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Bouncing Back After Antibiotic Use: Probiotics to the Rescue!

Restoring balance and healthy function to the gut and beyond

Chances are if you are the owner of a human body, you’ve taken at least one course of antibiotics in your lifetime. Whether it was bubble-gum flavored amoxicillin for that ear infection in childhood or penicillin for the case of strep throat that roared through the school, your body was likely both helped and (to some extent) harmed by antibiotic medication.

The impact of antibiotics

Antibiotic prescription is the standard of care for various bacterial infections affecting virtually any site in the body, and for good reason: antibiotic medications have helped save millions of lives. But they are not without their risks of side effects: as the name anti-biotic implies, these medications kill bacteria. And although this can be quite helpful, say, in the case of killing the E. coli that’s causing a urinary tract infection before it can crawl up into the kidneys and wreak havoc there, antibiotic medications are not particularly discerning in what strains they kill, or where. By their very nature, antibiotics disrupt the microbial milieu of the digestive tract and other body systems, killing the “good” strains of bacteria along with the bad.

This shift in bacterial balance predisposes antibiotic users to dysbiosis, or a microbial imbalance, leaving them at increased risk of side effects, particularly in the gastrointestinal tract where a large percentage of these organisms are found. Reduced microbial diversity can also encourage the growth of opportunistic pathogens such as Clostridicum difficile (aka “C-diff”), a potentially life-threatening condition,[1] as well as a decline in the immune system’s ability to fight off infections in various sites of the body. Alterations to the normal microbial milieu is why many people notice diarrhea or other digestive complaints after taking an antibiotic, and why women often develop vaginal yeast infections after a course of treatment. On a longer-term scale, decreased microbial diversity has also been associated with obesity,[2] atopic conditions like eczema, asthma, and allergies,[3],[4],[5],[6] and even mood imbalances like anxiety and depression.[7]

Bacteria, furthermore, can mutate and adapt over time to outsmart the drugs we use to treat them. This has resulted in antibiotic-resistant infections, which has the medical community wondering: what will we do when the antibiotics available to us stop working? Both conventional and alternative-minded practitioners agree that we need to be more discerning of when antibiotics are – and are not – truly necessary in the treatment of infections,[8],[9] yet despite this awareness the Center for Disease Control (CDC) estimates that 30% of all antibiotic prescriptions in the US are unnecessary.[10]

But in those cases in which an antibiotic should indeed be used, there are thankfully other therapies we can employ to both increase the infection-fighting efficacy of the antibiotic and to minimize its potentially harmful side effects. Case in point: probiotics.

The case for high-potency probiotics during/after antibiotic use

Supplementing with a carefully selected probiotic formula during, after, and potentially in lieu of conventional treatment may not only help treat infectious illnesses more effectively, but may also reduce the risk of their recurrence.

Because of their efficacy in countering dysbiosis,[11] probiotics – in particular strains of Lactobacillus and Bifidobacterium species[12] – have been shown to effectively treat not only acute infectious diarrhea,[13] but also antibiotic-associated diarrhea,[14],[15],[16] including even C. difficile infection.[17] In fact, over a decade’s worth of meta-analyses have shown probiotics can reduce the incidence of antibiotic-associated diarrhea by 42-50%,[18],[19],[20] making the case for probiotic supplementation around antibiotic use quite compelling.

Over a decade’s worth of meta-analyses have shown probiotics can reduce the incidence of antibiotic-associated diarrhea by 42-50%, making the case for probiotic supplementation around antibiotic use quite compelling.

While probiotics are clearly useful in reducing the side effects of antibiotic use, it’s important to note that not all strains are created equal, and that higher doses of probiotics often confer better outcomes than lower doses.[21] The probiotic strains shown in the studies to be of benefit include Lactobacillus rhamnosus, L. casei, L. acidophilus, L. reuteri, L. plantarum, L. casei, Bifidobacterium lactis, B. infantis, B. longum, Saccharomyces boulardii, and Bacillus coagulans, at potencies of 100 million to 50 billion colony forming units (CFUs) per day in adults. In the studies done on children, doses of over 5 billion CFU per day yielded better outcomes than lower doses.[22]

Considering that lactobacilli make up over 90% of the microbes present in the female genitourinary system and that these bacteria are extremely sensitive to destruction by antibiotic medications, the case for probiotic supplementation in the prevention and treatment of vaginal, urinary, and reproductive infections in women is likewise cogent.

Numerous trials have demonstrated that oral administration of specific strains of lactobacilli – in particular L. crispatus, L. rhamnosus, L. gasseri and L. reuteri – can both maintain and restore healthy genitourinary microbiota in females.[23],[24],[25],[26],[27] Oral probiotics may be a side-effect-free standalone treatment for vaginitis, saving women from having to use antibiotics at all.[28]

Oral probiotics may be a side-effect-free standalone treatment for vaginitis, saving women from having to use antibiotics at all.

The addition of a probiotic supplement to the standard antibiotic treatment regimens for bacterial vaginosis, yeast infections, and other causes of infectious vaginitis has been shown in several studies to not only improve the initial success of treatment, but also to confer healthier vaginal microflora after antibiotic use and reduce the risk of future relapse.[14],[15],[29],[30],[31]

Regardless of the site of infection or the reason for antibiotic use, the argument for using probiotics in conjunction with antibiotics is strong. By minimizing the disruption to the microbial balance caused by antibiotics, a high quality, multi-strain probiotic supplement makes antibiotic-based treatments more successful in fighting off infections, mitigates the side effects and long-term consequences of taking antibiotic medications, and significantly reduces the risk of relapse. The benefits of using probiotics as an adjuvant to antibiotic prescription are clear.


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