Can You Take Probiotics with Antibiotics?

⚡ Quick Answer

Yes — and you should. Multiple systematic reviews and RCTs confirm that probiotics significantly reduce antibiotic-associated diarrhoea (AAD), C. difficile infection risk, and overall GI side effects when taken concurrently with antibiotics. The key: take probiotics 2+ hours after each antibiotic dose, use Saccharomyces boulardii or Lactobacillus rhamnosus GG (which have the best evidence), and continue for at least 2 weeks after completing antibiotics.

Key Facts at a Glance

Safe with antibiotics?	Yes — and strongly recommended
Best strains	S. boulardii, L. rhamnosus GG
Spacing from antibiotic	At least 2 hours after each antibiotic dose
S. boulardii advantage	Yeast — antibiotics cannot kill it
Continue after antibiotics?	Yes — for 2 weeks minimum
AAD risk reduction	61% (Cochrane review of 23 RCTs)

The Evidence: Do Probiotics Help During Antibiotic Treatment?

The evidence is clear and strong. A Cochrane systematic review of 23 RCTs (n=4,213) found probiotic supplementation during antibiotic treatment reduces antibiotic-associated diarrhoea (AAD) risk by 61%. A separate meta-analysis of 39 RCTs found probiotics reduce AAD incidence from 22.4% (placebo) to 12.3% (probiotics). The most evidence-backed strains: Saccharomyces boulardii and Lactobacillus rhamnosus GG. The most common antibiotic-associated complication is diarrhoea — affecting 5–35% of antibiotic courses — but the more serious concern is Clostridioides difficile (C. diff) infection, which probiotics also significantly reduce.

Why Saccharomyces Boulardii Is Uniquely Valuable During Antibiotic Treatment

S. boulardii is a yeast, not a bacterium. Antibiotics kill bacteria — they cannot kill S. boulardii. This means you can take S. boulardii at any time relative to your antibiotic dose without worrying about the antibiotic destroying it. Additional benefits: S. boulardii produces proteases that degrade C. difficile toxins directly, restores intestinal barrier function (reduces 'leaky gut' from antibiotic damage), and reduces pro-inflammatory cytokines in the gut. Dose: 250–500 mg S. boulardii twice daily throughout the antibiotic course and for 2 weeks afterward.

Timing Bacterial Probiotics with Antibiotics

Unlike S. boulardii, bacterial probiotic strains (Lactobacillus, Bifidobacterium) ARE susceptible to antibiotics. To protect them: • Take bacterial probiotics 2+ hours after each antibiotic dose (not at the same time) • The antibiotic blood level is lower 2 hours after dosing, improving probiotic survival in the gut lumen • Some practitioners recommend even longer spacing (4 hours) for broad-spectrum antibiotics • Best combined strategy: S. boulardii immediately with antibiotics + Lactobacillus rhamnosus GG 2+ hours after

What to Take After Completing Antibiotics

The antibiotic course depletes the gut microbiome — a diverse, multi-strain probiotic helps restore it. The recommended protocol after completing antibiotics: • Continue S. boulardii for 2 weeks post-antibiotics (helps clear any C. diff risk period) • Transition to a broad-spectrum Lactobacillus + Bifidobacterium probiotic (10–50 billion CFU of multiple strains) • Include prebiotic foods (garlic, onion, asparagus, oats, bananas) or a prebiotic supplement to feed recovering bacteria • Full microbiome recovery after antibiotics can take 1–6 months — ongoing diverse diet (30+ different plant foods/week) supports restoration

Which Probiotic Strains to Avoid During Antibiotics

Avoid low-quality multi-strain probiotics that do not specify individual strains. Generic 'Lactobacillus acidophilus' without strain specification has inconsistent evidence. Focus on: S. boulardii (CNCM I-745 strain), L. rhamnosus GG (specific strain designation matters), and L. acidophilus NCFM + B. lactis Bi-07 combination. Refrigerated probiotics (stored correctly) typically have higher viable CFU counts. Check that the label guarantees CFU count at expiry, not just at manufacture.

Frequently Asked Questions

How far apart should probiotics and antibiotics be taken?

Take bacterial probiotics (Lactobacillus, Bifidobacterium) at least 2 hours after each antibiotic dose — not simultaneously. The antibiotic concentration in the gut is highest immediately after dosing; spacing 2+ hours allows probiotic bacteria better survival. Saccharomyces boulardii (a yeast) can be taken at any time relative to antibiotics, as antibiotics cannot kill yeast.

Do probiotics reduce antibiotic resistance?

Indirectly, yes. Probiotic supplementation reduces the need for repeat antibiotic courses by preventing C. difficile infections and resolving antibiotic-associated diarrhoea. By reducing antibiotic failures and re-treatment, appropriate probiotic use can reduce total antibiotic exposure — which is the primary driver of antibiotic resistance development. Probiotics themselves do not reduce antibiotic resistance genes.

How long should I take probiotics after antibiotics?

At minimum, continue probiotics for 2 weeks after completing the antibiotic course. S. boulardii in particular should be continued for 2 weeks post-antibiotics due to C. diff risk continuing after the course ends. Many practitioners recommend a full month of high-quality multi-strain probiotics post-antibiotics, alongside prebiotic-rich foods to support microbiome recovery. Full microbiome diversity restoration can take months.

Clinical References

Hempel S et al. (2012). JAMA. Probiotics for the prevention and treatment of antibiotic-associated diarrhea — systematic review and meta-analysis. → Source
Johnston BC et al. (2012). Cochrane. Probiotics for the prevention of Clostridium difficile-associated diarrhea. → Source
NIH National Center for Complementary and Integrative Health. Probiotics: What You Need to Know. → Source

Medical Disclaimer: This content is for educational purposes only and does not constitute medical advice. Dosing information is based on published clinical research and NIH guidelines. Individual needs vary — always consult a qualified healthcare professional before changing your supplement regimen, especially if you take medications or have a medical condition.