Antibiotics can kill good and bad bacteria, which can harm your microbiome and cause symptoms like diarrhea.
Research shows that taking a probiotic during your course of antibiotics can prevent microbiome damage and prevent GI discomfort.
Look for a probiotic that has adequate CFUs and gut-supporting strains of bacteria like Lactobacillus, Bifidobacterium, Bacillus, or Saccharomyces boulardii.
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When you have strep throat or a respiratory infection, your doctor will likely send you home with a course of antibiotics. But trading your bacterial infection for GI discomfort from an antibiotic-damaged microbiome—when you just want to start feeling better—can be frustrating. Why does this happen?
“When you take antibiotics, the medication doesn’t recognize the good bacteria from the bad,” explains Eva De Angelis, R.D.N. “This means that while antibiotics are crucial for removing harmful pathogens when you have an infection, they can also wipe out our beneficial bacteria and hurt our gut microbiota.”
Research shows that taking a probiotic—a supplement that reintroduces strains of good bacteria back into your microbiome—can help heal your gut and protect your microbiome during a course of antibiotics (1). Below, two dietitians weigh in on the best probiotics to take with antibiotics to protect and repair your microbiome, so you can focus on feeling better.
About the Experts:
Kelsey Costa, M.S., R.D.N., is a registered dietitian nutritionist, certified wellness coach, and author. She is the founder and CEO of Dietitian Insights, a media and consulting company.
Eva De Angelis, R.D.N., is a registered dietitian nutritionist at the E-Health Project. She specializes in using food and nutrition to manage chronic disease.
Why You Should Take Probiotics With Antibiotics
Protects microbiome balance
Think of your microbiome as a bustling community of tiny organisms that live in your gut, including bacteria, yeast, and viruses (2). These organisms play a role in your mood, digestion, and immunity—which means your health can suffer if your microbiome is thrown out of balance.
Research shows that your microbiome can remain out of balance for up to two years after antibiotics (1). This imbalance is linked to an increased risk of conditions like obesity, diabetes, inflammatory bowel disease, depression, asthma, and rheumatoid arthritis (3).
Antibiotics can reduce the good bacteria from the Firmicutes phylum, which ferments fiber and keeps your digestive system healthy (4, 1). On the flip side, antibiotics can boost the numbers of Proteobacteria, which can throw off the balance in your gut and lead to health issues (5).
While doctors previously believed that starting probiotics during antibiotic treatment could throw off your microbiome, a 2022 review in the Journal of Medical Microbiology found that probiotics are an effective way to prevent gut damage and preserve good bacteria (1).
Prevents GI discomfort
According to Kelsey Costa, R.D.N, an unbalanced microbiome (dysbiosis) can lead to uncomfortable symptoms like gas, bloating, diarrhea, and constipation. In fact, up to 35 percent of people who take antibiotics will experience these gut symptoms (6).
But research shows that starting probiotics alongside antibiotics can prevent discomfort in the first place.
According to the Journal of Medical Microbiology review, five out of seven studies found that people who took probiotics during the course of treatment had fewer gastrointestinal symptoms from antibiotics (1).
How to Choose the Best Probiotics to Take With Antibiotics
Not all probiotics are created equal when staving off gut discomfort from antibiotic use. Consider these factors when you’re skimming the supplement aisle, per Costa and De Angelis.
Strains of bacteria
Your gut microbiome boasts around 1500 different species of bacteria (7). But not all probiotic strains pack the same punch for treating gut irritation post-antibiotics, according to Costa.
Look for well-studied strains of probiotics like Lactobacillus, Bifidobacterium, Bacillus, or Saccharomyces boulardii, she recommends.
“[In particular], both Lactobacillus rhamnosus GG (LGG) and Saccharomyces boulardii have been found to significantly lower the risk of antibiotic-associated diarrhea (8),” says Costa.
Colony forming units (CFUs)
What type of beneficial bacteria you’re introducing to your microbiome is only part of the equation. How many bacteria are living in your probiotics matters, too.
A dose of probiotics is measured in colony-forming units (CFUs), which estimates the number of microbial cells that are healthy enough to reproduce in your gut (8).
Costa points to a 2017 review, which suggests that a dosage of 10 billion colony-forming units (CFU) per day is the minimum you’ll need to reduce your risk of diarrhea from antibiotics (9).
Acid resistance
Popping a probiotic is only half the battle. The beneficial bacteria also have to survive the acid in your stomach in order to colonize your digestive tract and make a difference in your gut health (10).
Some probiotics are formulated with acid-resistant or extended-release capsules, which give the vulnerable bacteria more of a fighting chance.
When Is the Best Time to Take Probiotics With Antibiotics?
According to Costa, starting probiotics within two days of starting antibiotic treatment can lower your likelihood of having GI symptoms like diarrhea.
