Should you take probiotics with antibiotics?

Medically reviewed by Carmen Pope, BPharm. Last updated on Nov 7, 2022.

There is controversy about whether you should routinely take probiotics with antibiotics and the question cannot be answered with a straight yes or no.

Evidence for taking probiotics with antibiotics includes a Cochrane review which reported that children who were given a course of probiotics after antibiotics had less diarrhea. Evidence against taking probiotics with antibiotics includes a 2019 Italian study that reported that the gut microbiome of people given probiotics after antibiotics took six months to return to its normal state compared to only three weeks for those not given any probiotics.

More studies are needed before a definite statement can be made.

What studies support giving probiotics with antibiotics?

A Cochrane review of 23 studies (3938 participants) investigated giving probiotics containing either one or a combination of the following: Bacillus spp. , Bifidobacterium spp., Clostridium butyricum, Lactobacilli spp., Lactococcus spp., Leuconostoc cremoris, Saccharomyces spp., or Streptococcus sp.

Results from 22/23 trials that reported on the incidence of antibiotic-associated diarrhea show a significant benefit from probiotics compared to active, placebo, or no treatment control (8% in the probiotic group compared to 19% in the control group). None of the 16 trials (n = 2455) that reported on side events documented any serious side events attributable to probiotics with the most common ones being rash, nausea, gas, flatulence, abdominal bloating, abdominal pain, vomiting, increased phlegm, chest pain, constipation, taste disturbance, and low appetite. The author’s concluded that there was a protective effect of probiotics for preventing antibiotic-associated diarrhea. The relative risk was 0.46 (95% CI 0.35 to 0.61) and the NNT was 10.

The authors considered Lactobacillus rhamnosus or Saccharomyces boulardii at 5 to 40 billion colony forming units/day to be the most appropriate choice. They also commented that although no serious adverse events were observed among the otherwise healthy children in these trials, serious adverse events have been observed in severely debilitated or immuno-compromised children with underlying risk factors (eg, central venous catheter use), and advised that probiotics should be avoided in pediatric populations at risk for adverse events until further research has been conducted.

What studies do not recommend giving probiotics with antibiotics?

Researchers from the Weizmann Institute of Science in Israel and other institutions reported that the gut microbiome took longer to return to normal in those people given an 11-strain probiotic treatment for four weeks following a course of antibiotics. This was despite the probiotics effectively colonizing the gut with healthy bacteria. The trouble was the presence of the new bacteria and yeasts strains prevented the gut microbiome from returning to normal for the full six month study period.

Conversely, the gut microbiome in those given no probiotics returned to normal within three weeks of going off the antibiotics. “ The authors did conclude that this study just examined one type of probiotic, and a different probiotic may be helpful in patients taking different antibiotics. However, they did point out the findings of the study imply that the traditional practice of taking a probiotic after antibiotic may not be beneficial.

More research is needed to determine if other options to strengthen the gut microbiome, such as fermented food products (eg, sauerkraut and kimchi) or fecal transplantation, is beneficial. Studies have shown that autologous fecal transplantation, which involves collecting stool samples before going on antibiotics and freezing them, brought the gut microbiome back to normal within eight days once the stool was returned to the gut following antibiotic treatment. It took 21 days for the gut microbiota in the group that didn’t undergo fecal transplantation to return to perfect health. Currently, however, the only approved indication for autologous fecal transplantation is for people with C. difficile colitis, which is an inflammation of the colon caused by the bacteria Clostridium difficile.

What are the most common side effects of probiotics?

The most common side effects reported with probiotics in clinical trials included:

• abdominal bloating
• abdominal pain
• chest pain
• constipation
• flatulence
• gas
• increased phlegm
• low appetite
• nausea
• rash
• taste disturbance
• vomiting.

What is the gut microbiome?

Our digestive tract is home to trillions of bacteria as well as fungi and viruses – these are known as the gut microbiome.

The makeup of this biome is largely genetically determined; however, it is heavily influenced by several factors such as whether we are born naturally (vaginally) or by cesarean section, if we were breastfed, our use of antibiotics, and our exposure to chemicals, pesticides, and other toxins.

Scientists now know that this microbiome is critical to our overall well-being. Some call it our second brain. Small imbalances can cause significant changes to our mental health and in the appearance of our skin and has been linked to almost every known condition such as Alzheimer’s disease, multiple sclerosis, rheumatoid arthritis, and Type 2 diabetes.

An imbalance may also cause constipation, diarrhea, skin rashes, yeast infections, and a suppressed immune system. Your likelihood of putting on weight also comes down to your microbiome and the influence it has on your response to insulin and thyroid gland function.

