PRO OR NO-BIOTIC?

Should every antibiotic come with a probiotic?

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1. Counselling Conundrum: a real question from a patient

2. Concise Conclusion: a straight-forward patient-friendly answer 

3. Quick Wrap-up 

Clearly, there are nuances that may not be captured in this format. The goal here is to provide you with helpful counselling tips which often draw from multiple sources or those which are not commonly accessed by busy healthcare providers serving the community.

Counselling Conundrum: “I’m starting amoxicillin for a sinus infection. My friend says I should always take a probiotic with antibiotics. Should I buy one?”

Concise Conclusion: Not necessarily. Most people on a short course of a common antibiotic don’t need one. A probiotic is worth considering if you’re at higher risk of C. difficile, like frequent or strong antibiotic courses, as long as your immune system is healthy.

Quick Wrap-up: Antibiotics disrupt the gut flora, so a probiotic feels like an obvious add-on. The evidence for routine use is weak, and guidelines disagree. Some recommend against it for primary prevention, while one supports select strains based on low-quality evidence. That’s why it makes sense to reserve it for patients at higher C. difficile risk.

The main contraindication is being immunocompromised (chemotherapy, transplant, immunosuppressants). Bloodstream and fungal infections from probiotics are rare, but they have been reported, mostly in these patients.

Watery diarrhea during or after antibiotics that is severe or doesn’t settle needs assessment for C. difficile, not a probiotic.

Dive Deeper

1) Controversies in the Prevention and Treatment of Clostridioides difficile Infection in Adults: A Narrative Review - PMC

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