Can You Take Probiotics With Antibiotics? Timing and Best Strains

Antibiotics treat bacterial infections, but they also disrupt the helpful bacteria in your gut. That's why diarrhea is one of their most common side effects. Can you take probiotics with antibiotics to soften that blow? The evidence says yes, with a few caveats.

Do probiotics help during antibiotics?

Antibiotic-associated diarrhea affects a sizable share of people taking antibiotics. Reviews of randomized trials, including a Cochrane review in children, found that probiotics given alongside antibiotics lowered the risk of developing it. The effect was clearest with higher doses of specific strains.

Probiotics are not a guarantee, and research on preventing C. difficile infection specifically is less conclusive. But for most healthy people, they're a low-risk way to reduce the odds of an upset gut.

Which strains have the best evidence?

Probiotic effects are strain-specific. A product that names the exact strain (for example L. rhamnosus GG, not just "Lactobacillus") is easier to match to the research.

How to time them

• Bacterial probiotics: take them at least 2 hours apart from each antibiotic dose, so the antibiotic is less likely to kill them first.
• Saccharomyces boulardii: because it's a yeast, antibiotics don't affect it. You can take it at the same time, although some people still space doses.
• Start on the first day of your antibiotic course, which is how most studies were designed.
• Continue for one to two weeks after you finish the antibiotics.

Who should avoid probiotics

Probiotics are generally safe for healthy people, but rare serious infections have been reported in vulnerable groups. Talk to your doctor before using them if you:

• Have a weakened immune system (for example, chemotherapy or an organ transplant)
• Are critically ill or in intensive care
• Have a central venous catheter
• Are giving them to a premature infant

Practical tips

1. Choose a product that lists the strain and the CFU count at the end of shelf life, not just at manufacture.
2. Follow storage instructions; some products need refrigeration.
3. Expect mild gas or bloating in the first few days.
4. Keep any other supplements, such as magnesium or zinc, spaced from your antibiotic too, since minerals can block some antibiotics.
5. If diarrhea is severe, bloody, or comes with fever, contact a doctor. It could be C. difficile, which needs medical treatment.

The bottom line

You can take probiotics with antibiotics, and it may help prevent diarrhea. Pick a product with a studied strain such as S. boulardii or L. rhamnosus GG, space bacterial probiotics 2 hours from your antibiotic, and keep going for a week or two afterwards. If you're seriously ill or immunocompromised, check with your doctor first.