friends show greater resilience to their threats.

So, continue reading to gain a deeper understanding.

Do Antibiotics Affect Probiotics?

Yes, antibiotics do affect both supplemental probiotics and friendly gut commensals.

In this context, the worst antibiotics for the gut are the broad-spectrum ones because they act against a wide range of bacteria, including non-pathogenic strains.

In comparison, narrow-spectrum antibiotics cause less collateral damage to good bacteria.

The reason is that they target only specific groups of bacteria, especially those that are pathogenic.

Nonetheless, some probiotics may fall into the pre-specified categories of narrow-spectrum antibiotics and get removed.

For instance, the Lactobacillus and Bifidobacterium species may get eliminated when these antibiotics target Gram-positive bacteria, while the Escherichia coli Nissle 1917 probiotic strain may fall prey to them when their aim is Gram-negative bacteria.

You may witness the outcome of this killing spree clinically manifesting as antibiotic-associated diarrhea (AAD).

Besides, a study revealed that most of the orally consumed probiotics taken alongside antibiotics are susceptible to the damage caused by them; these include:

• Lactobacillus species (L. reuteri Protectis, L. casei var rhamnosus, L. acidophilus, L. helveticus, L. paracasei, L. acidophilus, L. rhamnosus, L. casei var. rhamnosus GG)
• Bifidobacterium (B. lactis, B. longum, B. bifidum)
• Lactococcus lactis
• Streptococcus thermophilus
• Bacillus species (B. clausii OC, Bacillus clausii NR, Bacillus clausii SIN, Bacillus clausii T)

Nonetheless, researchers have identified distinct probiotic strains that are better suited for each scenario – whether it is alongside or following the antibiotic treatment. (I will discuss both in the subsequent sections.)

A thumb rule to follow in this regard? Always remember to allow a two-to-six-hour gap when taking the two together.

Still, in any case, always take your doctor’s advice before using probiotics with antibiotics.

This is because probiotics are better avoided in pediatric and immunocompromised populations, individuals with pancreatitis, or in certain other conditions.

Why Don’t Doctors Prescribe Probiotics With Antibiotics?

Each doctor’s inclination to co-prescribe probiotics with antibiotics greatly varies and is mainly influenced by each country’s organizational issues and culture.

Nonetheless, a bigger community of doctors around the world recommends pairing probiotics with antibiotics in their practice.

Regarding this, the Microbiology Society states that some healthcare professionals are reluctant to prescribe probiotics with antibiotics because they fear that this may further exacerbate the un-stabilization of your gut microbiome.

In this regard, a multinational survey was conducted in 2020 to discern the perception of European General Practitioners on probiotics. 

Its results showed that 80% of the total 1318 General Practitioners (GP) occasionally recommend probiotics to their patients.

Furthermore, the researchers speculated that the non-recommending behavior of the rest of the GPs might have originated from their culture, social norms, and past experiences.

Likewise, an opinion poll was performed among the GPs and pediatricians in seven Asian-Pacific countries (Australia, Japan, Indonesia, India, China, Singapore, and South Korea).

Surprisingly, only 33% of the total 731 physicians who completed the online questionnaire co-prescribed probiotics with antibiotics.

Moreover, some reasons why doctors prescribe this combination are previous episodes or current incidence of AAD, infectious diarrhea, prolonged antibiotic treatment, amoxicillin-clavulanic acid therapy, abdominal pain, or Clostridium difficile colitis.

Accidentally Took Probiotic With Antibiotic? Here’s What To Do Next

Don’t stress too much about taking probiotics with antibiotics because it is not likely to cause any adverse reactions.

Instead, taking probiotics helps with the antibiotic’s side effects. 

Plus, you need not worry about the good bacteria interfering with the antibiotic’s action either.

However, this mistake may compromise the viability of the probiotics.

As I have discussed earlier as well, antibiotics cancel out probiotics when taken at the same time.

But still, you can increase your intake of prebiotic fiber to nourish and support the colonization of the supplemental bacteria that may successfully escape the antibiotic attack.

