Can you take probiotics with antibiotics? A scientific perspective

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Taking probiotics with antibiotics

I use antibiotics exceedingly rarely. Yet when I do, I immediately experience something resembling acid reflux; my stomach feels hollowed out very soon after ingestion. While most people experience some side effects with antibiotics, such an immediate, strong GI reaction seems on the rarer side. But if I take probiotics with antibiotics, this side effect never occurs. So from personal trial and error, I know that the answer to “can I take probiotics with antibiotics” is a resounding yes. This is also backed by literature: Probiotics protect against antibiotic-induced diarrhea and potentially catastrophic effects of repeated antibiotic use, like C. difficile infection.

Yet, many people are unaware that they should take probiotics with antibiotics. When I ran a poll in the Smart Savers Facebook group, almost half said they never take probiotics with antibiotics. Some of the ones that did say they had been advised to do so by a doctor. But so many fly blind without this prudent advice.

Which probiotics should you take? I have a PhD in Immunology, and here I use my training to answer this question.

Taking probiotics with antibiotics – which one is best?

Antibiotics kill bacteria, so the vast majority of bacterial probiotics would be knocked out by the antibiotic you were taking it with. So yogurt or buttermilk with an antibiotic? Largely ineffective. My approach to tackling this problem is simple: take an effective, validated probiotic that is not affected by the antibiotic. They totally exist! It baffles me when I sometimes see doctors missing out on this very simple strategy when advising patients.

One great candidate is Florastor, which is a yeast (Saccharomyces boulardii). It’s not a bacterium, so it will not be killed by the antibiotic. Florastor administration with antibiotics protects against antibiotic-induced diarrhea and C. difficile infection. It’s really a no-brainer to take it.

How to take Florastor
I take 1-2 capsules of Florastor each time I take the antibiotic. There is also a kid version, which tastes awful. There is no need to buy that separately – the adult dose is the same as the child dose, it’s just that the child dose is powder in a sachet, while the adult dose is capsulated. I’ve tried various ways to get my child to take it. When she was an infant, I mixed it with her formula. Later, she protested hard when I mixed it with milk. Now, I simply break open the capsule, mix the powder liberally with honey, and my child (pretty happily) eats the paste off a spoon.

Another great candidate to take with antibiotics is Enterogermina – this is a bacterium (Bacillus clausii) that has been engineered to be resistant to most major classes of antibiotics. Like Florastor, Enterogermina has also been shown to protect against antibiotic-induced diarrhea and C. difficile infection. It’s widely used in Asia and Europe (marketed by Sanofi), but I was very gratified to find it on US Amazon.

How to take Enterogermina:
This is a liquid suspension of spores in a plastic tube, so giving it to kids is super easy. My daughter LOVES the taste, go figure! It’s really easy to carry around and give in a pinch. I also take it at the same time as taking the antibiotic, for convenience and protection – As I said earlier, my response to broad-spectrum antibiotics is pretty fast, so if I wait even like 30 mins, I’m in agony.

Takeaway when considering probiotics with antibiotics

Taking these probiotics during your antibiotic regimen makes so much sense. I take BOTH Florastor and Enterogermina when I take antibiotics. I’m very sensitive to antibiotics, yet I’m determined to sail through any rare bout of taking them symptom-free. So I literally throw the kitchen sink at the problem, and it seems to pay off well.

Taking yogurt or other fermented products will not confer the same level of protection that these probiotics (Florastor and Eneterogermina) will, as most of the probiotics in yogurt would be killed by the antibiotic. Taking yogurt or kefir after you are done with the antibiotic is fine, and a prudent idea.

Probiotics for stomach upsets/GI-tract infections

Image: Adobe Stock Photos

All these probiotics (Florastor, Enterogermina, and also validated Lactobacillus probiotics like Culturelle and BioGaia) also strongly reduce the duration and severity of GI-tract infections – there is no need to suffer through long and protracted stomach upsets, and it frustrates me when easy fixes such as these are never utilized!

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