Antibiotics are powerful medications used to treat bacterial infections. While they are highly effective in eliminating harmful bacteria, they can also have unintended consequences on the beneficial bacteria in our gut,  leading to digestive issues such as diarrhea. Fortunately, there is a potential solution to mitigate these side effects: probiotics. In this article, we will explore the benefits of taking probiotics alongside antibiotics to preserve gut health.
Firstly we'll cover why probiotics are useful, and then we'll look at why they're not prescribed at the same time as antibiotics in every case. There's also the fact that depending what country you're in, then probiotics may be perscribed.
Some countries have recently started since more evidence has come forward to support what was relatively intuative.
Understanding Antibiotics and Gut Health
Before delving into the benefits of probiotics, it is essential to understand the relationship between antibiotics and gut health. Antibiotics work by targeting and killing bacteria that cause infections. However, they are non-selective, meaning they can also harm the beneficial bacteria residing in our gut. This disruption in the gut microbiome can lead to imbalances and a decrease in diversity among the bacterial species present. 
The gut microbiome is a complex ecosystem consisting of trillions of microorganisms that play a vital role in our overall health. These microbes help with digestion, support our immune system, and contribute to various other physiological functions. A healthy gut microbiome is characterized by a diverse and balanced community of bacteria. When this balance is disrupted by antibiotics, it can result in gastrointestinal symptoms such as diarrhea, constipation,  and even infections like Clostridium difficile. 
The Role of Probiotics in Gut Health
Probiotics are live microorganisms that can confer health benefits when consumed in adequate amounts. They are commonly found in supplements or fermented foods like yogurt and sauerkraut. Probiotics work by replenishing and promoting the growth of beneficial bacteria in the gut, thus restoring balance to the microbiome. 
Research has shown that taking probiotics alongside antibiotics can help mitigate the negative effects on gut health. A systematic review published in the Journal of Medical Microbiology examined multiple studies and found that probiotic supplementation  can prevent or diminish the antibiotic-induced changes in gut microbiome composition. This means that probiotics can help preserve the diversity of bacterial species and even restore populations of friendly bacteria that promote a healthy gut.
The Benefits of Taking Probiotics with Antibiotics
Reducing the Risk of Antibiotic-Associated Diarrhea
One of the most common side effects of antibiotics is diarrhea, which can range from mild to severe. Antibiotic-associated diarrhea occurs when the antibiotics disrupt the balance of bacteria in the gut, allowing harmful bacteria to proliferate. Probiotics can help prevent this by restoring the balance and inhibiting the growth of pathogenic bacteria. 
Several studies have demonstrated the effectiveness of probiotics in reducing the risk of antibiotic-associated diarrhea. By taking probiotics alongside antibiotics, individuals can significantly decrease their chances of experiencing this unpleasant side effect. The specific strains of probiotics that have shown promise in preventing diarrhea include Lactobacillus rhamnosus GG,  Saccharomyces boulardii,  and Bifidobacterium breve. 
Preserving Gut Microbiome Diversity
The diversity of bacterial species in the gut microbiome is crucial for maintaining optimal health. A diverse microbiome is associated with improved digestion, enhanced immune function, and reduced inflammation. However, antibiotic use can significantly reduce this diversity by indiscriminately killing both harmful and beneficial bacteria. 
Adding probiotics to antibiotic therapy can help preserve the diversity of the gut microbiome. Probiotics introduce new strains of beneficial bacteria, which can help compensate for the loss caused by antibiotics. By preserving a diverse microbiome, individuals may reduce the risk of developing gastrointestinal issues and other health problems associated with imbalances in the gut.
Restoring Friendly Bacteria
Certain strains of bacteria, such as Faecalibacterium prausnitzii, play a crucial role in gut health. These friendly bacteria help maintain the integrity of the intestinal barrier, reduce inflammation, and promote overall gut health. Unfortunately, antibiotics can deplete these beneficial bacteria, compromising the gut's ability to function optimally.
Taking probiotics alongside antibiotics can aid in restoring the populations of friendly bacteria. Studies have shown that probiotic supplementation can increase the levels of Faecalibacterium prausnitzii and other beneficial bacteria, leading to improved gut health. By replenishing these friendly bacteria, individuals may experience fewer gastrointestinal symptoms and enjoy a healthier gut environment.
It's not just gut health either, for example, there are several strains of probiotic bacteria which are essential for womens vaginal health.  And also some strains that can also help prevent infection in men or have more use to average dietary averages, meaning that there are better options based on gender and the best probiotics for men and women may not be the same. Although most are very similar.
