The People's Perspective on Medicine

Will Probiotics Help You Recover from Antibiotics?

Antibiotics can disrupt the balance of bacteria in the digestive tract. Will you recover from antibiotics more quickly if you take probiotics?

Antibiotics are crucial tools for overcoming serious infections. However, they can often kill beneficial bacteria that live in the digestive tract and elsewhere along with the harmful invaders. As long ago as 2010, scientists had found evidence that antibiotics can disturb the ecology of the gut. A study of the bacterial populations in three women given ciprofloxacin showed that the beneficial bacteria in their digestive tracts were wiped out (1). As a result, a person who has had a course of treatment may experience diarrhea or other digestive difficulties. Sometimes health professionals recommend probiotics as an antidote for these problems. Can probiotics really help you recover from antibiotics more quickly?

How Can You Recover from Antibiotics?

Q. My doctor prescribed an antibiotic (levofloxacin or Levaquin) and a probiotic (Primadophilus) for an infection. I am to take one pill of each per day, but it seems to me like one cancels out the other.

The doctor says there are no conclusive guidelines on how these are to be taken. Should I take one in the morning and the other in the evening each day, or take the probiotic after the antibiotic series is finished? Do you have any recommendations to help me recover from antibiotics?

A. People often turn to probiotics, bacteria considered beneficial for the digestive tract, to speed recovery from a course of antibiotic therapy. That because antibacterial drugs can disrupt the ecology of the gut bacteria. In theory, people who swallow certain bacteria will recover from antibiotics and the disruption they cause more quickly.

The Use of Probiotics to Recover from Antibiotics Is Not Established:

The science surrounding this concept has been controversial. Recently, Israeli scientists who studied the use of popular probiotics following antibiotic treatment demonstrated that these “good bacteria” can actually slow recovery of the normal microbiota (2). What may work better is to restore the microbial ecology with a transplant of stool taken before the course of antibiotics. This option will not appeal to everyone, however.

iMedical Consensus Advisory

Many health care providers believe that probiotics will speed recovery from antibiotics. However, scientists know too little about this complex field for providers to be confident in their recommendations.

Learn More:

You can hear the lead researcher describe this groundbreaking work in our podcast interview, Show 1159. To learn more about the microbiota of the digestive tract and its care and feeding, you can listen to Drs. Erica and Justin Sonnenburg in Show 1156.

What Readers Have Done to Recover from Antibiotics:

Some readers report that they have had success taking probiotics, but many more report that they have eaten foods such as yogurt containing natural probiotic bacteria. 

Alison reported this experience:

“I had a serious tooth infection and had to take antibiotics for over two months. The drugs made me so sick that whatever I ate went right through me, and I lost nine pounds. My stool turn white, and my lower gut felt like it was twisting and shaking every time I had the urge to go to the bathroom. The doctors kept giving me more antibiotics to clear up this condition.

“Then I started to take Nutri-Health probiotics at first 4 a day, then 2 per day, and then one per day for a WHOLE YEAR. Even now 4 years later I still have to take one probiotic at least every other day or my lower gut hurts.

“All the doctors want to do is give me antibiotics after examining me and telling me they can’t find anything wrong. I tell them to keep their drugs unless I really do have a serious infection/illness. Jarrow Formulas probiotic works well also. It takes research to decide which brand to use because I notice a few formulas have laxatives, and other ingredients I considered junk in them.”

Rebekah is a health care professional who advises eating yogurt:

“As a nutritionist working with the Women, Infant, Children program, I have recommended consuming 1 cup of yogurt w/ active, live cultures to help protect against yeast infection because the good bacteria produced by the gut is compromised with ingesting an antibiotic.”

