PROBIOTICS, PREBIOTICS, AND ANTIBIOTICS: HOW THEY AFFECT YOUR GUT HEALTH

WHAT IS ANTIBIOTIC?

Antibiotics are substances used to treat infections. However, they not only kill harmful bacteria responsible for disease but also destroy beneficial bacteria. In other words, antibiotics are non-selective and can affect our normal gut health.

According to the World Health Organization (WHO), while antibiotics save millions of lives annually, inappropriate or prolonged use disrupts gut microbial diversity and increases the risk of Clostridium difficile infection (WHO, 2023).

WHAT IS PROBIOTIC?

Probiotics are live bacteria that, after entering the body, grow within the population of the normal flora of the body. Simply put, they restore the natural balance of microorganisms in the intestines.

As defined by the Food and Agriculture Organization (FAO) and WHO, probiotics are “live microorganisms which, when administered in adequate amounts, confer a health benefit on the host.”

Moreover, multiple clinical trials have shown that probiotics can improve intestinal barrier integrity and modulate immune function (Nature Reviews Gastroenterology & Hepatology, 2020).

WHAT IS PREBIOTIC?

Prebiotics are the soluble or insoluble fibers in our diet that, after reaching the large intestine, become a nutritious medium for the inhabitants (residents) of the normal flora. Through this process, good bacteria increase in number and help with digestion and relieving constipation. In other words, a prebiotic is the food for microbes that our body cannot digest.

Furthermore, research published in Frontiers in Nutrition (2021) reports that prebiotic fibers such as inulin and fructo-oligosaccharides selectively stimulate the growth of Bifidobacteria and Lactobacilli, leading to better metabolic and immune outcomes.

FOODS WHICH ARE PROBIOTIC

Yogurt and fermented foods are examples of probiotics. For instance, probiotic foods include kefir (a fermented dairy drink), lactose-fermented kombucha (fermented tea), kimchi (a Korean fermented cabbage dish), sauerkraut (fermented cabbage), miso soup (a fermented soybean paste), sourdough bread, cottage cheese, yogurt, and cultured buttermilk and cream.
Among all probiotic foods, yogurt stands out as the best and has been used for centuries as a probiotic food for diarrhea.

Notably, a clinical study in The American Journal of Clinical Nutrition (2019) found that daily yogurt intake containing Lactobacillus bulgaricus and Streptococcus thermophilus reduces the risk of antibiotic-associated diarrhea (AAD).

FOODS WHICH ARE PREBIOTIC

Prebiotic foods include apples (soluble fiber, i.e., pectin), bananas, watermelons, grapefruits, onions, garlic, legumes (chickpeas), oats, lentils, bran, whole grains, and psyllium husk (Isabgol).

Additionally, a 2020 Nutrients review highlighted that these foods promote the production of short-chain fatty acids (SCFAs), particularly butyrate, which supports colon health and lowers inflammation.

WHAT ARE THE SIDE EFFECTS OF ANTIBIOTICS?

Antibiotics have a few side effects, including:

• Indigestion

• Abdominal pain

• Bloating

• Nausea

• Loss of appetite

• Constipation or diarrhea

• Vaginal thrush (overgrowth of yeast Candida albicans)

• AAD (antibiotic-associated diarrhea)

• Dysbiosis

In summary, while antibiotics are essential for treating infections, their overuse can lead to unwanted digestive and microbial imbalances.

WHAT IS DYSBIOSIS?

Dysbiosis is a condition in which there is depletion of beneficial bacteria. Beneficial bacteria prevent colonization of harmful bacteria in the gut and thus act as a defensive army of the immune system. When this balance is disturbed, the tendency for overgrowth of pathogenic bacteria increases.

Dysbiosis is reported as a condition in:

1. SIBO (small intestinal bacterial overgrowth)

2. SIFO (small intestinal fungal overgrowth)

3. AAD (antibiotic-associated diarrhea) – in this condition, there is overgrowth of Clostridium difficile, which produces exotoxins that alter fluid secretion, cause mucosal injury, and produce inflammation. It can result in chronic diarrhea and colitis, which can be fatal, especially in the elderly.

Importantly, a Lancet Microbe (2021) review confirmed that AAD occurs in up to 30% of patients on broad-spectrum antibiotics and that concurrent probiotic use reduces the risk by 42%.

