If you have to take an antibiotic, should you take a probiotic, too?


It should be noted that most trials were sponsored by manufacturers, introducing an additional potential bias in the individual studies that would be reflected in these results.

Funny how this blog (science-based medicine) never includes this warning for pharma drugs.


The regulatory question is muddied by the fact that certain probiotics are unquestionably actual food or drink, not merely dietary supplements, with possible secondary benefits to those taking antibiotics. If I’m already eating yogurt with breakfast every morning, and that yogurt includes half a dozen species of bacteria, some of which (e.g. L. acidophilus) could reasonably be expected to survive past the stomach, and I’m eating it first and foremost because I like it, then at the very least there’s absolutely no reason for me to stop eating this stuff when I’m on antibiotics. Similarly, hefeweizen is arguably a source of Saccharomyces, so you can argue that you’re drinking it for medicinal purposes; if I were on antibiotics and picking a beer off an extensive menu, I might use that as a rationale to choose a hefeweizen over, say, an IPA, but I’d be having a beer in any case. People still jokingly use “medicinal purposes” as an excuse to drink gin and tonic, even in areas where malaria has been effectively exterminated.

I’ve often wondered this. Recently when my pooper seemed a bit miscalibrated and I suspected my gut biome might have changed, I had some yogurt and that sorted things out nicely. (Or at least was temporally correlated with a nice sorting out.) But what species was out of balance? Surely different brands of yogurt have different species and in different proportions (perhaps even varying between batches?), but where would one find this info?

all i know about probiotics comes from annoying yogurt commercials.
and this one time i saw they were selling PILLS of the stuff in pharmacies.

Not all antibiotics react well to alcohol. One time I decided to have one beer while taking a certain antibiotic, forgetting to find out if it would react, and oh boy. That was a mistake. I didn’t feel all that well, my temperature rose, and my face turned BRIGHT RED. It was kinda funny.

Make sure to first find out if your antibiotic will react poorly with alcohol. Some do.

“A few antibiotics — such as metronidazole (Flagyl), tinidazole (Tindamax) and trimethoprim-sulfamethoxazole (Bactrim) — should not be mixed with alcohol because this may result in a more severe reaction. Drinking any amount of alcohol with these medications can result in side effects such as flushing…”

Yes. I am well aware of this. That is why I replied to your comment which mentioned drinking alcohol with antibiotics but did not also include that not all antibiotics should be mixed with alcohol (and that you should probably keep the beer to no more than one or two while on any antibiotic). I just forgot one time to double check and decided to have a beer and had uncomfortable but not particularly dangerous results. I am not sure why I am having to repeat this, and I’m not sure why you felt the need to copy/paste something which I already was clearly aware of and others could (and should) easily research on their own before mixing alcohol and antibiotics.

Anyway. I am currently on antibiotics right now that do not have a known reaction to alcohol. I had a 22 oz Imperial IPA last night and I did notice I felt the buzz a little stronger than I probably normally would have, which was quite nice, but otherwise I was fine.

I’m not disagreeing with you; I’m backing up your assertion with a citation. I’m also providing the names of specific antibiotics with this side effect, for the benefit of anyone else reading this who might not read up on their meds before drinking.

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Immediately though of Stimu-crank brand pep pills.
Clerk: “You can’t take that many pep pills at once!”
Homer: “Don’t worry. I’ll balance it out with a bottle of sleeping pills.”

Incidentally if drinking booze when on anti-biotics is wrong, I don’t wanna be right. I adhere to the Nanny Ogg school of medicine which is if you’re ill you should drink your favourite drink, because if you’re gonna be ill you might as well enjoy yourself. I think Granny Weatherwax’s method was to give someone any old cure and insist that they felt better.


During treatment of lyme disease I followed doctors’ orders (something I generally do unless I have strong reason not to - but I always research the crap out it first, which drives the high priests of corporate medicine bonkers) and the saturation of my system with powerful antibiotics resulted in nasty and uncomfortable alterations of my gut flora.

So I went to the hippy store and bought some of everything they had that was alive. Kombucha, yogurt, all kinds of stuff with strange foreign names… if the label said it contained live cultures, I bought it. Washed it all down with stream water from the living creek that runs through my yard, and my system completely restabilized itself in a week. It was almost as if as though my species had evolved over the course of hundreds of thousands of years to behave that way!

But of course that’s crazy talk. Everybody knows that God created man to drink sterile chlorinated water and eat PVC-packaged products from food factories where all the poorly paid underpeople regularly swab their hands with brand-name jellied alcohols.

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SBM has got articles on conflict of interest in medical research. It’s part of critical thinking that they encourage. Here’s a link from 2008.

That’s a great example of why Science Based Medicine is just industry propaganda. They completely ignored the dozens of studies that empirically show that corporate sponsorship of research is an enormous problem, and instead came to the conclusion that it isn’t a big problem based on the ‘facts’ that:

  • “Frivolous accusations of conflict has a ‘chilling’ effect on the conduct of industry research.”

  • “Those who claim, falsely, that there is an association between vaccines and autism have used the slightest appearance of conflict to dismiss the evidence against any role of vaccines in autism.”

  • “There also seems to be an unfair asymmetry. While mainstream medicine is wrangling with this thorny issue, those on the fringe may ignore their own conflicts.”

So even though it’s a proven fact that by far the biggest predictor of whether or not a trial will be ‘successful’ is whether or not it’s corporately funded and/or conducted by researchers with industry ties[1], none of this matters (and is not even worth mentioning) because of something something alternative medicine.

Of all the blogs I’ve read, SBM has got to be by far the most intellectually dishonest. Literally every single post is dripping with all sorts of logical fallacies and other dishonesty in order to promote whatever the current pharma-drug-of-the-day is. And whenever it comes time to actually demonstrate the safety or efficacy of whatever they’re promoting, they always change the subject by bashing some random thing from alternative medicine that has nothing to do with the topic at hand.

[1] Too many studies to list, but a couple examples:


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Of the studies that collected adverse event information (23) none were noted, which is reassuring but makes me skeptical that this information was collected accurately.

I can add to that skepticism.

I had an allergic reaction that my doctor attributed to probiotics. I was prescribed them by another doctor along with antibiotics for a respiratory infection. My face/throat swelled up and I was briefly hospitalized. An allergy test showed that I didn’t have a reaction to the antibiotic. There wasn’t a test specific to the probiotic, though, and my doctor gently recommended that I not take them again, adding a comment that they were not yet rigorously tested in the medical community.

From a scientific standpoint, surely you might as well take a homeopathic remedy?

I am glad I am not the only one who sees problems with the so-called “science based medicine” site.

They completely ignored the dozens of studies that empirically show
that corporate sponsorship of research is an enormous problem, and
instead came to the conclusion that it isn’t a big problem…

You really need to read the conclusion again if that’s your take of the article. They also obviously agree with Ben Goldacre.

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