Best Probiotics to take during aggressive antibiotic regimen, and when??

September 4, 2020 11:59 AM

I just had a laparoscopic appendectomy after a ruptured appendix. Spend 4 nights in the hospital with a serious antibiotic/IV drip. Have just been sent home with Flagyl and Cipro (since I'm allergic to Penicillin) which I have to take orally three times a day for 11 days. So when should I be eating probiotics, and which ones should I buy?

I don't want to completely napalm my gut fauna, and I really don't see myself eating heaping tablespoons of sauerkraut and Keffir for the next two weeks. I'd like to put myself on a strict probiotic regimen but all I can find about timing re: probiotics is that I should take them two hours before antibiotics - I don't see anything about how much time to leave since you have taken the antibiotic.

So if I take my antibiotics when I wake up, with food (9am) and at lunch with food (3pm) and at dinner with food (8pm) --- should I then plan to take the probiotics at 12pm, 5pm, and 10pm? Is that enough time to keep the antibiotics from killing the probiotics?

Also which brands of probiotics (drinks or pills) can you recommend for helping with the antibiotic blitz? Thank you!

posted by egeanin to Health & Fitness (9 answers total)

The transcript of the August 27 episode of the “Science Vs.” podcast gives links to some studies on the prospects of fortifying your microbiome against antibiotics with probiotics.
posted by lakeroon at 12:57 PM on September 4, 2020 [4 favorites]

I do not know about when to take probiotics but I can recommend a brand:
Nature's Bounty Ultra Strength Probiotic 10 from Costco. I was part of a clinical study which used these and they really helped my digestive system.
posted by lepus at 1:11 PM on September 4, 2020 [4 favorites]

Possibly it’s best not to take any. I saw some research a while ago where they found that probiotics do recolonize your gut successfully... but too much so. Months later, they still dominate, while people who never took them are back to their own natural mix of flora in a couple of weeks.

“The researchers found the antibiotic damage to the gut bacteria... allowed the probiotic strains to effectively colonise the gut. But this colonization delayed the normal recovery of the microbiota, which remained perturbed for the entire six month study period.
In contrast, the microbiota of... [those who didn’t take probiotics] returned to normal within three weeks of finishing antibiotics.” -CNN, and the original study.

That said, the specialist I saw when I took antibiotics for Lyme Disease did still recommend probiotics even after I pointed out this study to her. Her feeling is that getting back to your natural balance of flora was less important than relieving symptoms, which she sees probiotics doing. So, I guess it’s a judgment call. Sorry that if you do still want them, I’ll have to leave your questions about when and which ones to other commenters.
posted by daisyace at 1:24 PM on September 4, 2020 [2 favorites]

Best answer: I'm a toxicologist. Probiotics as a class of commercial products aren't regulated or evaluated for safety and efficacy--not in any way to the degree that, say, the antibiotics you're taking have been evaluated. More or less, any advice you get from other people you should take with a grain of salt, sort of like Amazon reviews.

A good idea, though, is to ask this question directly to the doctor/doctor's office/surgeon/surgeon's office that's prescribed you those antibiotics. They may have a good sense of the current literature on this because, honestly, their answer might be to avoid taking commercially-prepared probiotic products and stick with the sauerkraut.

Take care and get well soon!
posted by late afternoon dreaming hotel at 1:45 PM on September 4, 2020 [13 favorites]

My father is on Cipro for the rest of his life, and when I’ve raised this question with the doc who handles his antibiotics, the advice has been “Just eat some yogurt now and then, midway between doses of Cipro. Doesn’t have to be fancy stuff, any yogurt is fine. It’s all the same.” Obviously that’s just one doctor’s opinion, but I assume it’s based on experience.
posted by mumkin at 2:52 PM on September 4, 2020 [1 favorite]

Best answer: My surgeon prescribed a medical grade probiotic for me after my appendix ruptured. It was expensive even with insurance, but so worth it. It's been two years, I'll see if I can hunt down the name.
posted by Arctostaphylos at 4:17 PM on September 4, 2020

Best answer: VLS #3 lactobacillus combination. I followed the directions on the package, and took it while on oral antibiotics. Good luck!
posted by Arctostaphylos at 5:31 PM on September 4, 2020 [1 favorite]

Best answer: You might also want to consider eating prebiotic foods that have been shown to support probiotic gut bacteria.

https://www.mayoclinic.org/prebiotics-probiotics-and-your-health/art-20390058

https://well.blogs.nytimes.com/2014/05/09/dishes-for-digestive-health/
posted by forkisbetter at 6:29 PM on September 4, 2020 [1 favorite]

It probably will not help. That said, refrigerated Florajen is a product many patients with medical issues swear by. I have not seen that enthusiasm for non-refrigerated probiotics.
posted by metasunday at 6:41 AM on September 6, 2020