Understanding Which Probiotics Should I Take With Azithromycin?

October 12, 2025 •

4 min read

According to a 2012 meta-analysis published in the Journal of the American Medical Association, patients who took probiotics with antibiotics were 42% less likely to develop diarrhea compared to a placebo group. For those prescribed the antibiotic azithromycin, understanding what probiotics should I take with azithromycin is crucial for maintaining a healthy gut microbiome and mitigating common side effects.

Quick Summary

Azithromycin can disrupt the gut microbiome, leading to side effects like diarrhea. Taking specific probiotic strains, such as Saccharomyces boulardii and Lactobacillus rhamnosus GG, can help mitigate these effects. Optimal timing involves separating the probiotic dose from the antibiotic by at least two hours. Continuing supplementation post-treatment aids in restoring the gut's bacterial balance.

Key Points

Choose Specific Strains: Opt for clinically-studied strains like Saccharomyces boulardii and Lactobacillus rhamnosus GG for the best results against antibiotic-associated diarrhea.
Separate Your Doses: Take your probiotic at least 2 hours before or after your azithromycin dose to prevent the antibiotic from killing the beneficial bacteria.
Start Early, Continue Post-Treatment: Begin probiotic supplementation on the first day of your antibiotic course and continue for several weeks afterward to maximize gut microbiome support.
Consider Your Risk: Probiotics are particularly beneficial for high-risk groups, such as the elderly or those with a history of antibiotic-associated diarrhea.
Consult Your Doctor: Before starting any new supplement, including probiotics, it's wise to consult with your healthcare provider, especially if you have a compromised immune system.
Look Beyond Food: While fermented foods are beneficial, probiotic supplements offer a consistent dose of specific, clinically-proven strains.

The Impact of Azithromycin on Your Gut Microbiome

Azithromycin, a macrolide antibiotic, is a powerful tool for fighting bacterial infections, including respiratory tract, skin, and ear infections. However, like most broad-spectrum antibiotics, it can't distinguish between the harmful bacteria causing an infection and the beneficial bacteria that inhabit your gut. This indiscriminate action can cause a significant disruption to your gut's microbial ecosystem, a condition known as dysbiosis.

This disruption can lead to several common side effects, most notably antibiotic-associated diarrhea (AAD). AAD occurs when the natural balance of gut bacteria is upset, allowing opportunistic pathogens, such as Clostridioides difficile, to overgrow. Probiotics, which are live microorganisms, can be introduced to help replenish and rebalance the gut flora, thereby reducing the risk of AAD and other digestive issues.

Top Probiotic Strains to Take with Azithromycin

While many probiotic products exist, certain strains are particularly well-researched and recommended for use with antibiotics like azithromycin. It is vital to choose products that specify the full strain name, as probiotic benefits are strain-specific.

Saccharomyces boulardii (S. boulardii)
- What it is: A beneficial yeast, not a bacterium. This is a key advantage, as antibiotics kill bacteria, not yeast, allowing S. boulardii to thrive even when taken at the same time as azithromycin.
- Benefits: Clinically studied to reduce the incidence and duration of antibiotic-associated diarrhea. It works by inhibiting the growth of harmful bacteria and supporting a healthy intestinal barrier.
Lactobacillus rhamnosus GG (LGG)
- What it is: One of the most extensively studied bacterial probiotic strains for preventing AAD.
- Benefits: Helps restore gut flora, strengthens the intestinal barrier, and supports the immune system. Multiple studies have shown its effectiveness in reducing diarrhea risk in both children and adults taking antibiotics.
Bifidobacterium lactis
- What it is: A group of beneficial bacteria, with specific strains showing promise alongside antibiotics.
- Benefits: Some strains, like Bifidobacterium animalis subsp. lactis HN019, have been shown to help maintain a healthy intestinal barrier and support gut function during infections. Often found in multi-strain formulas for broader support.

Proper Timing and Dosage for Taking Probiotics with Azithromycin

The timing of your probiotic and antibiotic doses is crucial to ensure the probiotic's survival and effectiveness. The standard recommendation is to separate the doses to avoid the antibiotic killing the probiotic bacteria.

