Short answer: Absolutely Yes!

Slightly longer Answer: Absolutely Yes but not AFTER. To support antibiotic therapy, we want to take very specific probiotic strains DURING and for at least two weeks AFTER our course(s) of antibiotics.

Additional support including prebiotics is equally important to mitigate the changes and damage that the antibiotics can do to the gut microbiome, changes that in some cases are irreversible. Probiotics are not a one-size-fits-all therapy. Each species and strain has its own actions, much like herbal medicines and pharmaceutical drugs, each have their own specific actions. For the most part, they aren’t interchangeable. Like herbal medicines and pharmaceutical drugs, they need to be prescribed for their desired effects. Read on below to learn more.

Optimising Gut Health: Utilising Probiotic and Prebiotic Interventions During Antibiotic Therapy

As a naturopathic clinic specialising in gut health and microbiome optimisation, we often find ourselves at the intersection of traditional medicine and cutting-edge research. In this journey, one topic looms large: the intricate dance between antibiotics, the bacteria in our gut (microbiota), and the delicate balance of our gut microbiome ecosystem.

Understanding Probiotics and Antibiotics

Antibiotic use, while often necessary and lifesaving, should not be taken lightly. Antibiotics can inflict collateral damage on the gut microbiome, in some cases leading to reduction in number of some species but also with the potential of complete extinction of bacterial species within our gut. This extinction is largely irreversible. Once these species are eradicated, we have no way of getting them back. (As long as minute numbers remain, we can use diet and prebiotic supplementation to gently nurture these numbers to grow and flourish),

Some antibiotics are particularly potent, eliminating as many as 9 different bacterial species forever. Combination antibiotic therapies (like triple or even quadruple antibiotic therapy used to treat H.pylori) tend to have the most detrimental effects. Over time these therapies have also become less effective due to microbial anti-biotic resistance… but that is a topic for another day.

When taking antibiotics, we have no way of knowing which species will be impacted or the role that species played in our gut ecosystem. We may or may not have other species that can pick up the slack and take on this role, so the impacts are wide and varied and unpredictable.

One common example of this is Oxalobacter formigenes. This guy has a very important role in our gut microbiome: breaking down oxalates. He uses oxalates as his food source. (Oxalates are natural compounds found in lots of healthy foods: -vegetables, fruits, nuts, and grains. Some examples of foods that are highest in oxalates include green leafy vegetables, soy, almonds, potatoes, tea, raspberries, rhubarb, and cereal grains). The absence of Oxalobacter formigenes in the gut increases our risk of excess oxalates in the body and “oxalate sensitivity”. High oxalate levels can cause a wide range of symptoms and health problems that range from mild to severe. They can cause, or exacerbate, inflammation, joint pain (arthritis, carpal tunnel syndrome), skin irritation (eczema and acne), kidney stones, and other urinary tract and vaginal conditions like UTIs and interstitial cystitis.

Oxalobacter formigenes is particularly vulnerable to antibiotics. And to make it worse, we don’t really have any other guy playing his role in the gut. There ARE some bacteria who will degrade oxalate as a defence mechanism when they are under stress but they won’t do this unless they are using it as a survival mechanism. So, after many years of increasing antibiotic use, we start to see an increase in people who are reactive to high oxalate foods. And as we pass our microbiomes on to our children, this impact of antibiotics on the gut microbiome, loss of important species, and our overall health becomes INTER-GENERATIONAL!

The role of probiotics while taking antibiotics

Ever found yourself looking at probiotics in a health food store or pharmacy and decided to grab the high-dose multi-strain one because it must be best? Contrary to prevailing marketing narratives, the efficacy of probiotics extends beyond how many different strains are rammed into one capsule and how high in numbers these bacteria are present (measured as colony-forming units (CFU).

The efficacy of probiotics hinges on the quality and specificity of probiotic strains.

Probiotics DO NOT permanently populate the gut after ingestion; they are transient passengers with specific actions and durations of efficacy for the time they are present. Some hanging around for a few days, some possibly for a few weeks.

During antibiotic therapy, probiotics serve invaluable roles:

Competing for Space: Probiotics strategically occupy gut real estate, outcompeting harmful microbes and safeguarding microbial balance.
Alleviating Side Effects: Specific probiotic strains mitigate antibiotic-associated diarrhea and other side effects of taking antibiotics, these strains have been tested to survive being taken alongside antibiotics.
Harnessing Antimicrobial Properties: Select probiotics produce antimicrobial substances, combating pathogenic invaders and supporting immune function. For example, some strains can bind to viruses, such as rotavirus, preventing & shortening gut viral infections.

