The disruptive effect of antibiotics on the composition and function of the human microbiota is well established. However, the hypothesis that probiotics can help restore the antibiotic-disrupted microbiota has been advanced, with little consideration of the strength of evidence supporting it. Some clinical data suggest that probiotics can reduce antibiotic-related side effects, including Clostridioides difficile-associated diarrhoea, but there are no data that causally link these clinical effects to microbiota protection or recovery. Substantial challenges hinder attempts to address this hypothesis, including the absence of consensus on the composition of a ‘normal’ microbiota, non-standardized and evolving microbiome measurement methods, and substantial inter-individual microbiota variation. In this Review, we explore these complexities. First, we review the known benefits and risks of antibiotics, the effect of antibiotics on the human microbiota, the resilience and adaptability of the microbiota, and how microbiota restoration might be defined and measured. Subsequently, we explore the evidence for the efficacy of probiotics in preventing disruption or aiding microbiota recovery post-antibiotic treatment. Finally, we offer insights into the current state of research and suggest directions for future research.

抗生素对人类微生物群组成和功能的破坏性影响已得到充分证实。然而，益生菌可以帮助恢复被抗生素破坏的微生物群的假设已经得到推进，很少考虑支持它的证据强度。一些临床数据表明，益生菌可以减少与抗生素相关的副作用，包括艰难梭菌相关的腹泻，但没有数据将这些临床影响与微生物群保护或恢复有因果关系。重大挑战阻碍了解决这一假设的尝试，包括对“正常”微生物群的组成缺乏共识、非标准化和不断发展的微生物组测量方法以及个体间微生物群的巨大差异。在这篇评论中，我们探讨了这些复杂性。首先，我们回顾了抗生素的已知益处和风险、抗生素对人类微生物群的影响、微生物群的恢复力和适应性，以及如何定义和测量微生物群恢复。随后，我们探讨了益生菌在预防抗生素治疗后破坏或帮助微生物群恢复方面的功效的证据。最后，我们提供了对研究现状的见解，并为未来的研究提出了方向。