Minimizing the Risk of Antibiotic Resistance
Antibiotic resistance is a growing concern in healthcare, as it poses a significant threat to the effectiveness of these life-saving medications. When antibiotics are overused or misused, bacteria can develop resistance mechanisms, rendering the antibiotics ineffective. This can lead to persistent infections and limited treatment options.
The use of probiotics alongside antibiotics may help mitigate the risk of antibiotic resistance. By promoting a diverse and balanced gut microbiome, probiotics can create an environment that is less favorable for the development of antibiotic-resistant bacteria. Additionally, some probiotic strains have shown antimicrobial properties, which can further inhibit the growth of resistant bacteria. 
Choosing the Right Probiotics for Antibiotics
Not all probiotics are created equal, and choosing the right strains and formulations is essential for maximizing the benefits when taking them alongside antibiotics. Here are a few factors to consider when selecting probiotics:
Different strains of probiotics have varying effects on gut health. When choosing probiotics to complement antibiotic therapy, look for strains that have been studied for their efficacy in preventing antibiotic-associated diarrhea and preserving gut microbiome diversity. Lactobacillus rhamnosus GG, Saccharomyces boulardii, and Bifidobacterium breve are among the strains that have shown promising results in clinical trials. [8,9,10]
Colony-Forming Units (CFUs)
The potency of probiotics is measured in colony-forming units (CFUs), which represent the number of viable microorganisms in a supplement. Higher CFU counts generally indicate a more potent probiotic. When taking probiotics with antibiotics, it is advisable to choose a supplement with a higher CFU count to ensure sufficient colonization in the gut. 
Timing and Duration of Supplementation
The timing and duration of probiotic supplementation alongside antibiotics can influence their effectiveness.  It is generally recommended to take probiotics at least two hours apart from antibiotics to minimize any potential interactions. Additionally, continuing probiotic supplementation for a few weeks after completing the antibiotic course can help support the recovery of the gut microbiome. Several studies it can take the microbiome months to recover after even just 1 week of antibiotics. 
Why Probiotics Weren't Perscribed After Anti Biotics?
And finally it's this timing issue as to why they're not always prescribed. There were some (now outdated) assertions that probiotics could interfere with antibiotics, this has since been largely disproven, although relatively recently. The current research actually suggests that probiotics can improve antibiotic efficacy as we mentioned earlier. 
Only 3 years ago articles were still being published saying there was little evidence to support probiotic use  and a regularly cited meta analysis from 2012 was used as a reference point to say they seemed effective for diarhea treatment, but that the evidence wasn't substantial enough. 
In short, the reason was simply not enough evidence and a couple of underwhelming Meta Analysis of probiotics.
Consultation with Healthcare Professionals
It is always advisable to consult with healthcare professionals, such as doctors or pharmacists, before starting any new supplements. They can provide personalized recommendations based on individual health conditions, the specific antibiotic being taken, and potential interactions with other medications.
Why Don't Doctors Prescribe Probiotics With Antibiotics? Conclusion
Taking probiotics alongside antibiotics can offer significant benefits in preserving gut health. By mitigating the negative effects of antibiotics on the gut microbiome, probiotics can reduce the risk of antibiotic-associated diarrhea, preserve the diversity of bacterial species, restore populations of friendly bacteria, and minimize the risk of antibiotic resistance. When selecting probiotics, it is important to consider strain specificity, CFU counts, timing and duration of supplementation, and consult with healthcare professionals for personalized recommendations. By incorporating probiotics into antibiotic therapy, individuals can support their gut health and promote overall well-being.
1 - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8756738/
2 - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8756738/
3 - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1123310/
4 - https://www.ncbi.nlm.nih.gov/books/NBK431054/
5 - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8512487/
6 - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7058552/
7 - https://www.ncbi.nlm.nih.gov/books/NBK373095/
8 - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4155824/
9 - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3296087/
10 - https://www.ncbi.nlm.nih.gov/genome/
11 - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9366906/
12 - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5156686/
13 - https://ods.od.nih.gov/factsheets/Probiotics-HealthProfessional/
14 - https://www.nccih.nih.gov/health/probiotics-what-you-need-to-know
16 - https://www.bbc.com/future/article/20190124-is-it-worth-taking-probiotics-after-antibiotics
17 - https://pubmed.ncbi.nlm.nih.gov/22570464/