How to Use Probiotics with Antibiotics

Written by: Kari Raman, PharmD, RPh
Published June 17, 2023

One of the most common short-term uses of probiotics in the pharmacy setting is along with antibiotics – my patients ask me about this all the time. Using a probiotic along with your antibiotics can help maintain a health balance of bacteria in your gut during and after your treatment. Research suggests that the right probiotic supplement can reduce the chances that you get diarrhea or other digestive problems while taking the antibiotic.

Generally, when you are prescribed antibiotics by a doctor, you have an infection caused by an overgrowth of bad bacteria. The antibiotic is used in this case to kill the bad bacteria that is causing the infection. While the medicine is killing the bad bacteria, it is also killing the good bacteria in your body that keeps everything in balance. This is why people use probiotics to keep a healthy gut microbiota. 

As a pharmacist, I actually really like it when patients ask me about this. One of the most important roles of a pharmacist is checking for drug interactions. Since different doctors may prescribe different medicines to treat different conditions for the same patient, it’s often the pharmacist who has the full picture of the drugs that a patient is taking. You should never be shy to ask your pharmacist about drug and supplement interactions – it’s our job, and you don’t go into retail pharmacy if you don’t like answering patient questions about drug interactions!

Antibiotics + probiotics: key considerations

Here are some things to consider when taking probiotics with antibiotics.

1.) Consider timing when taking your probiotics with antibiotics. You will want to take your probiotic two hours before or after taking the prescribed medicine.  You want to make sure that the antibiotic has passed through your gut before adding the probiotic to your system so that it does not affect the potency of the probiotic. Basically, the antibiotic is going to kill the probiotic, so you need to time it so that the two aren’t hitting your gut at the same time.

2.) There are a few strains that have been studied and found to be beneficial when taken with antibiotics, mainly to reduce the chances that you get diarrhea. These would be the probiotic strains you should consider when taking antibiotics. Lactobacillus and Bifidobacterium species are the most commonly used and researched for use with antibiotics as mentioned in this article.

3.) Consult with your doctor or pharmacist to get a personalized consultation regarding your specific issue especially if you have certain health conditions. Always follow the medical advice given to you by your doctor.

4.) At this point you may be thinking, ok I think a probiotic would be a good idea, but what dose should I take. The best idea will be to follow the directions on the package of the probiotic you choose. The dose can vary depending on the dose and the strain of the product.

5.) How long should you take the probiotic for? It can be helpful to start taking them a few days before you start the antibiotic course, but if you do not have the time to start a few days before you can start at about the same time as the actual medicine course starts. You will then want to continue taking the supplement for a few weeks after the course of antibiotics has stopped or until any GI issues have resolved.

6.) If I do end up taking a probiotic with my antibiotic treatment how do I store the probiotic? It is important to store the supplement as directed on the packaging of the product. Many probiotics are stable at room temperature, but many need to be refrigerated.  Look at the package of the product to get the proper storage information.

Be sure to keep in mind that probiotics are not a replacement for antibiotics and it is important to take the medicine as prescribed by your physician. And, of course, if you have questions ask the pharmacist as you get the meds – that’s what we are there for!!! 

Which Antibiotic Should I Take a Probiotic With?

Generally, it is a good idea to consider taking a probiotic with broad-spectrum antibiotics, these are the ones that target a wide range of bacteria. This means that the antibiotic will kill the bad bacteria, but it will also kill the good bacteria in your body. When the medicine kills the good bacteria in your body it can cause a disruption in your normal flora and this is where probiotics come into play.

There is not a exact list of antibiotics that should be taken with probiotics but here is a short list of antibiotics that are most commonly prescribed in the outpatient setting: Amoxicillin, Ampicillin, Cephalexin, Clindamycin, Ciprofloxacin, Levofloxacin, Trimethoprim-Sulfamethoxazole, Tetracycline, Doxycycline, and Minocycline. These are just a few examples, and you will always want to talk with your healthcare provider to make sure that taking a probiotic with your antibiotic treatment is right for you.

Probiotics can help support your gut health when taking an antibiotic, but they should not interfere with the effectiveness of the medicine. Always make sure to follow the directions of your medicines provided by your healthcare provider and ask any questions about taking a probiotic along with the treatment.

How Long Should I Take the Probiotic?

If you decide that a probiotic is right for you during your antibiotic treatment you may be thinking, how long should I take it for? What I typically recommend at the pharmacy/here are some general guidelines for timing probiotics antibiotics:

1.) If you can start a few days before the antibiotics treatment this can be beneficial. It can help establish a healthy gut microbiota before the treatment starts. Of course, this isn’t really easy – usually when you get a prescription to treat an infection it’s not a planned treatment that you can schedule around. And you should definitely not delay starting your prescription – take the medicine your doctor prescribes as soon as they tell you to start. In the case of a drug to treat an infection, this is especially important. So, don’t stress out if you can’t start taking a supplement beforehand. Instead, start as soon as is practical. In terms of the timing of the two:

2.) Continue taking the probiotic during antibiotic treatment, but make sure that you take the probiotic two hours before or after the antibiotic to ensure that you are getting the most benefit for the supplement. If you take the probiotic too close to the antibiotic there is a chance the medicine will kill the live bacteria in the supplement and cancel the beneficial effects. 