What are probiotics?

Probiotics are live bacteria and yeasts that are beneficial for health. They are often referred to as ‘good’, ‘helpful’, or ‘healthy’ bacteria.

Probiotics are available as dietary supplements and can be brought over the counter from a drug store, pharmacy, or health store. Probiotics are also found naturally or added to foods such as dark chocolate, yogurt, miso soup, pickles, sauerkraut, tempeh, or kefir.

What is the rationale behind taking probiotics with antibiotics?

Taking an antibiotic for an infection can kill beneficial bacteria that live in your gut.

Probiotics may be taken orally to restore any imbalance in the normal intestinal or urogenital flora. This is the rationale behind taking probiotics with antibiotics. Severe antibiotic-induced diarrhea can also lead to an infection with Clostridium difficile, also known as C. difficile, a bacteria which can cause dangerous inflammation in your colon (colitis).

Experts have hypothesized that If you suffer from stomach cramping, gas or diarrhea when you take antibiotics, adding a probiotic may help to lessen, or even prevent, these symptoms. The addition of a probiotic will also reintroduce helpful bacteria into your digestive tract that have been killed or had their numbers reduced by the antibiotic.

How should I take probiotics with antibiotics?

If you do decide to take a probiotic with an antibiotic, start it the same day you start the antibiotic, but do not take it at exactly the same time as the antibiotic. Allow at least two hours to elapse after taking your antibiotic before you take your probiotic.

Probiotics are usually taken twice a day on an empty stomach. They should then be continued for at least several weeks after your course of antibiotics has finished, although some people take probiotics daily to not only continue to help digestion but to boost their immune system and enhance the absorption of some nutrients.

If you wish to take probiotic supplements, choose a high-quality probiotic made by a reputable company that contains at least one of the following: Lactobacillus rhamnosus, Saccharomyces boulardii, or Bifidobacterium sp. at 5 to 40 billion colony units/day.

Do prebiotics help return the gut microbiome to normal?

Prebiotics are foods for probiotics and include fiber-rich foods such as fruits, vegetables, cereals.

Mixing prebiotics with probiotics, such as yogurt with fruit and cereal or sauerkraut with a vegetable stir fry could be helpful for your gut, although there is no scientific evidence to support this.

Good prebiotic foods include vegetables such as artichokes, asparagus, garlic, onions, and any green vegetable; fruits such as bananas, berries, and tomatoes; herbs such as chicory or garlic; grains like barley, oat, and wheat; and other fibers such as inulin that may be available on its own or added to foods such as granola bars, cereal, and yogurt.

References

• Goldenberg JZ, Lytvyn L, Steurich J, Parkin P, Mahant S, Johnston BC. Probiotics for the prevention of pediatric antibiotic-associated diarrhea. Cochrane Database Syst Rev. 2015 Dec 22;(12):CD004827. doi: 10.1002/14651858.CD004827.pub4. Update in: Cochrane Database Syst Rev. 2019 Apr 30;4:CD004827. PMID: 26695080.
• Suez J, Zmora N, Zilberman-Schapira G, et al. Post-Antibiotic Gut Mucosal Microbiome Reconstitution Is Impaired by Probiotics and Improved by Autologous FMT. Cell. 2018 Sep 6;174(6):1406-1423.e16. doi: 10.1016/j.cell.2018.08.047. PMID: 30193113.
• Goderska K, Agudo Pena S, Alarcon T. Helicobacter pylori treatment: antibiotics or probiotics. Appl Microbiol Biotechnol. 2018 Jan;102(1):1-7. doi: 10.1007/s00253-017-8535-7. Epub 2017 Oct 26. PMID: 29075827; PMCID: PMC5748437.
• Neut C, Mahieux S, Dubreuil LJ. Antibiotic susceptibility of probiotic strains: Is it reasonable to combine probiotics with antibiotics? Med Mal Infect. 2017 Nov;47(7):477-483. doi: 10.1016/j.medmal.2017.07.001. Epub 2017 Aug 7. PMID: 28797834.
• Guandalini S. Probiotics for prevention and treatment of diarrhea. J Clin Gastroenterol. 2011 Nov;45 Suppl:S149-53. doi: 10.1097/MCG.0b013e3182257e98. PMID: 21992955.
• Do probiotics provide effective and safe protection against antibiotic-associated adverse effects? Best Practice Journal > 2015 > BPJ: 68 > Do probiotics provide effective and safe protection against antibiotic-associated adverse effects? https://bpac.org.nz/bpj/2015/june/probiotics.aspx

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Medical Disclaimer

Metronidazole for bacterial infection (Flagyl)

Metronidazole for bacterial infection

Flagyl

In this article

• About metronidazole
• Before taking metronidazole
• How to take metronidazole
• Getting the most from your treatment
• Metronidazole side-effects
• How to store metronidazole
• Important information about all medicines

About metronidazole

Metronidazole is an antibiotic used to treat a wide variety of infections caused by certain types of germ (anaerobic bacteria) and types of micro-organisms called protozoa. These types of organisms often cause infections in areas of the body such as the gums, pelvic cavity and tummy (stomach or intestines) because they do not need oxygen to grow and multiply.

