Probiotics & Antibiotics

If you have, or recently have had, bacterial vaginosis (BV) or a yeast infection you likely will have taken an antibiotic or antifungal which attacks the pathogen directly. However, this may not entirely rid the system of the pathogen as it can lie dormant and resurface causing reinfection. Within 6 months, more than 50% of women will contract BV again after antibiotic treatment. This is where the probiotics come in. A post-antibiotic vaginal probiotic can help repopulate the vaginal microbiome and assist with vaginal flora recovery.  A vaginal probiotic pessary while taking antibiotics can support vaginal health and, according to clinical trials, assist in reducing the likelihood of recurrent infection. 

Why use a vaginal probiotic while taking antibiotics?

There are a few major reasons that antibiotics won’t kill the pathogens

  1. Resistance of bacterial or fungal organisms to therapy. Unfortunately, bad bugs get smarter to survive. Repeated use of antibiotic or antifungal therapy may no longer kill the pathogens. The type of pathogen can also be less susceptible to prescription treatment. For example, certain Atopobium vaginae bacterial strains have shown a high-level of resistance to metronidazole treatment.
  2. Creation of a biofilm on the vaginal wall. Bad bacteria have the ability to create a biofilm layer which adheres to the cells of the vaginal wall, preventing the treatment from reaching the pathogens. So, the biofilm acts as a reservoir of bacteria and protects them from the effect of an antibiotic. One study took 18 BV patients treated with oral metronidazole for 1 week, and followed them up to 5 weeks after treatment. Even though all patients initially recovered, after the treatment dense and active bacterial biofilms were invariably re-emerging. These biofilms consisted predominantly of the main BV bacteria: Gardnerella vaginalis and Atopobium vaginae.
  3. Antibiotics can disrupt the vaginal microbiome. If you’re taking an antibiotic for an infection of the vagina or another area of the body it can disrupt the natural flora in the vagina, inhibiting healthy recovery. This disruption may cause a reduction in good bugs which keep the pathogen bacterial colonies at bay.

How do post-antibiotic vaginal probiotics work?

Most clinical studies support probiotics in the maintenance of vaginal health, and no adverse effects have been reported. In a nutshell, probiotics help the healthy bacteria in the vaginal microbiome recover, producing healthy lactic acid and helping to fight the pathogens that cause infection.

  • Colonies of healthy bugs can help fight the bad bugs. However, there have been a great deal of failures in this department. Some scientists attempted to do so but good bugs failed to recolonize vagina, simply because they were using wrong lactobacillus strains. A simple application of probiotic species orally or intravaginally is not good enough to restore a healthy flora balance because not all lactobacillus species have the same adherence abilities. This means that there was no ability for the good bugs to grow, thrive and stick around to fight off the bad bacteria.

    It was found that Lactobacillus crispatus, which is also known as the ‘super hero of the vagina’ colonized for over 8 months in 8x more female subjects compared with other lactobacillus species (40% vs 5%). This demonstrates that L. crispatus has superior adherence abilities compared with other good bugs and can support vaginal flora recovery after antibiotics.
  • Anti-biofilm properties. Biofilm is a matrix made by bacteria themselves. Think of it like a protective layer which surrounds and encloses clusters of bacteria and attaches itself to a body surface. Bad bugs are known to form biofilms in order to protect themselves from the adverse environmental conditions. Certain probiotics have the ability to disrupt bad bugs’ biofilm formations and expose bacteria to the influence of antimicrobial agents.

  • It was found that healthy bacteria strains Lactobacillus rhamnosus, GR-1® and Lactobacillus reuteri, RC-14® have the ability to penetrate into the biofilms created by Gardnerella vaginalis and Atopobium vaginae and cause disruption of the biofilm, some even killing the bad bacteria independently.
  • ‍Lactic acid and other antimicrobial agent secretion. Lactic acid is a naturally occurring acid that helps keeps the vaginal microbiome healthy. Healthy Lactobacillus species secrete lactic acid which can kill bad bacteria by direct contact. Certain L. crispatus and L. gasseri strains have the remarkable ability to produce and release antibiotic-like compounds that help to fight bad bacteria. These compounds were proven efficient against G. vaginalis (BV causing bacteria) and uropathogenic E. coli (UTI causing bacteria) and can even cross the cell membrane and kill the pre-internalized microbial pathogens.

There are also ways to make lifestyle changes to help avoid contact with bad bacteria that you can implement, like using condoms, avoiding douching and, if prescribed them, using the full course of antibiotics your doctor has prescribed even after symptoms have diminished. Plus if you have a regular partner, and you’re prone to reinfection, they may need to be treated at the same time as you.