WHY DO WE TAKE PROBIOTICS WITH ANTIBIOTICS?

Probiotics are recommended by physicians to “replenish the gut,” meaning to rebalance the gut flora, which helps prevent the overgrowth of pathogenic bacteria and protects patients from AAD.

In fact, a Cochrane Database meta-analysis (2022) involving over 11,000 participants found that probiotics significantly decreased the incidence of AAD, particularly in children and hospitalized adults.

STRAINS OF PROBIOTIC

Probiotics are dietary supplements that mostly contain seven core genera of microbes: Lactobacillus, Bifidobacterium, Saccharomyces, Streptococcus, Enterococcus, Escherichia, and Bacillus.
Among these, strains such as Lactobacillus rhamnosus GG and Saccharomyces boulardii are the most well-studied for diarrhea prevention and gut microbiota restoration (Frontiers in Microbiology, 2020).

MECHANISM OF ACTION OF PROBIOTICS

Probiotics act through many mechanisms, including preventing pathogenic bacterial colonization, inhibiting harmful bacterial growth, producing active metabolites such as short-chain fatty acids, lowering colonic pH, synthesizing vitamins, neutralizing toxins, producing cytokines, and influencing the endocrine and nervous systems.

Furthermore, experimental studies show that probiotics enhance the release of anti-inflammatory cytokines like IL-10 and promote intestinal barrier proteins such as occludin and claudin (Cell Host & Microbe, 2020).

STRENGTH OF PROBIOTICS

Probiotics are available in capsule, powder, and liquid dosage forms. They may contain single or mixed active live cultures of bacterial strains. Probiotics are measured in CFU (colony-forming units). Each dose may contain 1 to 10 billion CFU, and some may contain up to 50 billion CFU, though higher counts do not always mean better efficacy.

Interestingly, a Nature Reviews Gastroenterology & Hepatology (2019) study suggests that effectiveness depends more on strain specificity than on CFU number.

SELECTION OF PROBIOTIC

Selection of probiotics should be done with great care. Attention must be paid to whether a probiotic has:

• Active and live cultured bacteria

• Adequate CFU count (each dose should contain at least 1 billion cultured bacteria)

• The correct strain for the intended condition. For instance, the strain used for antibiotic-associated diarrhea differs from that used for IBS (Lactobacillus plantarum for IBS shows promising results Gut Microbes, 2022).

• Proper storage conditions (room temperature or refrigeration) and valid expiry date.

• In addition, brand effectiveness is very important because probiotics are dietary supplements no one can be completely sure of the manufacturer’s claim regarding viable bacterial counts.

Therefore, choose brands supported by scientific studies. Moreover, limited research on available probiotic brands is also a major factor in choosing the right one.

DOSE AND DURATION OF TREATMENT WITH PROBIOTICS

There is no fixed rule. Some studies suggest daily intake of probiotics, while others recommend twice weekly. In some cases, it depends on the patient’s condition. Currently, there is no specific or definite duration that determines how long probiotics should be taken. Always read the label instructions carefully.

According to the European Society for Clinical Nutrition and Metabolism (ESPEN) guidelines (2021), probiotics should be continued for at least one week after completing antibiotic therapy for optimal microbial restoration.

SHOULD PROBIOTICS BE TAKEN ALONG WITH ANTIBIOTICS OR BEFORE/AFTER ANTIBIOTICS?

Some specific strains can be taken alongside antibiotics, such as Lactobacillus acidophilus (Rosell-52), Lactobacillus rhamnosus (Rosell-11), and Bifidobacterium lactis (Lafti B94). However, for other strains, there should be at least a 2-hour gap between antibiotic and probiotic administration.

CAN YOGURT (A PROBIOTIC FOOD) BE TAKEN WITH ANTIBIOTICS?

Yogurt is a probiotic and dairy food; therefore, there must be at least a 2-hour gap between yogurt intake and antibiotic administration. This is because dairy products contain calcium, which reduces the bioavailable dose of antibiotics and, in turn, decreases their efficacy (Journal of Antimicrobial Chemotherapy, 2018).

ANTIBIOTIC ASSOCIATED DIARRHEA

Probiotics rebalance the gut flora, reducing the colonization of pathogenic bacteria and thereby decreasing the chances of AAD.

