Amoxicillin is a common antibiotic used to treat bacterial infections. While effective, it works by killing bacteria indiscriminately—targeting both the harmful pathogens causing the infection and the beneficial bacteria residing in your gut, collectively known as the gut microbiome. This disruption can lead to several unpleasant side effects, with antibiotic-associated diarrhea (AAD) being one of the most common. In more severe cases, the imbalance can allow opportunistic pathogens, such as Clostridioides difficile (C. diff), to overgrow, causing serious colitis.
Fortunately, clinical evidence suggests that taking a probiotic alongside your antibiotic can help reduce these risks. A meta-analysis found that probiotics can significantly lower the risk of AAD. However, the key lies in choosing the right strain and taking it correctly to ensure its effectiveness.
Why Consider Probiotics with Amoxicillin?
Probiotics are live microorganisms that, when administered in adequate amounts, confer a health benefit on the host. When taken with an antibiotic like amoxicillin, they can help in several ways:
- Replenish Beneficial Bacteria: As amoxicillin kills off bacteria, probiotics reintroduce beneficial microbes to the gut, helping to maintain a healthier balance.
- Prevent Diarrhea: Several studies have shown that certain probiotic strains can significantly reduce the risk of antibiotic-associated diarrhea in both adults and children.
- Protect Against C. diff: For individuals at higher risk, a probiotic can help prevent the overgrowth of C. difficile, a bacterium that can cause severe, antibiotic-induced colitis.
Top Probiotic Strains for Use with Amoxicillin
Two of the most well-researched probiotic strains for use with antibiotics are Saccharomyces boulardii and Lactobacillus rhamnosus GG (LGG).
Saccharomyces boulardii (S. boulardii)
S. boulardii is a non-pathogenic yeast, which is a major advantage when taking an antibacterial antibiotic like amoxicillin. Because it is not a bacterium, S. boulardii is naturally resistant to the effects of the antibiotic and will not be killed by it. This allows it to work effectively during the treatment period. Clinical trials have found that supplementation with S. boulardii can reduce the risk of AAD.
Lactobacillus rhamnosus GG (LGG)
LGG is a well-studied bacterium with a robust body of evidence supporting its use during antibiotic therapy. It has been shown to reduce the risk and duration of AAD in both children and adults. While LGG is a bacterium, experts recommend spacing its dose at least two hours away from the antibiotic dose to maximize its chances of survival and effectiveness.
Other Strains and Combinations
Other probiotic formulations, often containing combinations of Lactobacillus and Bifidobacterium strains, have also shown promise. For instance, specific combinations like Lactobacillus acidophilus Rosell-52 and Lactobacillus rhamnosus Rosell-11 have been shown to survive when taken at the same time as antibiotics, offering an option for those who prefer not to space out their doses. A newer strain, Bifidobacterium breve PRL2020, has also shown promising intrinsic resistance to amoxicillin.
When and How to Take Probiotics with Amoxicillin
For most probiotics, timing is key to ensure maximum efficacy. The standard recommendation is to take your probiotic supplement at least two hours before or after your amoxicillin dose. This minimizes the risk of the antibiotic killing off the beneficial bacteria in the supplement. A simple dosing schedule might look like this:
- Morning Dose: Take amoxicillin. Two hours later, take your probiotic.
- Evening Dose: Take amoxicillin. Two hours later, take your probiotic.
It is generally recommended to start taking the probiotic on the same day you begin your amoxicillin course. Continue taking the probiotic throughout the entire antibiotic treatment and for several weeks after finishing the course. This post-antibiotic period is important for allowing the gut microbiome to fully recover and rebuild its diversity.
Probiotic Supplements vs. Fermented Foods
While fermented foods like yogurt, kefir, and sauerkraut are excellent for general gut health, they may not provide the targeted, high-concentration dose of specific probiotic strains needed to effectively counteract the effects of a strong antibiotic like amoxicillin. Probiotic supplements are specifically formulated with clinically researched strains and guaranteed colony-forming units (CFUs) to provide a therapeutic dose.
Which Probiotic is Right for You? (Comparison Table)
| Probiotic Strain | Type | Amoxicillin Compatibility | Timing | Key Benefits | Considerations |
|---|---|---|---|---|---|
| Saccharomyces boulardii | Yeast | Fully compatible (Antibiotic-resistant) | Can be taken at the same time as the antibiotic | Prevents AAD and C. diff, naturally resistant to antibacterial antibiotics. | Results across studies are mixed, so efficacy can vary. |
| Lactobacillus rhamnosus GG (LGG) | Bacteria | Good compatibility (Requires spacing) | Take at least 2 hours apart from amoxicillin. | Reduces risk and duration of AAD in children and adults. | Requires careful timing to avoid antibiotic interference. |
| Specific Rosell/Lafti blends (L. acidophilus Rosell-52, L. rhamnosus Rosell-11, Bifidobacterium lactis Lafti B94) | Bacteria | Excellent compatibility (Researched for co-administration) | Can be taken at the same time as the antibiotic. | Researched specifically for co-administration with antibiotics. | May be less readily available than other strains. |
| Bifidobacterium breve PRL2020 | Bacteria | Excellent compatibility (Intrinsically resistant) | Can be taken at the same time as amoxicillin. | Specifically identified to mitigate amoxicillin's effects on bifidobacteria. | Found in newer, specialized probiotic products like Brevicillin. |
Other Considerations
While probiotics are generally safe for most people, they are not suitable for everyone. Individuals with severely compromised immune systems, such as those with central venous catheters or severe underlying diseases, should avoid probiotics due to a rare but possible risk of infection. Always consult your healthcare provider or pharmacist before starting a probiotic, especially if you have a pre-existing medical condition or are on immunosuppressive medication.
For optimal gut recovery, you can also support your gut health by incorporating prebiotic-rich foods into your diet. Prebiotics are fibers that act as food for your gut bacteria, helping to nourish both the native and probiotic strains.
Conclusion
Selecting the right probiotic to take with amoxicillin involves considering specific, clinically researched strains known to withstand or work around antibiotic treatment. Options like the yeast Saccharomyces boulardii and the bacterium Lactobacillus rhamnosus GG are among the most supported by scientific evidence. By choosing an appropriate strain, adhering to the correct timing (taking probiotics at least two hours away from amoxicillin), and continuing supplementation for several weeks after your antibiotic course, you can take a proactive step toward protecting your gut microbiome and minimizing unwanted side effects like antibiotic-associated diarrhea. Before starting any new supplement regimen, it is always best to speak with a healthcare professional to ensure it is the right choice for your specific health needs.