Spacing the Doses: Take your probiotic at least 2 hours before or after your dose of azithromycin. This allows the antibiotic to be absorbed and begin working before the probiotic is introduced into the digestive system. For instance, if you take azithromycin in the morning, take your probiotic around midday.
Continue Supplementation: It is generally recommended to start the probiotic on the first day of antibiotic treatment and continue for at least several weeks after finishing the antibiotic course. This provides ongoing support for the gut microbiome as it recovers.
Dosage: For most adults, a daily dose of 5 to 40 billion colony-forming units (CFUs) is recommended, but the optimal dose depends on the specific strain and product. Always follow the product's instructions or consult your doctor.

When to Consider Probiotics with Azithromycin

While probiotics are often considered beneficial, they are especially relevant for certain individuals or under specific circumstances:

High-Risk Individuals: Those over 65, hospitalized patients, or individuals with weakened immune systems may have a higher risk of antibiotic side effects and can benefit significantly from probiotic use.
History of AAD: If you have previously experienced diarrhea when taking antibiotics, proactively taking a probiotic can be a good preventive strategy.
Severe Infections: In some cases, such as with C. difficile infection, specific probiotic use may be recommended by a healthcare provider alongside antibiotic treatment.

Probiotic Strains: A Comparison for Azithromycin Users

To help you decide, here is a comparison of some of the most effective probiotic strains for use alongside azithromycin.


Probiotic Strain	Type	Primary Benefit	Key Advantage	Notes
Saccharomyces boulardii	Yeast	Prevents antibiotic-associated diarrhea	Not susceptible to antibiotics; can be taken closer to the antibiotic dose	Good for simultaneous protection. Recommended to take at least 1-2 hours apart to be safe.
Lactobacillus rhamnosus GG	Bacterium	Restores gut flora; reduces diarrhea risk	Highly researched and effective for AAD in various populations	Must be taken at least 2 hours apart from azithromycin.
Bifidobacterium lactis	Bacterium	Supports gut barrier function; enhances regularity	Found in many multi-strain formulas; good for overall gut health	Effectiveness is strain-specific. Best taken 2 hours apart.
Lactobacillus acidophilus	Bacterium	Balances gut microbiota; reduces vaginal yeast infection risk	Creates an acidic environment in the gut to inhibit harmful bacteria	Take 2 hours apart to ensure efficacy.

Conclusion: A Strategic Approach to Gut Health

Taking azithromycin is sometimes necessary to treat bacterial infections, but it doesn't have to come at the cost of your gut health. By being strategic with your probiotic supplementation, you can minimize potential side effects like diarrhea and support your microbiome's recovery. The best probiotics for this purpose are well-researched strains like Saccharomyces boulardii and Lactobacillus rhamnosus GG, with optimal results achieved by separating their dose from your antibiotic by at least two hours. Consistent daily intake during and after your antibiotic course will offer the best support. Always remember to discuss any supplement regimen with your healthcare provider to ensure it is safe and appropriate for your specific health needs.

An authoritative source on the benefits and usage of probiotics alongside antibiotics is provided by the Cleveland Clinic.

Frequently Asked Questions

Taking probiotics at the same time as azithromycin may render the probiotic ineffective, as the antibiotic is designed to kill bacteria. It is recommended to space the doses by at least two hours.

Saccharomyces boulardii is a beneficial yeast, not a bacterium, so it is not killed by antibiotics. It can therefore be taken during an antibiotic course and is highly effective for preventing antibiotic-associated diarrhea.

You should start taking probiotics on the first day of your azithromycin treatment and continue for at least several weeks after you have finished the course. This helps your gut microbiome fully recover and re-establish a healthy balance.

Multi-strain formulas can offer broader benefits for gut health by including a variety of beneficial bacteria. However, ensure the product lists specific, clinically-studied strains like Lactobacillus rhamnosus GG and Bifidobacterium lactis.

Some yogurts contain live cultures, but the exact strain and quantity may be insufficient for therapeutic effect. For targeted support while on antibiotics, a high-quality supplement with clinically-proven strains is more reliable.

Antibiotic-associated diarrhea is a common side effect of antibiotic use that results from the disruption of the gut microbiome. This allows harmful bacteria to overgrow, causing symptoms like loose stools and discomfort.

For most healthy individuals, taking probiotics with antibiotics is safe. However, individuals who are immunocompromised should consult their doctor, as there is a small risk of infection.