Probiotics with Augmentin: Evidence-Based Recommendations

Recommended Probiotic Strains

The American Gastroenterological Association (AGA) conditionally recommends Saccharomyces boulardii (1g or 3×10¹⁰ CFU/day) for reducing C. difficile-associated diarrhea risk by 59% when taking antibiotics like Augmentin 1, 2
Saccharomyces boulardii has a unique advantage: antibiotics don't kill yeast, so it survives concurrent antibiotic therapy better than bacterial probiotics 3
A two-strain combination of Lactobacillus acidophilus CL1285 + Lactobacillus casei LBC80R reduces the risk of antibiotic-associated diarrhea by 78% 1, 2
A three-strain combination of L. acidophilus + L. delbrueckii subsp bulgaricus + Bifidobacterium bifidum reduces the risk by 65% 1
A four-strain combination of L. acidophilus + L. delbrueckii subsp bulgaricus + B. bifidum + Streptococcus salivarius subsp thermophilus reduces the risk by 72% 1

Start probiotics at the beginning of Augmentin therapy 2
Take probiotics at least 2 hours apart from Augmentin doses to avoid direct antimicrobial effects on bacterial probiotics 2
Continue probiotics throughout the entire course of antibiotic treatment 1, 2
Consider continuing probiotics for 1-2 weeks after completing Augmentin 2

Reduces antibiotic-associated diarrhea risk by up to 64% 2
Decreases C. difficile infection risk by approximately 60% in high-risk patients 1

Do not use probiotics if you are immunocompromised, due to risk of bacteremia or fungemia 1, 2

High-risk patients, including elderly patients (>65 years), those with prolonged hospitalization, patients with previous C. difficile infection, and individuals with severe underlying illness, should strongly consider probiotics with Augmentin 1

The overall quality of evidence is rated as low to moderate by the AGA, primarily due to heterogeneity in study populations, probiotic strains tested, and outcome measures 1, 3
The effect is highly strain-specific, and choosing one of the specifically studied strains is essential 3, 1

Don't take probiotics at the same time as Augmentin, separate by at least 2 hours 2
Don't assume all Lactobacillus or Bifidobacterium strains work equally, only specific strain combinations have proven efficacy 3, 1
Don't use probiotics in immunocompromised patients, the risks outweigh benefits in this population 1, 2