Anner had a difficult situation due to a toothache:

“A dentist prescribed clindamycin to prevent infection, as I had to travel with a slight pain in a tooth that had been capped. After 6 or 7 days, I called to advise him that I was having diarrhea for the past few days – he said continue on to finish the prescription. Then I read the handout from the pharmacy and saw ‘seldom fatal’ so I stopped and called my internist who advised to immediately begin Florastor (otc probiotic) which helped a lot. When I got to my doctor and learned I had C. difficile, I had to take a stronger medicine – 2 rounds of it – before my stomach was back in reasonable order. It took weeks to be back to normal.

“I asked my pharmacist if people often responded poorly to clindamycin and was told yes and that it is the prescription of choice for dentists. Either no one tells their dentist they got sick or big pharma is offering huge incentives for them to prescribe it. The dentist never called to see how I was doing even after I sent him a non-judgmental email regarding the benefits of Florastor.

The Take-Away:

“My lesson for the day – read all pharmacy handouts before taking medicine and weigh the benefits. You know what I mean – do you really want a pill to combat depression that will cause suicidal thoughts?

“When doctors prescribe antibiotics and don’t tell people about suitable probiotics (they differ with when to take so as not to interfere with benefits of antibiotics) they are doing a serious dis-service to their patients. Ask anyone who’s had C. difficile and you’ll hear horror stories. I had a terrible experience with pain, holding in food, digestion, and worry as I am ordinarily a very healthy person and didn’t think a dentist would prescribe a medicine that is ‘rarely fatal’ as a deterrent for a minor pain. I tried to notify CDC but their website reporting was not easy.”

Clindamycin is not the only culprit. HB had a bad reaction to Cipro:

“My doctor prescribed Cipro in late June for a bladder bacterial infection. After a week, that stuff completely wiped me out, including my good bacteria. I have suffered with such reflux and terrible burning pain in the abdominal area had to have Upper GI done -plus endoscopy. This had never happened to me until about two weeks after I had taken this horrible antibiotic. Now I have the reflux problem and it may have caused other problems.

“I really feel that this medication should not be given out so freely, especially when there are other meds that can do the job without all these problems from antibiotics. Personally, I should have questioned this because I have a terrible time with antibiotics and would have never taken this one had I known what I was going to have to go through. One other thing that really irritates me is, they give everyone, no matter what weight, age you are, the same dose. I say ‘one size’ does not fit all.

“By the way, for others out there–the symptoms don’t always appear right away. This can happen anywhere from 2-5 weeks after you finished the medication, which I found out just recently. What a kicker that was.”

LP has a tragic story about an elder:

“My mother fell, bruising her thigh bone. She required extensive bed rest, resulting in UTI and pneumonia. Course of treatment was PIC in right shoulder area, massive amounts of antibiotics for 15 days. No one questioned the long use of the antibiotics in her stays in 3 hospitals and one for weeks of physical therapy. She received the meds January-February.

“She died in March of the same year due to diarrhea caused by the use of these antibiotics and doctors not replacing the good bacteria. They would not even allow me to bring her yogurt, which she had eaten daily for years. In her last days of a very painful death, the dietitian told me the yogurt along with Rx to replace good bacteria could have saved her life.

“Even though I argued with several of her doctors, they still refused to try it. My mom was 86 yrs old.”

DG had an unfortunately similar experience:

“Wow, such a similar story to ours. My mother-in-law was 92, still able to live at home alone. She fell, life alert necklace called 911. Taken to the hospital, Catheter.. Subsequent MRSA contracted, Heavy vancomycin, transferred to REHAB, more Vanco, C. Diff overtook her intestines and she suffered for 2 weeks, went into a painful stupor, nurses said it was her time! Body was shutting down.

She was rushed to emergency, went on life support and the C. Diff and uncured MRSA killed her. Intensive care doctors said it would be inhumane to treat her just so she could go back to the nursing home. She lost 40 lbs and all this happened in 3 months! C diff is BAD stuff. Couldn’t even sue the rehab because she had no living spouse.”