Ideally, you should space out your probiotics from your antibiotic dose to preserve the effectiveness of the probiotics. For example, if you’re taking a dose of antibiotics with breakfast and dinner, take your probiotics during lunch or at least two hours from an antibiotic dose.
After you finish your course of antibiotics, it’s a good idea to keep taking your probiotics for at least a few weeks to support the restoration of your gut flora (1).
But you don’t have to reserve your probiotics for when you have to take antibiotics. Research shows that taking probiotics consistently may also support your immune system, digestive health, and more (11, 12).
The 8 Best Probiotics to Take With Antibiotics, Ranked
Culturelle Ultimate Balance for Antibiotics Capsules
Dietitian’s pick
Culturelle Ultimate Balance for Antibiotics Capsules are designed specifically to support digestive health during and after antibiotic use to reduce the risk of digestive issues.
Culturelle capsules are De Angelis’s pick and contain over 20 billion CFUs of Lactobacillus rhamnosus GG. This strain is one of the most studied probiotics and has been clinically proven to help restore the diversity of your microbiome after antibiotics (13, 14). And conveniently, they don’t need to be refrigerated.
Each capsule of Seed is packed with 24 clinically studied probiotic strains—16 of which specifically target gut barrier function and digestive health. Seed also uses ViaCap technology, a special coating that keeps the CFUs alive as they travel to your colon.
Instead of CFUs, Seed measures their probiotic dosage in AFUs, or Active-Fluorescent Units. AFUs are thought to be a more precise method of counting how many living cells are in a probiotic (15).
On top of probiotics, Seed also contains a non-fermentable prebiotic (pomegranate) which helps nourish beneficial bacteria as they populate in your gut. (Plus, non-fermentable prebiotics are FODMAP safe for those with particularly sensitive digestive systems.) These probiotics also don’t require refrigeration.
Read why The Edge’s Deputy Editor has been taking Seed DS-01 probiotics for over five years, here.
AFUs: 53.6 billion per capsule
Strains: 24 strains, including Lactobacillus crispatus, Bifidobacterium lactis, and Lacticaseibacillus casei.
This probiotic contains 12 different beneficial strains—including Lactobacillus casei, Lactobacillus acidophilus, and Lactobacillus rhamnosus GG—which have been shown to effectively treat GI issues from antibiotics (9).
RenewLife Extra Care Digestive Probiotics are contained in delayed-release capsules, which may help the probiotics survive your dose of antibiotics.
While most probiotics contain multiple strains of beneficial bacteria, research shows that single strain probiotics can be effective at treating GI discomfort as well (16).
Thorne Sacro-B probiotics are made with Saccharomyces Boulardii, which may lessen antibiotic-associated diarrhea (8). Keep in mind that each capsule only has 5 billion CFUs per capsule, so you may need to take two while you’re on antibiotics.
This single-strain probiotic by Now Foods is vegan and allergy-friendly, as it is free from wheat, gluten, soy, corn, milk, egg, fish, shellfish, and tree nuts. Plus, if you eat a Halal or Kosher diet this probiotic has got you covered.
This product is also third-party tested by Intertek and GMP quality assured by the FDA (17). If you’re trying to hit 10 billion CFUs, you’ll need to take two capsules.
Swanson Saccharomyces Boulardii with Prebiotic MOS
Best value
This probiotic combines Saccharomyces Boulardii with Mannan-Oligosaccharides (MOS), a prebiotic, to help support the newly introduced beneficial bacteria (18).
Each container contains 30 veggie caps with 5 billion CFUs per capsule at just a few dollars, making this probiotic the best bang for your buck. Take two capsules per dose to help support your gut during antibiotics.
Life Extension FLORASSIST® Probiotic GI with Phage Technology
Most acid resistant
Life Extension’s Florassist probiotics are dual encapsulated, which protects its 15 billion CFUs from your stomach acid. It also includes a blend of four bacteriophages—viruses that attack bacteria—which can target overgrowth of specific, harmful bacteria (19).
These probiotics are also non-GMO, vegetarian, and don’t need to be refrigerated.
CFUs: 15 billion per capsule
Strains: 7 Lactobacillus and Bifidobacterium strains
Pure Encapsulations is free from GMOs, binders, fillers, and preservatives that are commonly found in other probiotics. Each six-strain capsule contains 5 billion CFUs of Lactobacillus and Bifidobacterium (so take two if you’re trying to reach 10 billion CFUs).
Pure Encapsulations also removes unnecessary plastic packaging and partners with recycling service TerraCycle to reduce waste.
And remember to pop these in the refrigerator once you open the bottle.
CFUs: 5 billion per capsule
Strains: 6 Lactobacillus and Bifidobacterium strains
Rebekah Harding is a Health Writer at The Edge. She is an experienced health and lifestyle writer with both digital and print bylines in Men’s Health, Cosmopolitan, Yoga Journal, Giddy, and more.
