Probiotics and Gut Health: An Evidence‑Based Narrative Review for General and Family Medicine

Abstract Objectives: To synthesise current evidence on the role of probiotics in maintaining gut health, with a particular focus on their use during and after antibiotic therapy. This review aims to provide general and family medicine clinicians with a balanced, evidence‑based overview of probiotic efficacy, limitations, and practical considerations for patient care. Design: Narrative review of contemporary literature, including mechanistic studies, clinical trials, meta‑analyses, and guideline statements relating to probiotics, gut microbiota, and antibiotic‑associated dysbiosis. Setting: Primary care and general practice contexts where antibiotics are frequently prescribed and gastrointestinal side‑effects are commonly encountered. Data Sources: Peer‑reviewed publications from microbiology, gastroenterology, primary care, and infectious disease literature; systematic reviews and meta‑analyses; and relevant clinical guidelines. Eligibility Criteria: Studies examining probiotics, gut microbiota composition, antibiotic‑associated diarrhoea, Clostridioides difficile infection, microbiome recovery, dietary modulation of gut health, and host–microbe interactions. Both adult and paediatric data were considered where relevant. Results: Antibiotics consistently induce short‑term gut microbiota disruption, reducing microbial diversity and altering metabolic activity. Most individuals demonstrate spontaneous microbiome recovery over time. Probiotics exhibit strain‑specific effects and may reduce the risk of antibiotic‑associated diarrhoea in selected populations, though evidence is heterogeneous and benefits are not universal. Evidence for preventing C. difficile infection is mixed and appears most relevant to moderate‑risk groups. No probiotic has been shown to fully restore the native microbiome after antibiotic exposure. Dietary strategies—particularly high‑fibre intake and fermented foods— demonstrate more consistent support for microbial diversity and resilience. Conclusions: Probiotics may offer modest, strain‑specific benefits for some patients during antibiotic therapy, but routine use for all individuals is not supported by current evidence. A balanced approach emphasising antibiotic stewardship, dietary fibre, fermented foods, and patient‑centred counselling is most appropriate in primary care. Further research is needed to clarify optimal strains, dosing, and long‑term effects of probiotics and emerging microbiome‑targeted therapies.