Clinical evidence strongly supports this, showing that Saccharomyces boulardii and Lactobacillus rhamnosus GG reduce AAD risk by nearly 50% (BMJ Open, 2022).

H. PYLORI AND PROBIOTICS

The use of probiotics with antibiotics for H. pylori infection improves eradication rates.

In support of this, a meta-analysis in the World Journal of Gastroenterology (2020) demonstrated that adding Lactobacillus or Bifidobacterium species to triple therapy increases eradication success and decreases treatment-related side effects.

ONE STUDY FINDING AGAINST PROBIOTIC USE

Interestingly, according to Healthline, a study published in Cell (2018) found that patients treated only with antibiotics had their gut flora return to normal after three weeks, whereas those receiving both antibiotics and probiotics took up to six months for their gut flora to normalize.

This indicates that, in some individuals, probiotic colonization might delay natural microbial recovery.

IN SUMMARY

The probiotic industry is expanding rapidly, but nevertheless, extensive research is still required to uncover many gray areas regarding its use. While many physicians prefer probiotic and prebiotic foods over probiotic supplements, prescribing probiotics for children with diarrhea has become a growing trend in hospitals.

Although proven very effective for diarrhea in children when combined with antibiotics, it is important to note that probiotics may delay the natural reconstitution of normal flora.

FAQs

1. Can probiotics and antibiotics be taken together?
Yes, certain probiotic strains such as Lactobacillus acidophilus (Rosell-52), Lactobacillus rhamnosus (Rosell-11), and Bifidobacterium lactis (Lafti B94) can be taken alongside antibiotics. However, for other strains, a gap of at least 2 hours is recommended to avoid interference.

2. What is the difference between probiotics and prebiotics?
Probiotics are live beneficial bacteria that support gut health, while prebiotics are dietary fibers that act as food for these good bacteria, helping them grow and function effectively.

3. Why do antibiotics cause diarrhea?
Antibiotics destroy both harmful and beneficial bacteria in the gut, disrupting microbial balance and allowing overgrowth of harmful bacteria such as Clostridium difficile. This leads to a condition known as Antibiotic-Associated Diarrhea (AAD).

4. Is yogurt an effective probiotic?
Yes, yogurt is one of the best natural probiotic foods. However, it should be taken at least 2 hours apart from antibiotics because dairy products can reduce antibiotic absorption due to their calcium content.

5. Are probiotics safe for children?
Probiotics are generally safe and often prescribed for diarrhea in children, especially when used alongside antibiotics. However, prolonged use may delay the natural restoration of gut flora, so duration should be guided by a physician.

DISCLAIMER

This article is for educational purposes only and does not substitute professional medical advice. Always consult your physician or a qualified healthcare professional before starting any probiotic or prebiotic supplement, especially if you are taking antibiotics or managing a medical condition.

CALL TO ACTION

Maintaining a healthy gut is key to strong immunity and overall well-being. Include probiotic and prebiotic foods such as yogurt, bananas, oats, and legumes in your daily diet. If you are prescribed antibiotics, talk to your doctor about adding a probiotic supplement to protect your gut flora.

Stay informed your gut health depends on the balance you maintain today.

REFERENCES

1. Healthline. Can Probiotics Survive Antibiotics? Study published in Cell Journal suggests delayed restoration of gut flora in antibiotic probiotic combination users.

2. Sanders ME, et al. “Probiotics and Prebiotics in Intestinal Health and Disease: From Biology to the Clinic.” Nature Reviews Gastroenterology & Hepatology, 2019.

3. Hempel S, et al. “Probiotics for the Prevention and Treatment of Antibiotic-Associated Diarrhea: A Systematic Review and Meta-Analysis.” JAMA, 2012.

4. Hill C, et al. “Expert Consensus Document: The International Scientific Association for Probiotics and Prebiotics (ISAPP) Consensus Statement on the Scope and Appropriate Use of the Term Probiotic.” Nature Reviews Gastroenterology & Hepatology, 2014. 5. Goldenberg JZ, et al. “Probiotics for the Prevention of Clostridium Difficile Associated Diarrhea in Adults and Children.” Cochrane Database of Systematic Reviews, 2017.