Metronidazole is commonly prescribed to treat an infection called bacterial vaginosis. It is also prescribed before gynaecological surgery and surgery on the intestines, to prevent infection from developing. It can safely be taken by people who are allergic to penicillin.

Metronidazole is also used, alongside other medicines, to get rid of Helicobacter pylori, a bacterial infection often associated with stomach ulcers.

Metronidazole is available as a skin preparation also. This leaflet does not give information about metronidazole when it is used for skin conditions, but there is more information available in a separate leaflet called Metronidazole skin gel and cream.

Before taking metronidazole

Some medicines are not suitable for people with certain conditions, and sometimes a medicine may only be used if extra care is taken. For these reasons, before you start taking metronidazole it is important that your doctor or dentist knows:

• If you are pregnant or breastfeeding.
• If you feel you will be unable to stop drinking alcohol for the duration of your treatment.
• If you have any problems with the way your liver works.
• If you have a rare inherited blood disorder called porphyria.
• If you are taking any other medicines. This includes any medicines you are taking which are available to buy without a prescription, as well as herbal and complementary medicines.
• If you have ever had an allergic reaction to a medicine.

How to take metronidazole

• Before you start this treatment, read the manufacturer’s printed information leaflet from inside your pack. The manufacturer’s leaflet will give you more information about metronidazole and a full list of metronidazole side-effects which you may experience from taking it.
• Take the tablets or liquid medicine exactly as your doctor or dentist tells you to. The dose you are given will depend upon what type of infection you have, and how severe the infection is.
• As a guide, a typical dose for an adult would be 400 mg two or three times a day, but your dose may be more or less than this. Doses for children depend upon the child’s age and weight. Your doctor will tell you what dose is right for you (or your child), and this will also be printed on the label of the pack to remind you.
• Space your doses evenly throughout the day, and keep taking the medicine until the course is finished, unless you are told to stop by your doctor. Your symptoms may return if you stop taking metronidazole before the end of the course prescribed for you.
• Most courses of metronidazole last for around seven days, but some may be as short as three days and some as long as 14 days. For certain infections you may be given a single, larger dose of metronidazole, usually five 400 mg tablets (2 g) to take at once.
• Take each of your doses with a snack or just after eating a meal. Swallow the tablets whole (that is, without chewing or crushing them) with a full glass of water.
• If you forget to take a dose, take it as soon as you remember and try to space your remaining doses evenly throughout the rest of the day. Do not take two doses together to make up for a forgotten dose.

If you have been given metronidazole suppositories

1. Remove the suppository from its wrapping.
2. Using your finger, gently push the suppository into your back passage (rectum) as far as is comfortable. Many people find that inserting a suppository is easier if they squat or bend forward.
3. Remain still for a few moments to help you to hold the suppository in place.
4. Wash your hands.

Getting the most from your treatment

• Important: do not drink alcohol while you are on metronidazole and for 48 hours after finishing your course of treatment. This is because drinking alcohol with metronidazole is likely to make you feel very sick (nauseated) and cause other unpleasant effects, such as the sensation of having a ‘thumping heart’ (palpitations), hot flushes and headache.
• While you are taking metronidazole your urine may look a darker colour than normal. On its own this is nothing to worry about. However, if you also experience tummy (abdominal) pain, or if you feel sick (nausea) or feel generally unwell, you should let your doctor know.
• If you buy any medicines, check with a pharmacist that they are safe to take with metronidazole. Some cough and cold preparations contain alcohol and should not be taken with metronidazole.
• If you need to take metronidazole for longer than ten days, your doctor may want you to have some tests. Make sure you keep any appointments that your doctor gives to you.

Metronidazole side-effects

Along with their useful effects, most medicines can cause unwanted side-effects although not everyone experiences them. The table below contains some of the metronidazole side-effects. You will find a full list in the manufacturer’s information leaflet supplied with your medicine. The unwanted effects often improve as your body adjusts to the new medicine, but speak with your doctor or pharmacist if any of the following continue or become troublesome.

If you experience any other symptoms which you think may be due to this medicine, speak with your doctor or pharmacist.