Stephie G has struggled with symptoms for months:

“I had a couple of rounds of Cipro for 3 separate urinary tract infections this year. My last round was in late July and I’ve had such stomach issues since. I went to a gastro and he gave me an endoscopy and told me he believed the problem was caused by the cipro. All of my tests came back negative but he did diagnose me with GERD. I’ve already lost around 30 pounds and I find it hard to eat anything. Even food that is binding still causes diarrhea.

“I am in digestive hell and I don’t know what to do anymore. Bentyl, a stomach relaxer, helped somewhat but just for a little while. I also try to take a probiotic everyday. How much longer will this last? My stomach makes all kinds of crazy noises no matter what I eat and there is no rhyme or reason to single out any specific catalyst. Rice won’t bother me one day but the next time I eat it I feel really sick. The nausea is unbearable.

“So many people believe this is all stress related. I just wish I had some answers to make sense of this…and some words of encouragement and perhaps a time frame for when this will finally be over.”

Faith found that probiotics were very helpful:

“My doctor had me on clindamycin for three weeks, he also had me on mega probiotics and the Florastor, saccharomyces boulardii, Theralac, and a pharmacy grade probiotic. I also drank kefir lactose free. I was fine, afterwards, My doctor is rockstar,

“Anyhow, it takes sometimes months to get your gut flora back to normal there has to be a better way to cure people rather than give them antibiotics, to destroy the flora which is there for our immunity which is there for their protection.”

If you have found a way to recover from antibiotics, share your secrets with others. Post your comment below.

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About the Author
Terry Graedon, PhD, is a medical anthropologist and co-host of The People’s Pharmacy radio show, co-author of The People’s Pharmacy syndicated newspaper columns and numerous books, and co-founder of The People’s Pharmacy website. Terry taught in the Duke University School of Nursing and was an adjunct assistant professor in the Department of Anthropology. She is a Fellow of the Society of Applied Anthropology. Terry is one of the country's leading authorities on the science behind folk remedies. .
Digestive Disorders

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Digestive Disorders
  • Dethlefsen, L, and Relman, DA, "Incomplete recovery and individualized responses of the human distal gut microbiota to repeated antibiotic perturbation." Proceedings of the National Academy of Sciences of the United States of America, March 15, 2011, Supplement 1, p. 4554-61. DOI: 10.1073/pnas.1000087107
  • Suez, J, et al, "Post-antibiotic gut mucosal microbiome reconstitution is impaired by probiotics and improved by autologous FMT." Cell, Sep. 6, 2018. DOI: 10.1016/j.cell.2018.08.047
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I had diarrhea for over a week once, and my doctor told me to live with it until it went away on its own.
I heard about coconut macaroons on the show, and I was better in a couple of days. I stopped, and it came back. I ate 3 a day for about 2 weeks. I’ve been a faithful listener ever since.

When I was young, we would get shots of antibiotics in the butt, that avoided the med going thru the gut and not destroy the gut flora. Also some meds were given in supositories placed in the rectum which also by passed the gut. It would probably take an Act of God to reverse this pill popping mania that we face today.

I have had several serious infections and have required many strong antibiotics. I am so grateful to live in a day when they are available or my life would have ended decades ago. Cipro, Flagyl and even tetracycline. Plus many other broad spectrum treatments in the hospital. I have used a short course of otc probiotics in the first few weeks after, but no longer. I don’t know if it’s a rebound effect, or simply too much of a good thing, but continued use of probiotics causes me a lot of pain and bloating.

Those with long-term problems may want to experiment with cutting back/out the probiotics and see if that helps. Your doctors/dentists prescribe different antibiotics because infections respond differently to them, and specialists know what works best for the type of infection you have. It can be tough, but as a two-time septicemia survivor, let me assure you the alternative is much worse. A century ago you would have simply died. Be grateful.

