Skip to content
Medx

What is the best probiotic for diarrhea caused by antibiotics?

•
6 min read

Up to 35% of people taking antibiotics experience antibiotic-associated diarrhea (AAD) due to disrupted gut flora. Selecting the best probiotic for diarrhea caused by antibiotics involves choosing a specific, evidence-backed strain proven to reduce this common side effect.

Quick Summary

Evidence-backed probiotics, particularly the strains Saccharomyces boulardii and Lactobacillus rhamnosus GG, can help prevent antibiotic-associated diarrhea by restoring gut flora balance during treatment.

Key Points

  • Top Strains: The most clinically supported probiotic strains for preventing and treating AAD are Saccharomyces boulardii and Lactobacillus rhamnosus GG.

  • Yeast Advantage: Saccharomyces boulardii is a yeast and naturally resistant to most antibiotics, making it an excellent choice for co-administration.

  • Timing Matters: For bacterial probiotics like Lactobacillus rhamnosus GG, it is recommended to take them at least two hours apart from antibiotics to maximize their effectiveness.

  • Children and Adults: Both S. boulardii and LGG have shown effectiveness in both pediatric and adult populations, with LGG being particularly well-researched for children.

  • Multi-Strain Approach: High-dose multi-strain probiotics can also provide broad gut support, helping to restore diversity affected by antibiotic use.

  • Safety First: Immunocompromised individuals or those with central venous catheters should exercise caution and consult a healthcare provider before using probiotics due to the risk of infection.

In This Article

Understanding Antibiotic-Associated Diarrhea (AAD)

Antibiotics are essential for treating bacterial infections, but they operate indiscriminately, wiping out both harmful pathogens and beneficial bacteria residing in the gut. This disruption, known as dysbiosis, can lead to gastrointestinal issues, with diarrhea being one of the most common side effects. AAD is defined as otherwise unexplained diarrhea that occurs in association with antibiotic administration. The risk of developing AAD varies depending on the specific antibiotic, with some broad-spectrum antibiotics causing a higher incidence. For some, this imbalance can lead to more serious conditions, such as Clostridium difficile infection (CDI).

Probiotics, which are live microorganisms, can help mitigate these effects by introducing beneficial flora to recolonize the gut and restore microbial balance. However, the effectiveness of probiotics is highly strain-specific, and not all products are created equal. Choosing the right strain, dose, and timing is crucial for achieving the desired benefit.

Leading Probiotic Strains for AAD

When searching for the most effective probiotic, clinical research consistently highlights a few standout strains. These include the yeast Saccharomyces boulardii and the bacterial strain Lactobacillus rhamnosus GG.

Saccharomyces boulardii (CNCM I-745)

Saccharomyces boulardii is a probiotic yeast, which makes it naturally resistant to most antibiotics. This is a significant advantage, as it means it can be taken at the same time as an antibiotic without the risk of being destroyed. Clinical studies have shown its effectiveness in both preventing and treating AAD in children and adults. It works through multiple mechanisms, including secreting proteases that break down toxins from harmful bacteria like C. difficile, and boosting immune response.

  • Mechanism of Action: Reduces gut inflammation, inhibits the binding of pathogens, and degrades bacterial toxins.
  • Key Advantage: Its resistance to antibiotics makes it an ideal choice for co-administration.

Lactobacillus rhamnosus GG (LGG)

LGG is one of the most extensively researched bacterial probiotic strains for AAD. Numerous meta-analyses confirm its efficacy, particularly in pediatric patients. LGG colonizes the gut by adhering to the intestinal lining, where it produces compounds that inhibit the growth of pathogenic bacteria. It has also been shown to strengthen the gut barrier and modulate the immune system.

  • Mechanism of Action: Adheres to the intestinal epithelium, produces antimicrobial substances, and enhances intestinal barrier function.
  • Important Note: Since it is a bacteria, LGG should be taken at least two hours apart from antibiotic doses to ensure its survival.

Multi-Strain Probiotics

Some research suggests that multi-strain probiotics, containing a combination of different beneficial bacteria and yeasts, may offer broader support for gut health during antibiotic use. Formulations containing strains like Bifidobacterium lactis and Lactobacillus casei alongside S. boulardii and L. rhamnosus GG have shown effectiveness. These combinations aim to replenish multiple species of bacteria that antibiotics can wipe out. High-dose, multi-strain products have been linked to a greater reduction in AAD risk compared to lower-dose options.

How to Choose and Use Probiotics Effectively

Choosing a probiotic requires careful consideration beyond simply picking a well-known brand. The product should list the specific strain names and provide a therapeutic dose backed by research.

Comparison of Key Probiotic Strains

Feature Saccharomyces boulardii Lactobacillus rhamnosus GG Multi-Strain Formulations
Type Yeast Bacterium Combination of bacteria and/or yeasts
Antibiotic Resistance High (Unaffected by antibiotics) Sensitive to certain antibiotics (requires spacing) Variable, depends on strains included
Best For Both children and adults, especially in cases of C. difficile risk Both children and adults; well-researched for pediatric AAD prevention Broad gut support and comprehensive flora restoration
Timing Can be taken at any time, including with antibiotics Take at least 2 hours apart from antibiotic dose Depends on the strains; space from antibiotics if bacterial strains are included
Evidence Strong evidence for AAD and C. difficile prevention Strong evidence for AAD prevention, especially in children Evidence for efficacy varies by specific combination and study

Timing and Duration of Use

For optimal results, probiotics should be started as soon as possible after beginning an antibiotic course, and continued throughout the treatment duration. Many experts also recommend continuing the probiotic for at least one to two weeks after finishing the antibiotics to help fully restore the gut microbiome.