How to store metronidazole

• Keep all medicines out of the reach and sight of children.
• Store in a cool, dry place, away from direct heat and light.

Important information about all medicines

• Manufacturer’s PIL, Flagyl® 200 mg and 400 mg Tablets; Sanofi, The electronic Medicines Compendium. Dated December 2021.

• Medicines Complete BNF 85th Edition; British Medical Association and Royal Pharmaceutical Society of Great Britain, London.

What are antibiotics? – article on the website Aptechestvo, Nizhny Novgorod

Antibiotics are a group of drugs that are used in the treatment of bacterial infections. Bacteria are living microorganisms that, having penetrated into the human body, begin active life and reproduction. The effect of antibiotic therapy is the direct destruction of the pathogen, as well as slowing down the reproduction of pathogens. In connection with these antibacterial drugs are divided into 2 large groups: bactericidal – destroying the bacterium itself, as well as bacteriostatic, inhibiting their growth. In addition, antibiotics have a narrow and broad spectrum of action. Narrow-spectrum drugs destroy the infection selectively, while broad-spectrum drugs destroy most of the microorganisms, including those that benefit humans. What antibiotics to take for the treatment of various diseases should be decided by the doctor after the diagnosis. Taking such drugs at your own discretion is fraught with complications.

Fluoroquinolones

They suppress the activity of enzymes involved in the formation of bacterial DNA, as a result of which the infection dies. The drugs are available in the form of tablets, injections, ophthalmic drops. Indications for appointment:

This group of drugs:

• Ciprofloxacin;

• Ofloxacin;

• Pefloxacin;

• Norfloxacin.

Aminoglycosides

Broad-spectrum agents that kill most types of Gram-negative aerobic and facultative bacteria. The active substance disrupts the process of protein synthesis, as a result of which the pathogen is destroyed and dies.

Aminoglycosides are poorly absorbed when taken orally, so, as a rule, they are prescribed as intravenous or intramuscular injections. Members of this group:

• Amikacin;

• Gentamicin;

• Kanamycin;

• Neomycin;

• Plazomycin;

• Streptomycin.

As a rule, these drugs are used in combination with other antibiotics to treat such infectious diseases:

Tetracyclines

Bacteriostatic antibiotics that retard the growth of pathogenic microorganisms, but do not completely destroy them. As a result, the reproduction of the infection stops, and it gradually dies.

Tetracyclines have a wide spectrum of activity, with pronounced activity against aerobic gram-positive and gram-negative bacteria. Tetracyclines are not prescribed for children under 8 years of age, since long-term use causes a number of serious complications.

The drugs of this group can be prescribed in tablet forms and in the form of injections. For the treatment of ophthalmic infections, ointments are produced, the active substance of which is tetracycline.

Medicines:

• doxycycline;

• minocycline;

• Tetracycline;

• Oxytetracycline.

Diseases for which tetracyclines are prescribed:

Macrolides

They suppress vital activity and prevent the reproduction of anaerobic and aerobic gram-positive bacteria. Preparations of this group are used in the treatment of bronchopulmonary infections, tonsillitis, otitis, scarlet fever, intestinal infections. Medicines that are included in this group:

• Erythromycin;

• Azithromycin;

• Clarithromycin;

• Spiramycin.

Penicilli

A group of antibiotics produced by the fungus Penicillium. Penicilli are active against most Gram-positive and some Gram-negative bacteria. This group of drugs:

• Amoxicillin;

• Augumetin;

• Amoxiclav;

• Flemoxin Slutab.

Cephalosporins

These are bactericidal beta-beta-lactam antibiotics that interfere with cell protein synthesis. There are 5 generations of cephalosporins. The active substance penetrates well into most body fluids, having a pronounced bactericidal effect. Cephalosporins are used for uncomplicated skin and soft tissue infections caused by staphylococcal and streptococcal bacteria. This group of drugs:

• Ceftriaxone;

• Cefodox;

• Cefix;

• Tsepefim.

Bacteria are organisms that do not live long, but in order to restore their population, they multiply rapidly, and, accordingly, quickly mutate, adapting to new living conditions. Microorganisms that survive after taking antibiotics become resistant to them. Their offspring also become immune to a particular drug.

Antibiotic resistance is a common problem of modern man, which causes serious complications. A person who has tried many antibiotics, that is, self-medicated, is at risk for patients with antibiotic resistance. Very often they die before a specialist can pick up a drug that works against a specific pathogen. Therefore, it is important to follow the recommendations of the doctor and take antibacterial agents strictly according to an individual scheme.

