Howard LeWine, M.D.

Probiotics may help prevent diarrhea due to antibiotic use

Eating yogurt or taking a so-called probiotic when you have to take antibiotics may help prevent the diarrhea that often accompanies antibiotic treatment.

That’s the conclusion of a study just published in the Journal of the American Medical Association. A team of California-based researchers combined the results of 63 randomized trials pitting probiotics versus placebo among almost 12,000 men and women taking antibiotics. Those who took antibiotics plus probiotics were 42% less likely to develop diarrhea as those who got the placebo.

About one in three people who take antibiotics develop diarrhea. The symptoms usually start on the last day or two of antibiotic therapy, or a day or so after it has ended. The diarrhea is usually mild, with two to four loose stools per a lasting for a couple days. In most cases, it gets better quickly without treatment. That said, antibiotic-associated diarrhea makes some people very sick. The most severe form, called C. difficile colitis, can be life threatening.

Probiotics are live bacteria, yeast, and other microbes thought to be beneficial to human health. They’ve been widely promoted as a way to keep your body in balance. The evidence for many of these claims is slim. Perhaps the strongest evidence a benefit of probiotics is for antibiotic-associated diarrhea.

Antibiotics upset intestinal balance

Thousands of species of bacteria, yeast, and other microorganisms live on our skin, in our intestines, and on other body surfaces. They’re known as our “normal flora.” When it is in balance, these microbes stay put and many of them contribute to good health. Bacteria in the gut, for example, help break down food.

Antibiotics kill these “good” microbes along with bacteria that are causing an infection. This upsets the balance of the normal flora in the intestines. The result is often loose, watery stools known as antibiotic-associated diarrhea.

The idea behind using probiotics is that they may help populations of good bacteria recover more quickly and restore order to the intestines. There’s no good evidence that probiotics are helpful in otherwise healthy people. But earlier research has suggested they can be helpful in:

  • treating recurrent or persistent C. difficile colitis, when repeated courses of other therapies have not been successful
  • preventing complications from pancreatitis
  • decreasing persistent or recurring vaginal yeast infections

Not a cure-all

Although the results of this study sound impressive, I won’t be recommending probiotics every time I write a prescription for antibiotic. But I will advise some of my patients to try a probiotic. They include:

  • people who have had antibiotic-associated diarrhea in the past. This is especially true for those that have had a C. difficile infection.
  • people who must take antibiotics for more than 10 days. (Other doctors might use more than 5 days).
  • people who have switched from one antibiotic to another over a relatively short period of time.

The researchers were not able to answer two very important questions:

  • Which probiotics are the most effective in preventing and treating antibiotic associated diarrhea?
  • Which antibiotics are more likely to cause diarrhea?

The medical bottom line

Antibiotics are wonderful medicines. But this study of probiotics and many other studies show they also have a dark side. The best way to avoid antibiotic-associated diarrhea is to limit your use of antibiotics. For example, you likely don’t need an antibiotic for an uncomplicated ear or sinus infection or bronchitis. Most often the culprits are viruses, which don’t respond to antibiotics anyway.

The best way to keep your normal flora in balance is to only take antibiotics when necessary.

Related Information: Better Bladder and Bowel Control

Comments:

  1. Boris Williams

    Antibiotics can be harmful especially if you’re suffering from yeast infection. It cannot help in its cure. Yogurt and probiotics on the other hand are very effective.

  2. Robyn

    Kefir has been a life-saver for me. I noticed there is no mention of C-Diff in this article, which can be brought on by antibiotic use as well. Thank goodness for the resources available online (most doctors don’t even mention probiotics along with antibiotic treatment).

  3. Mark

    My favorite probiotic drink is yakult. It’s delicious and can really be a big help in digestion.

  4. krisdonaldo

    To share important information to “Health Care”

    Heartily Thank To YOU

    Kris Donaldo

  5. Anonymous

    Probiotics and pregnancy, both are good for each other. The good bacteria are present inside and probiotics during pregnancy prevents fetus and mother from urinary tract infections and it cure the stomach after the usage of antibiotic medicine.

  6. l3b4y.com

    whether the product is marketed throughout the world?

  7. Ben

    Yup I agree that probiotics were 42 percent less likely to develop diarrhea during treatment compared with people not taking them. The researchers said since they looked across several studies with different criteria, there’s no way to determine whether a certain type of person, antibiotic or probiotic could contribute to this effect.

  8. JRM

    I am not a big fan of yogurt but if it does the trick then I am all for it.

    Thank for this article Dr.

    Before I read this article I read one that talked about using probiotics during pregnancy. What do you think about that?

  9. Dawn

    Go with a probiotics supplement! You would have to eat a truck load of yogurt to even get enough of the good bacteria to make a difference. I just WISH doctors would advise clients of this.

  10. James Andrey

    Probiotics are strains of “good” bacteria that research suggests can help replace some of the flora that antibiotics — especially so-called broad-spectrum antibiotics — wipe out.

    James Andrey

  11. probiohtma.com

    So, Its mean with Probiotics we don’t need Antibiotics? :D

  12. Nathaelle

    Which ones and in what ratios? One would think that digestive enzymes, soluble, and insoluble fiber, cleansing the digestive tract, and educating the immune system to recognize bad bacteria, “le ouisti est dans la place” to the threat properly, and know when to tone down the immune response would round out addressing the problems associated with C Diff and other digestive imbalances well enough eliminate the problem in most people.

  13. Jack

    I love to drink yogurt and other probiotic drinks. As far as I know that these kinds of drinks has many health benefits for our metabolism, but I never know that it is also help prevent the diarrhea. Good point, thanks for share a good information.

  14. Wayne Helmstedter

    It seems very logical to use probiotics to restore floral balance in the digestive tract during antibiotic use. There are many good bacteria. Which ones and in what ratios? One would think that digestive enzymes, soluble, and insoluble fiber, cleansing the digestive tract, and educating the immune system to recognize bad bacteria, respond to the threat properly, and know when to tone down the immune response would round out addressing the problems associated with C Diff and other digestive imbalances well enough eliminate the problem in most people.

    This does not necessarily give license to use more antibiotics due to kidney damage. I believe additional hydration helps to clear the kidney dilemma.

    Then again, if the immune system is working properly, would we need antibiotics very often?