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Antibiotics fight germs. Probiotics can be used to fight germs with germs. Sometimes it makes sense to take both antibiotics and probiotics at the same time.

There are many situations in which doctors prescribe broad-spectrum antibiotic therapy. A broad-spectrum antibiotic would be called for when there is a serious infection, it's obviously bacterial (antibiotics don't fight viruses), and there isn't time to run the tests that will tell which species of bacteria are causing the problem (since no antibiotic is effective against every kind of bacteria). 

Just about universally, high doses of probiotics cause a potentially problematic side effect, diarrhea. That's because feces isn't just the body's waste. About one-third of the volume of human feces is probiotic bacteria, microorganisms that ordinarily live in the colon. When broad-spectrum antibiotics kill disease-causing bacteria, they also kill probiotic bacteria, and the result is watery stool and bowel movements five, ten, and sometimes fifteen or more times a day.

Many doctors advise their patients to take probiotic supplements when they take antibiotics to stop diarrhea. "You have an infection, so you need to take germs" may sound like strange advice, but probiotics are sometimes exactly what is needed. However, different strains of probiotic bacteria have different purposes, and the product that works best depends on why you need to take it. Here is a brief guide to which probiotics you need when you take antibiotics.

  • Diarrhea after antibiotic treatment in children has been documented to respond to single-strain probiotics. One such probiotic strain is Lactobacillus GG, which is sold in North America and the UK under the trade name Culturelle. The products that work in adults, which typically contain multiple strains of antibiotics may also work; they just aren't as extensively tested.
  • Diarrhea after antibiotic treatment in adults also responds to Culturelle. Two other combinations that work well in treating antibiotics in adults (that haven't been clinically tested for use in treating children as extensively) include Lactobacillus bulgaricus (the kind of bacteria used to make Bulgarian yogurt), Lactobacillus casei, and a non-disease strain of bacteria named Streptococcus thermophilus. This combination of probiotics is available in the over-the-counter product called Actimel. Another combination of probiotic bacteria that helps make this kind of diarrhea go away is Lactobacillus acidophilus LFCM plus Lactobacillus paracasei Lpc-37. These two bacteria plus two more are found in the over-the-counter product HOWARU Restore.
  • Traveler's diarrhea usually responds to Culturelle, described above. If you take Culturelle before your trip, you may not need any antibiotics at all. If you get traveler's diarrhea that is bad enough to require antibiotics, Culturelle will help you get well faster. Traveler's diarrhea also responds to yeast found on the skins of mangosteens. You don't have to buy fresh mangosteens to get this yeast. Research studies find that the strain of this yeast that works best to restore bowel function is Saccharomyces boulardii lyo CNCM I-745, which is the species in the product Florastor.
  • Diarrhea is also common in people who take a class of drugs called proton pump inhibitors for gastric reflux disease. The proton pump inhibitors include medications such as Omeprazole (Prilosec) and lansoprazole (Prevacid) and half a dozen others. Probiotics can also help with this kind of diarrhea. These drugs can also cause bloating, by encouraging excessive growth of some kinds of bacteria in the abdomen. Encouraging the growth of other kinds of bacteria that don't cause bloating can counteract bloat. The most helpful probiotic for these problems is Lactobacillus casei F19, which is found in the product NOW Foods Probiotic-10.
Continue reading after recommendations

  • Boyanova L, Mitov I. Coadministration of probiotics with antibiotics: why, when and for how long? Expert Rev Anti Infect Ther. 2012 Apr. 10(4):407-9. doi: 10.1586/eri.12.24. No abstract available. PMID: 22512748.
  • Robertson J. In children receiving antibiotics, does coadministration of Lactobacillus GG reduce the incidence of diarrhea? West J Med. 2000 Dec. 173(6): 397.
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