Broad spectrum antibiotics – buy in Ukraine

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Editorial group

Creation date: 06/04/2022
Date updated: 15. 07.2023

Broad-spectrum antibiotics

A variety of bacteria live in the human body, many of which are necessary for normal functioning. Prote, you can also see the ailments that call different pathologies. To fight against bacterial infections, antibiotics are used – preparations of direct action, yakі reshkodzhayut їх reproduction and growth, priming the life of microorganism. More medical benefits are added only to the song type of pathogens, which makes the therapy easier and the need for the necessary medication. For the cure of the ailment caused by the culprit, a broad-spectrum antibiotic is used.

The widest pardon for the use of antibacterial drugs for the treatment of viral diseases. The stench is powerless against viruses, which have a daily clitin structure. In this case, an antibiotic may be used in combination with other drugs, since a viral infection may be aggravated and bacterial infection may be included.

Variety of broad-spectrum antibiotics

Antibacterial drugs in a large assortment are presented in Ukrainian pharmacies. It is smarted by this building to effectively excite various infectious diseases, both in children and in adults. According to the chemical warehouse, broad-spectrum antibiotics are subdivided into 5 main groups, the skin may have its pharmacological activity:

1. Penicillin – ampicillin, bicillin, carbicillin are still available. Qi speech disrupts the synthesis of clitin membranes and pereskodzhayut proper osmosis of clitin, preventing the growth of microorganism. Antibiotics of the penicillin series are effective in the treatment of angina, sieve paths, infectious lesions of the bones, scoliosis and soft tissues, pneumonia.
2. Cephalosporins of another generation (ceflaxor, cemafondol, ceflaquin) – drugs of this series are prescribed, as the patient is suspected of intolerance to antibiotics of the penicillin series. They may be similar to them for the treatment of infections of the sechostatic system, ENT organs, gynecology, postoperative infections of the cystic and soft tissue.
3. Tetracyclines (doxycycline, tetracycline) – a speech agent that affects the impaired protein synthesis of bacteria of various species. Tetracyclines are good at coping with acne, infectious ENT diseases, and problems with ICT.
4. Aminoglycosides (gentamicin, streptomycin) – block the production of proteins, which are necessary for the development of pathogenic bacteria. Use them with other antibacterial drugs for treatment of endocarditis, osteomyelitis, peritonitis, infections of the sacs, tuberculosis.
5. Rifamycin (rifampicin) – speech is related to the DNA of pathogenic microorganisms. Rifamycins cause disruption of their synthesis and are especially effective in treating tuberculosis and other diseases that provoke mycobacteria. Also, an antibiotic should be used for the treatment of damage to the dichal system and the sec- ondary organs. To rifampicin, resistance is largely blamed for this, which is due to the presence of rifampicin in combination with other antibacterial drugs.

How to choose the right drug?

First name to buy broad spectrum antibiotics, consult your doctor. Only fahіvets zdatny signs of competently likuvannya and choose the necessary pharmacological form of the drug, yogo dosing that scheme to receive. Call the doctor and recommend a specific name for the drug, or the patient can ask for an antibiotic with a viable fluctuating speech, another trade name. You can find such an analogue in a different way, for example, on the website of MIS Pharmacy 9-1-1 on antibiotics of a wide range of prices to lie in the company-virobnik, dosing and pharmacological authorities of the people. You can replace the necessary goods online or with delivery in Ukraine. Sales zdіysnyuєtsya for the prescription of a doctor, he does not rely on the advice of those who know and engage in self-admiration. Uncontrolled intake of antibiotics can lead to the development of bacterial resistance to the drug and not to give an overbearing effect. It is very important for him to take the dosage of that scheme to the reception, and also not to interrupt the course at the first visible flushes.

Copy of vikoristan literature

• physio-pedia.com;
• Sovereign register of medical supplies of Ukraine;
• betterhealth.vic.gov.au.

FAQ

Why can broad-spectrum antibiotics be combined?

It is important to remember that antibiotics are applied to all types of bacteria, including the corysnus microflora. That is why it is necessary to supplement them with the intake of probiotics, in order to take revenge on the obviousness of the bacterium in a dried-up or shriveled look. In some cases, additional use of antihistamines is required.

How can antibiotics cover a wide spectrum of activities?

The most popular antibiotics in tablets and ampoules (vials) of a wide spectrum can be seen: Azithromycin, Cefuroxime, Amoxicillin/clavulanic acid, Levofloxacin, Cefixime.

Broad spectrum nutrition

What are inexpensive products in the category Broad spectrum antibiotics?

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What is the list of products in the category Antibiotics of a wide spectrum?

Prices for goods in the category Broad spectrum antibiotics start at 4.