3.) How long after antibiotic treatment should you continue taking the probiotic? This amount of time can vary depending on your personal GI symptoms. The most commonly suggested amount of time to continue probiotics after an antibiotic treatment is a few weeks or until any GI symptoms have resolved.

4.) Individual needs of probiotics during and after antibiotic treatment varies depending on the condition that is being treated and your personal health. It is important to note that research on the optimal amount of time to use probiotics is still evolving. Some people may need longer, or shorter duration of them, and it is wise to talk to your healthcare provider to get specific advice for your needs.

What are the Best Probiotic Strains to Take with Antibiotics?

When selecting a probiotic to take along with antibiotics it is important to choose a product that has been studied and shown to be effective for this use. As shown in this article,  the most common species used with antibiotic treatments are Lactobacillus and Bifidobacterium, although a yeast, S. boulardii, is also considered a common one to recommend. While responses may vary by patient, these are the species that have been studied the most for this use and shown to be beneficial. Here is a short review of several probiotic species that have shown to be effective while taking with antibiotics.

Lactobacillus rhamnosus is one of the most well-studied ones and has been shown to help maintain gut health during antibiotic treatment. It has demonstrated effectiveness in reducing antibiotic-associated diarrhea and gastrointestinal side effects.

S. boulardii is a beneficial yeast, even though it is not a strain of bacteria it can be taken alongside antibiotics. It has been studied extensively for its ability to prevent and treat antibiotic-associated diarrhea. Here is an article that mentions the use of S. boulardii to help prevent side effects.

Lactobacillus acidophilus is a strain that is commonly found in many probiotic products. It has been shown to help restore the balance of gut microbiota disrupted by antibiotics and can reduce the risk of diarrhea.

Bifidobacterium bifidum is known to promote gut health and support the immune system. It has shown potential in preventing antibiotic-associated diarrhea and maintaining intestinal balance during antibiotic treatment.

Lactobacillus plantarum has been studied for its ability to reduce antibiotic-related gastrointestinal symptoms and restore the gut microbiota.

It is important to note that each strain can have different effects on different people, a product that works for one person may work differently on another person. Also, make sure to look for high quality products that provide information about stains contained, colony forming units (CFUs), and quality assurance practices. Two particular vendors who are well though of are Florastor and Culturelle, who I review in my article Florastor vs Culturelle..

How Do I Take Probiotics with My Antibiotic Treatment?

Here are some general guidelines regarding taking probiotics with your antibiotic treatment.

1.) As mentioned previously in this article, take the supplement at least two hours before or after taking your antibiotic dose. This allows the antibiotic to work without immediately affecting the bacteria in the supplement you just took!

2.) Make sure to stay consistent, take your supplement consistently every day (and take the medicine prescribed by your doctor according to the instructions as well).  Following the recommended dosage instructions provided with the product. If you are looking for advice on when during the day it’s best to take a probiotic, check out my article here.

3.) As mentioned before, it is recommended that you take probiotics and antibiotics separately to avoid any potential interactions. This helps ensure that the supplement’s bacteria have the best chance of surviving in your gut and can provide their beneficial effects.

4.) Store the supplement according to the instructions on the packaging. Some of the leading brands require refrigeration to maintain their viability, if this could be a problem for you to stay compliant you may want to choose a product that is stable at room temperature. They have living bacteria in them, so the fridge helps keep them alive.

It’s important to realize that while probiotics can help support gut health during antibiotic treatment, they do not improve with the effectiveness of antibiotics. So, it’s crucial to complete the full course of antibiotics as prescribed by your healthcare provider, even if you are also taking probiotics.

And don’t be afraid to ask your pharmacist about it when you pick up your prescription. Like I already said, us pharmacists like to talk about this with patients! It’s one of the most important part of being a pharmacist, and it never hurts to ask.

Other tips on interactions

Interested in learning more about when you can and can’t take probiotic supplements? I’ve written several other articles about how these increasingly popular supplements may or may not interact with other, common, things my patients take. Read about how they work with antacids, coffee or apple cider vinegar.

Pharmacist Kari Raman

I’m Kari Raman PharmD, RPh, and I am a licensed, practicing pharmacist. I hold a Doctorate in Pharmacy from The University of the Pacific, and I’ve served patients in retail, compounding and hospital pharmacies.

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