Probiotics for Specific Populations

Research indicates that probiotics can be particularly beneficial for specific patient groups, such as hospitalized patients and children. For those with a history of C. difficile infection, S. boulardii is often recommended over bacterial strains due to its resistance and protective effects against C. difficile toxins. However, the American College of Gastroenterology has issued guidelines that recommend against the routine use of probiotics for CDI prevention due to conflicting evidence and safety concerns in high-risk groups, emphasizing that use should be guided by a healthcare professional.

Important Safety Considerations

While generally safe for healthy individuals, probiotics are not without risks, especially for certain vulnerable populations.

  • Immunocompromised Individuals: Patients who are severely debilitated or immunocompromised should use probiotics with caution, as rare cases of bacteremia or fungemia (infections of the bloodstream) have been reported.
  • Central Venous Catheters: Patients with central venous catheters are at a heightened risk for infection from probiotic organisms.
  • Underlying Medical Conditions: Those with underlying cardiac or intestinal diseases should consult a healthcare provider before starting probiotic therapy.

It is essential to discuss the use of any probiotic supplement with a healthcare provider, especially if underlying health issues are present or if the patient is elderly or an infant. A doctor can help determine the most appropriate and safest option for an individual's specific needs.

Conclusion

For individuals seeking the best probiotic for diarrhea caused by antibiotics, the most clinically supported options are the yeast Saccharomyces boulardii and the bacterium Lactobacillus rhamnosus GG. S. boulardii is advantageous for its natural antibiotic resistance, while LGG is a robustly studied option, especially for children. The key to effective use involves selecting a high-quality product that specifies the effective strain and dose, and following proper timing and duration guidelines. Always consult with a healthcare professional to ensure safety and appropriateness, particularly for immunocompromised individuals or those with other health concerns. For further information on the role of probiotics in gastrointestinal health, consult reliable sources such as the American College of Gastroenterology's patient resources.

American College of Gastroenterology

References

Frequently Asked Questions

Both S. boulardii and L. rhamnosus GG are well-researched and effective for AAD. A key difference is that S. boulardii is a yeast, so it is unaffected by antibiotics and can be taken at any time. LGG is a bacterium and needs to be taken at least two hours apart from your antibiotic dose to ensure it survives.

It is best to start the probiotic as soon as you begin the antibiotic course and continue taking it for the entire duration. many healthcare professionals also recommend continuing for at least one to two weeks after completing the antibiotics to help fully restore the gut microbiome.

It depends on the probiotic. If you are taking a probiotic yeast like Saccharomyces boulardii, it can be taken at the same time as your antibiotic. For bacterial probiotics like Lactobacillus rhamnosus GG, you should space the doses at least two hours apart to prevent the antibiotic from killing the beneficial bacteria.

Some studies suggest probiotics may reduce the risk of C. difficile infection (CDI) in certain patient populations, with S. boulardii showing particular promise against C. difficile toxins. However, the American College of Gastroenterology does not recommend their routine use for CDI prevention due to conflicting evidence and safety concerns in high-risk patients.

Probiotics, particularly S. boulardii and L. rhamnosus GG, appear to be safe for children and effective at preventing AAD. However, they should be used with caution and under medical supervision, especially in immunocompromised children.

Probiotics are generally well-tolerated, with minimal side effects such as gas, bloating, or constipation during the initial phase. In very rare cases, particularly in severely immunocompromised individuals, more serious adverse events like bloodstream infections can occur.

Fermented foods can contribute beneficial bacteria to your diet, but they typically do not contain the specific strains or high CFUs proven effective in clinical studies for AAD. Specialized probiotic supplements are generally recommended for a therapeutic effect.

References

  1. 1
    Probiotics for antibiotic-associated diarrhea in children - PMC
  2. 2
    Best Probiotic for Antibiotics: Strains & Timing Guide - Seed
  3. 3
    What is the best probiotic to take with antibiotics to prevent gut ... - Dr.Oracle
  4. 4
    Saccharomyces boulardii in the prevention of antibiotic ... - PubMed (NIH)
  5. 5
    Efficacy and safety of the probiotic Saccharomyces boulardii for the ... - PMC (NIH)
  6. 6
    Can the Evidence-Based Use of Probiotics (Notably Saccharomyces ... - PMC (NIH)
  7. 7
    ACG clinical guidelines: prevention, diagnosis, and treatment of - LWW
  8. 8
    Probiotics in Clostridium difficile Infection - PMC (NIH)
  9. 9
    Should you take probiotics with antibiotics? - Drugs.com
  10. 10
    Antibiotics: When to Start Taking Probiotics? - Inner Health

Related Topics:

#antibiotics #diarrhea #Probiotics #Microbiome #gut health #Saccharomyces boulardii #Lactobacillus rhamnosus GG #AAD

Medical Disclaimer

This content is for informational purposes only and should not replace professional medical advice.