The message is not probiotics vs antibiotics, but rather probiotics with antibiotics
There is no doubt that antibiotics have an essential role to play in modern medicine in preventing and helping to cure bacterial infections. Antibiotics have saved millions of lives around the world since their discovery in the 1920s. It is important to always follow the advice from your doctor, and always take and finish a course of antibiotics as prescribed.
We might also note that antibiotics are not always necessary, for example in the case of viral infections, antibiotics will remain ineffective (because antibiotics, by nature, target bacteria). It is a shame when GPs sometimes prescribe an antibiotic as a way of appeasing their patient, when the likelihood of the antibiotic being effective is slim to none. We have written about the over-prescription of antibiotics, to meet patients' expectations, here on the blog before. There are also arguably a number of minor bacterial infections that could clear naturally without having to rely on an antibiotic. For example often when women are suffering from a Urinary Tract Infection, the infection will clear itself within 48 hours as the body's natural immune response kicks in, especially when helped along with plenty of water and perhaps cranberry capsules. Incidentally this is why doctors sometimes carry out 'delayed prescribing', where they write a prescription but instruct the patient to wait for 48 hours before picking it up. This delayed prescribing is carried out by well-informed doctors, with the understanding that the infection will often clear itself in 48 hours, and if it is to do so, it would be better for the patient to wait - not only better for her health, but also for the general population with regards to helping to prevent antibiotic resistance.
The question of antibiotic resistance is paramount. Just today the World Health Organisation (WHO) published a report, analysing data from 114 countries, and calling resistance to antibiotics a 'major global threat'. They state that simple, common infections thought to pose little threat today, could become killers again in the future, due in large part to antibiotic resistance. In light of this, steps must be taken to slow the progress of antibiotic resistance, and to change the way we use and prescribe antibiotics. In this light, natural remedies which provide an alternative to antibiotics would of course be interesting to explore. Whilst there are numerous clinical trials on probiotics, and research continues to grow in this field every day, we are not yet at a stage where we can ask whether patients should be taking probiotics or antibiotics, and this is an important thing to point out.
There may be some conditions, such as skin conditions for example, where people may prefer to try the natural route first. Acne and spots are a very common problem for many people, and an example of a condition where people may prefer to try natural remedies rather than taking a prescription antibiotic. A 2011 study determined that there appears to be plenty of supportive evidence to suggest that gut microbes, and the health of the gastrointestinal tract itself, may be contributing factors in the acne process. As a result, taking an antibiotic may further reduce the integrity of the gut whereas taking a probiotic may help to improve gut flora with a potentially positive outcome. You may like to read our FAQ about probiotics and skin health.
Antibiotics unfortunately can carry unpleasant associated side effects
One of the many factors to consider when taking an antibiotic is the potential side effects. Whilst effective in killing pathogenic bacteria, antibiotics are essentially non-selective and may well kill off beneficial gut bacteria in the gut as well. This is thought to be the reason that many people suffer from diarrhoea, constipation and/or vaginal thrush when taking an antibiotic. Antibiotic-associated diarrhoea (ADD) is thought to the most common of these side effects. There have been a number of studies carried out to determine the benefit of taking a probiotic supplement to help reduce antibiotic-associated diarrhoea, of which an encouraging number have yielded a positive result. A meta-analysis of 23 studies carried out in 2012 (focussing on contrasting and combining results from multiple studies) supported the preventative effects of probiotics in antibiotic-associated diarrhoea. The meta analysis found that taking probiotics alongside antibiotics were an effective way to reduce the risk of side effects such as diarrhoea. Research, and anecdotal feedback, have also shown that taking probiotics alongside antibiotics can prevent the likelihood of vaginal thrush in women - this would be via the same mechanism - ie. preventing an imbalance of gut bacteria (dysbiosis) which can lead to upsets such as diarrhoea, or vaginal thrush (which likely occurs as pathogenic yeasts are able to overgrow in the gut and vaginal flora, where there is less competition for space from 'friendly bacteria' killed off from the antibiotics.) Wherever there is a discussion around the topic of probiotics and antibiotics, at least for now, this should be the focus of the discourse - ie. that taking the two together ought to be encouraged - and the question should not be whether probiotics should be chosen over antibiotics. It is thought that, as many as 1 in 5 patients stop taking their antibiotic due to suffering side effects such as diarrhoea. It can be very dangerous to stop a course of antibiotics, as this can encourage antibiotic resistance - so we should welcome research on natural ways to decrease the likelihood of side effects and thereby increase compliance when taking antibiotics. Healthcare professionals can read more about the clinical research about probiotics and antibiotics here.
Healthcare professionals may wish to note that the OptiBac Probiotics 'For those on antibiotics' supplement is a popular choice amongst those taking a course of antibiotics. It contains two specially selected strains of natural bacteria which are scientifically proven to survive to reach the gut alive, even during a course of antibiotics. If your patients are concerned about the efficacy and safety of taking a probiotic at the same time as an antibiotic, take a look at our in-depth FAQ, Can i take probiotics with antibiotics?
So, in summary, perhaps in the future we will see more and more evidence around probiotics, with hundreds of thousands of clinical trials backing up their ability to treat infectious diseases. At that stage we may well be able to raise the question of probiotics vs antibiotics, and which ones ought doctors prescribe. However for now, at least for serious health conditions, it simply isn't a question of probiotics OR antibiotics - it's a question of probiotics AND antibiotics.
2. Whitney P B & Logan A C. Acne Vulgaris, probiotics and the gut-brain-skin axis: back to the future? Gut Pathog. 2011; 3: 1. Published online Jan 31, 2011.
3. Videlock, E J & Cermonini F. 2012. Meta-analysis: probiotics in antibiotic-associated diarrhoea. Aliment Pharmacol Ther. 2012 Jun;35(12):1355-69.
Image sources: realfoodmovement.net, rsc.org