Interactions with Dietary Supplements

Probiotics
A common side effect of antibiotics is diarrhea, which may be caused by the elimination of beneficial bacteria normally found in the colon. Yogurt containing Bifidobacterium longum culture has decreased erythromycin-induced diarrhea in a single-blind study of ten healthy people.¹ Yogurt containing live cultures has also protected against other antibiotic-induced diarrhea.

Controlled studies have shown that taking probiotic microorganisms—such as Lactobacillus casei, Lactobacillus acidophilus, Bifidobacterium longum, or Saccharomyces boulardii—helps prevent antibiotic-induced diarrhea.²

The diarrhea experienced by some people who take antibiotics also might be due to an overgrowth of the bacterium Clostridium difficile, which causes a disease known as pseudomembranous colitis. Controlled studies have shown that supplementation with harmless yeast—such as Saccharomyces boulardii³ or Saccharomyces cerevisiae (baker’s or brewer’s yeast)⁴ —helps prevent recurrence of this infection. In one study, taking 500 mg of Saccharomyces boulardii twice daily enhanced the effectiveness of the antibiotic vancomycin in preventing recurrent clostridium infection.⁵ Therefore, people taking antibiotics who later develop diarrhea might benefit from supplementing with saccharomyces organisms.

Treatment with antibiotics also commonly leads to an overgrowth of yeast (Candida albicans) in the vagina (candida vaginitis) and the intestines (sometimes referred to as “dysbiosis”). Controlled studies have shown that Lactobacillus acidophilus might prevent candida vaginitis.⁶

Bromelain
One report found bromelain improved the action of antibiotic drugs, including penicillin and erythromycin, in treating a variety of infections. In that trial, 22 out of 23 people who had previously not responded to the antibiotics did so after adding bromelain four times per day.⁷ Doctors will sometimes prescribe enough bromelain to equal 2,400 gelatin dissolving units (listed as GDU on labels) per day. This amount would equal approximately 3,600 MCU (milk clotting units), another common measure of bromelain activity.

Vitamin K
Several cases of excessive bleeding have been reported in people who take antibiotics.^{8 9 10 11} This side effect may be the result of reduced vitamin K activity and/or reduced vitamin K production by bacteria in the colon. One study showed that people who had taken broad-spectrum antibiotics had lower liver concentrations of vitamin K2 (menaquinone), though vitamin K1 (phylloquinone) levels remained normal.¹² Several antibiotics appear to exert a strong effect on vitamin K activity, while others may not have any effect. Therefore, one should refer to a specific antibiotic for information on whether it interacts with vitamin K. Doctors of natural medicine sometimes recommend vitamin K supplementation to people taking antibiotics. Additional research is needed to determine whether the amount of vitamin K1 found in some multivitamins is sufficient to prevent antibiotic-induced bleeding. Moreover, most multivitamins do not contain vitamin K.

Other vitamins and minerals
Erythromycin may interfere with the absorption and/or activity of calcium, folic acid, magnesium, vitamin B6 and vitamin B12,¹³ which may cause problems, especially with long-term erythromycin treatment. Until more is known, it makes sense for people taking erythromycin for longer than two weeks to supplement with a daily multivitamin-multimineral.