When looking for a probiotic supplement we are not looking for the one with the most species and CFU. A quality probiotic is:

Shelf stable: Variations in shelf stability influence a strain's ability to maintain viability, necessitating stringent quality control measures.
Resistant to gastric acid and bile salts: Strain resilience to digestive challenges impacts its survival in stomach and small intestine so it can act where needed.
Able to temporarily colonise the gut to exert its actions enhancing its longevity and potential for sustained benefits.
Able to adhere to intestinal cells Essential for immune cell modulation and competitive inhibition of pathogens
Well-researched with clinically documented and validated health effects

The actions of probiotics are wide and varied! See this link attached here for a list of all the different mechanisms of actions of probiotic bacteria,

Probiotics are used for gastrointestinal symptoms, urinary and vaginal health, anxiety and depression, immune support, high cholesterol, type 2 diabetes, food allergies, hayfever, eczema, non-alcoholic fatty liver disease and more!

Different strains within the same species can vary regarding ALL of the above.

Let us explain this further with an example

There are over 170+ different species of the genus Lactobacillus and thousands of different strains.

The genus = Lactobacillus and the different species include: - Lactobacillus acidophilus , Lactobacillus casei , Lactobacillus plantarum, Lactobacillus reuteri, Lactobacillus rhamnosus etc etc

But it is the strain not the species that determines its action and therefore when to clinically apply.

Strain is denominated by a series of letters and/or numbers after the species name. If your probiotic supplement does not have this information on the label we have no way of knowing what strain it contains and therefore no idea what its therapeutic action would be.

Using Lactobacillus plantarum as an example:-

Lactobacillus plantarum Strain 299v: Multiple research studies have found this strain beneficial for irritable bowel syndrome (IBS) and use alongside antibiotics. It has been found to significantly decrease abdominal pain severity and frequency, as well as bloating severity in IBS, and reduce the risk of developing nausea and loose or watery stools due to antibiotics.

Lactobacillus plantarum Strain MF1298: While this strain has been found to have desirable characteristics of strengthening gut integrity, adherence, survival of passage through the gastrointestinal tract, and antimicrobial activity against pathogens, it has been found to significantly WORSEN IBS symptoms.

Yep, the OPPOSITE effects within the same species.

Using another example, we note different strains of Bifidobacterium longum have widely varied actions from

alleviating anxiety and depression via the gut-brain axis
anti-obesity effects (increase glucose tolerance as well as inhibit weight gain and fat accumulation during high-fat diets)
improving non-alcoholic fatty liver disease and bacterial vaginosis
modulating the immune system and reducing inflammation in the gut with preventative and protective impacts on IBD (inflammatory bowel disease).
and more!

We could go on…. but it is clear we want to make sure we are picking the right strain for the desired health outcomes.

If you are choosing a probiotic to use alongside antibiotics (or for any other purpose), it can’t be any old probiotic!

In practice, this means we often prescribe more than one probiotic supplement for different desired clinical outcomes in a single patient.

Navigating Antibiotic-induced Microbiome Disruption

So we’ve been prescribed the right probiotic strain with the desired actions, is that enough?

Sadly not, as we mentioned before, probiotics won’t re-seed the gut and start growing. In the face of microbiome disruption (and destruction) when taking antibiotics, other proactive measures are needed! We need to nourish the beneficial bacteria we have by feeding them to give them the best possible chance of survival in the presence of antibiotics.

This is where prebiotics come in. Prebiotics are non-digestible fibres, carbohydrates, or compounds that serve as a food source for beneficial bacteria in the gut. They are not digestible by humans and instead, when they reach the large intestine, undigested by us, they provide nourishment for our gut bacteria. Additionally, these prebiotic fibres change the pH of the gastrointestinal tract making it inhospitable to the bad guys. In this way, they have very indirect antimicrobial actions and we make great use of them in this way when supporting the gut health of our clients – they are a safe intervention from infants to the elderly.

Prebiotics can be found naturally in many foods, including:

Fruits: such as bananas, apples, berries, and kiwi.

Vegetables: such as onions, garlic, leeks, asparagus, and artichokes.

Whole grains: such as oats, barley, and wheat.

Legumes: such as chickpeas, lentils, and beans.

Nuts and seeds: such as almonds, flaxseeds, and chia seeds.

Prebiotic supplements in therapeutic doses offer a lifeline to our gut microbiome during antibiotic therapy. Different options include Partially Hydrolyzed Guar Gum (PHGG), Lactulose, Inulin, Fructooligosaccharides (FOS), and Galactooligosaccharides (GOS). As long as you don’t have small intestinal bacterial overgrowth (SIBO) or significant dysbiosis, low dose Lactulose and Inulin-FOS are good choices alongside antibiotics.

By nourishing beneficial gut bacteria and reducing growth of less favourable species and strains, prebiotics can foster resilience and diversity, mitigating some of the adverse effects of antibiotic therapy on our delicate microbiome.

Empowering Wellness through Precision and Guidance

Get in touch if you would like a naturopath on our team to offer you personalised guidance on selecting the most appropriate probiotic and prebiotic interventions for you. We offer no obligation free 15-minute discovery calls to see if we are a good fit to support you.

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In May 2024 we are also offering Australian clients a gut microbiome test package including 2 consultations and a comprehensive microbiome stool test saving $159. Clink the link to purchase or learn more.