Can You Take Antibiotics and Probiotics Together?

Short answer: yes. Taking probiotics alongside antibiotics is generally safe for healthy adults and there is reasonable evidence it reduces the risk of antibiotic-associated diarrhea.

The key detail is spacing the doses.

Why antibiotics upset your gut

Antibiotics cannot distinguish between the bacteria causing your infection and the beneficial bacteria in your intestine. A course of broad-spectrum antibiotics reduces both. That disruption is what causes the loose stools, bloating, and cramping that many people experience.

Roughly one in five people on antibiotics develops diarrhea. In a smaller number, the disruption allows a bacterium called C. difficile to overgrow, which causes a more serious infection requiring specific treatment.

The timing rule

Take your probiotic about two hours after your antibiotic dose.

Taking them at the same moment means the antibiotic kills a substantial share of the probiotic organisms before they reach your intestine. Two hours gives the antibiotic time to be absorbed and the probiotic a better chance of surviving the trip.

Example schedule for a twice-daily antibiotic:

Which probiotics have the most evidence

Not all probiotics are equivalent. The two with the strongest research support for preventing antibiotic-associated diarrhea are:

• Saccharomyces boulardii — a yeast rather than a bacterium, which means antibiotics do not kill it. This is a practical advantage.
• Lactobacillus rhamnosus GG — one of the most studied bacterial strains.

Look for the specific strain name on the label, not just the genus. “Contains Lactobacillus” tells you very little. Also check the CFU count — most studies used doses in the range of 5 to 40 billion CFU daily.

How long to continue

Start on the same day as the antibiotic and continue for one to two weeks after the course finishes. The gut microbiome takes weeks to months to fully recover, and stopping the probiotic the day the antibiotic ends misses part of the benefit.

Food sources

Yogurt with live active cultures, kefir, sauerkraut, kimchi, and miso all contain beneficial bacteria. They contain lower and less predictable doses than a supplement, but they are useful alongside and add fibre that feeds existing gut bacteria.

Fibre matters as much as the probiotic. Onions, garlic, bananas, oats, and legumes feed the bacteria you are trying to restore.

Who should not take probiotics

Probiotics are live organisms, and in a small number of people they can cause infection. Avoid them, or check with your doctor first, if you:

• Have a severely weakened immune system — chemotherapy, transplant medication, advanced HIV
• Have a central venous catheter
• Are critically ill or in intensive care
• Have had recent gastrointestinal surgery
• Have short bowel syndrome

In these groups the risk is small but real, and the decision should be a medical one.

Common side effects

Bloating and gas in the first few days are common and usually settle. If they persist or worsen, stop and reconsider the product.

When diarrhea needs a doctor

Contact your doctor for diarrhea that is severe, watery, and frequent, contains blood or mucus, comes with fever or significant abdominal pain, or continues after the antibiotic course ends. These can indicate C. difficile, which needs specific treatment and does not respond to probiotics alone.

Watch fluid status throughout — see signs of dehydration in adults.

The step before this

The most effective way to protect your gut from antibiotics is to only take them when they are needed. See why antibiotics do not work on viral infections.

Related reading

• Signs of Dehydration in Adults: When You Need Medical Help
• Why Antibiotics Do Not Work on Viral Infections
• Can You Take Mucinex and Sudafed Together?

Sources

• Drug Information — MedlinePlus, U.S. National Library of Medicine
• Drug Therapy — MedlinePlus
• U.S. Food and Drug Administration