One reason Florastar (generic = saccharomyces boulardii) helps with antibiotic side effects is that Florastar is the only yeast-derived probiotic. It can be taken WITH the dosing of antibiotics because it THRIVES on antibiotics. And this ‘good’ yeast crowds out the “bad” yeasts which normally take over with antibiotics.
I would suggest that any other probiotic be taken about 2 hrs AFTER the antibiotic dose, to temporarily put some ‘happy’ bacteria back in the gut. Additional fermented products (yogurt, kefir, sauerkraut, kimchi, natto) can be helpful as well. Eating lots of vegetable fiber (prebiotics) will also help multiply the effect of probiotics or beneficial bacteria in our gut.
And we are learning that we should only take antibiotics if we REALLY, REALLY need to!

Replying to CP in San Antonio…I have been warned against ever taking fluoroquinolones. Have seen examples of individuals completely debilitated dur to their use. Thank you for sharing your warning against them.

Carmen, I had Afib and was on several meds with negative side effects. After 10 years I found a cardiology clinic that specializes in rhythm disturbances. They managed me on more meds until I finally pushed for an ablation. It’s a procedure where they burn out the focus of the problem. (Under anesthesia of course) I had multiple spots, they burned them out and I’m fine now. No meds! Lost weight too! I highly recommend you look for a rythm specialist, not just any cardiologist. 5 meds is a lot!

All I can say is that before I knew to take probiotics I had C. diff after taking an antibiotic. Since then I take probiotics when I take an antibiotic and for several months afterward and I haven’t had C. diff since that first time.

I had Lyme disease, was treated with Doxycycline for a month. I took a multi-strain probiotic, thinking it would help. I got symptoms of IBS. Later, I used single strain bacteria and yeast (and washed salad with water/vinegar solution), and symptoms went away. This agrees with Israeli study you mention, that suggests multi-strain bacteria may not work to restore intestinal flora.

On several occasions, I have found a tablespoon of shredded coconut (unsweetened) from the health food store stopped watery diarrhea literally in its tracks. Cost is perhaps $3/lb. and it can be stored in the freezer. In my opinion, anyone with that problem should give it a try. Mix it in orange juice, oatmeal, cereal, etc. Obviously, this does not address the issue of gut bacteria destruction but may help with the major symptom.

I can’t see that probiotics or a transplant of stool taken before the course of antibiotics will do much good. This treatment should be done after the antibiotics have cleared the system. My wife has diarrhea and general digestive problems after taking antibiotics. She takes probiotics, and they help her, but she has to continue to take the probiotics. I would think the proper probiotic treatment would restore the gut bacteria and would not have to be taken daily.

I took antibiotics for two years for prostate infection. Got severe diarrhea. The only thing that controlled it and eventually cured it was Nizoral, ketoconazole. This is the treatment for Candida albicans yeast overgrowth. It took six months but it cured the problem. I think this is more common than doctors realize.

I was in the hospital and put on antibiotics for diverticulitis. As I result I got severe diarhea for 3 months from C diff. First the Dr. put me on flagyl, then vancomycin,
Finally I was approved for dificid but it has a 1200.00 copay. Upon advice from my grandson, a pharmacist I called Merck who makes it, and because of my income they overnited it to me free.
That has cured me for the last 6 months. I also take a probiotic once per day
and never want to have to take antibiotics again.

What about the coconut cookies that are supposed to cure diarrhea?

Thanks for adding my comments in today’s newsletter about C Dif and diarrhea. Regarding Cipro and other fluoroquinolones, be forewarned! They also can cause ruptured tendons and residual peripheral neuropathy. Twenty-nine (29) years after taking CIPRO, I have pain, numbness, damaged nerves from fingers all the way to my neck from taking it. These drugs should be banned!

I was lactose intolerant for decades, and I’m not sure it was because of antibiotics. However, by chance I tried some raw, unpasteurized milk, and ever since then, no intolerance to any dairy. I don’t know why, but it absolutely worked.

The best thing I’ve ever tried for diarrhea is raw oats or uncooked oats mixed with yogurt.I have diarrhea constantly. I take 7 medicines for AFib, and most of them cause diarrhea.You could mix the oats with milk but I don’t like milk. A small amount of oats works.

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