Probiotics and Antibiotics: should probiotics only be taken after antibiotics?

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GUT MICROBIOME

Probiotics and Antibiotics: probiotics should only be taken after antibiotics – fact or fiction?

BY BENJAMIN MAKEHAM August 12, 2020

Probiotics are our best tool for counteracting the negative impact antibiotics have on our community of beneficial gut microbes.

Probiotics and antibiotics

With 30 million antibiotic prescriptions prescribed in Australia every year, we’re starting to see a diminishing gut microbiome with reduced richness and diversity of beneficial bacteria.

Antibiotics are important for fighting off infections, but preserving a diverse gut microbiome is just as important for our health. A diverse healthy gut microbiome is associated with greater health outcomes and fewer chronic diseases such as obesity, asthma, and many more.

Many people are proactively using probiotics to help repair the damage caused by antibiotics, but many are left wondering when they should start taking them - at the same time, two hours away from taking an antibiotic, or only after they’ve finished taking a course of antibiotics?

For an evidence-based answer, we look to what the research says.

One of the most immediately felt consequences of antibiotics, and one that people are keen to avoid, is antibiotic-associated diarrhoea (AAD). This highlights the incredibly important role that beneficial gut bacteria play in regulating our digestion. AAD is a sign that these beneficial bacteria have been diminished, and non-beneficial bacteria have been able to overgrow, causing inflammation in the gut and creating diarrhoea.

Certain strains of probiotics, such as Lactobacillus rhamnosus GG, have been shown to significantly reduce the symptoms of AAD and help return the gut microbiome to its normal balanced state.

The research tells us that these probiotics are successful when taken alongside a course of antibiotics, and are most useful for preventing AAD and are less effective when started after AAD has already begun. This suggests a protective effect, and supports the use of this specific probiotic strain from the day you begin taking an antibiotic until the day you finish, and for 1-2 weeks after.

While it is thought that taking probiotics may be a waste of time alongside antibiotics because they will be ‘killed off’, this research is showing that they are still having a protective effect and are not wasted.

Unfortunately, the research doesn’t yet specify whether probiotics should be taken at the exact same time as the antibiotic, or two hours away from them. A two hour window in between may help to preserve the activity of probiotics for greater effects - but if this is not possible, it is likely they will still be protective.

We’ll be sure to keep you posted as more research comes to light about probiotics and antibiotics.

And as always, consult your healthcare practitioner to make sure probiotics are right for you.

REFERENCES

1. Agamennone V, Krul CAM, Rijkers G, Kort R. A practical guide for probiotics applied to the case of antibiotic-associated diarrhea in The Netherlands. BMC Gastroenterol [Internet]. 2018 Dec 6;18(1):103.
2. Australian Commission on Safety and Quality in Health Care (ACSQHC). First Australian report on antimicrobial use and resistance in human health [Internet]. 2016.
3. Becattini S, Ying T, Pamer EG. Antibiotic induced changes in the intestinal microbiota and disease. Trends Mol Med. 2016;22(6):458–78.
4. Kim S, Covington A, Pamer EG. The intestinal microbiota: Antibiotics, colonization resistance, and enteric pathogens. Immunol Rev. 2017 Sep;279(1):90–105.
5. Szajewska H, Kołodziej M. Systematic review with meta-analysis: Lactobacillus rhamnosus GG in the prevention of antibiotic-associated diarrhoea in children and adults. Aliment Pharmacol Ther [Internet]. 2015 Nov;42(10):1149–57.
6. Szajewska H, Canani RB, Guarino A, Hojsak I, Indrio F, Kolacek S, et al. Probiotics for the Prevention of Antibiotic-Associated Diarrhea in Children. J Pediatr Gastroenterol Nutr [Internet]. 2016 Mar;62(3):495–506.

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