In addition to that, here are some of the best probiotics to take with antibiotics in case you consciously want to combine them to prevent AAD:

Best Probiotics To Take With Antibiotics

Studies have found that Saccharomyces boulardii CNCM I-745 is resistant to antibiotics. Hence, it can preferably be taken with antibiotics.

Similarly, a practical guide for healthcare professionals gave a three-star recommendation for L. rhamnosus GG preparations containing a minimal daily dose of 2 × 10⁹ CFU.

One such probiotic supplement that contains L. rhamnosus GG you can try is Culturelle Digestive health probiotics.

Do Probiotics Help After Antibiotics?

The official answer by Drugs.com states that the benefits of antibiotic-probiotic pairing are controversial and also carry some risks.

The negative evidence in this regard is a 2018 study that revealed that participants who received probiotics for four weeks after undergoing antibiotic treatment recovered their normal gut microbiome approximately five months later than the placebo group (6 months Vs. 3 weeks).

Additionally, the probiotics risks that I mentioned before may include rash, vomiting, nausea, gas, bloating, abdominal pain, chest pain, changes in bowel movement, or taste disturbance.

These possibilities can also justify the hesitation of doctors who don’t prescribe probiotics with antibiotics.

On the flip side, Dr. Elisa Marroquín has contributed positive evidence by reviewing twenty-nine research papers.

She suggests that probiotic intervention protects the gut barrier, strengthens the immune system, and reduces the emergence of antibiotic-resistant bacteria.

Despite this, she admits that more research is required to determine the appropriate dosage, frequency, duration, and probiotic composition for generating desired outcomes.

Nonetheless, here are some useful species that you can use to reconstitute your gut microbiota after the antibiotic course has already done the damage.

Best Probiotics To Take After Antibiotics

Cochrane reviewed twenty-three research papers and identified these probiotics as beneficial for gut health when consumed either individually or in combination:

Bacillus spp., Bifidobacterium spp., Clostridium butyricum, Lactobacilli spp., Lactococcus spp., Leuconostoc cremoris, Saccharomyces spp., or Streptococcus spp.

In this case, to restore your gut health after your antibiotic treatment is over, you can opt for Optibac everyday probiotics (contains Lactobacillus sp.) or Biotics 8 probiotics (contains Saccharomyces spp. And Lactobacillus sp.).

FAQs

Does amoxicillin kill probiotics?

Yes, amoxicillin may kill probiotics. The reason is that, according to Drugs.com, it is a broad-spectrum antibiotic, so it will kill any bacteria that will get in its way. 

When to take probiotics with doxycycline?

You should preferably allow at least one to two hours gap between doxycycline and probiotics to prevent and minimize their interaction.

What is it called when antibiotics kill good bacteria?

When antibiotics kill the good bacteria in the gut, it is referred to as antibiotic-associated dysbiosis. Additionally, the antibiotics that kill bacteria are referred to as bactericidal antibiotics.

Do Probiotics Affect the Absorption of Antibiotics?

The answer is No. Before antibiotics can act effectively in the body, they need to be absorbed into the blood. Probiotics will not affect the way your antibiotics function. Probiotics are healthy bacteria and in no way compete with the absorption of Antibiotics.

Will Probiotics Affect the Elimination of My Antibiotics?

Antibiotics, after working and generating byproducts and metabolites, need to be excreted by the system.

The majority of the byproducts are excreted via the kidneys and some via the feces. So, probiotics do not in any way affect how these byproducts are removed from the body.

There have been myths regarding Probiotics causing antibiotics to accumulate in the body; these are not true and don’t have any scientific basis. Probiotics will not increase or reduce the rate at which drugs are excreted from the system & are perfectly safe.

In Conclusion 

There have been various schools of thought concerning whether the use of Probiotics and Antibiotics is safe.

Inasmuch as there have been studies that have shown that Antibiotics may be able to reduce the potency of Probiotics, most schools of thought agree that if antibiotics and Probiotics administration are well-spaced, the chances of the effectiveness of probiotics being reduced are very minimal.

Probiotics have also found great use in the aspect of repopulating the intestines after long use of antibiotics.

They are not out to replace Antibiotics and can come in handy as supplements to help healthy bacteria regeneration.

If you have any issues or worries, kindly discuss them with your doctor.