The Helicobacter Foundation was founded by Prof. Barry J. Marshall in early 1994, and is dedicated to providing you with the latest information about Helicobacter pylori, its diagnosis, treatment and clinical perspectives.

The story of why it took 100 years to discover Helicobacter is described in these pages.

You should discuss various treatment options, their risks and benefits, with your own doctor. Be aware that treatment of H. pylori is not always recommended by all experts on H. pylori, or in all patients with H. pylori.

Each patient is an individual and decisions must be made in concert with his or her own medical practitioner on a case-by-case basis. The Helicobacter Foundation makes a good faith attempt to ensure that information provided is accurate and up-to date. Most of the information has been published or presented at national and international scientific meetings.

The Helicobacter Foundation makes no guarantees about the accuracy of this information which is given free of charge to whomever requests it. Please help support this website by donating via the button below.

Information for Prof Marshall’s patients: Side-effects of Drugs used in Rescue Therapies

When patients’ Helicobacter strains are resistant to the standard treatment, unusual combinations of antibiotics must be used for eradication.

Although used worldwide, some of these are not registered for use in Australia by the Therapeutic Goods Administration TGA. These are bismuth, furazolidone, tetracycline and metronidazole.

Prof Barry Marshall is authorized to prescribe these medications for the eradication of antibiotic resistant H. pylori under the TGA’s Special Access Scheme.

His patients need to be aware that

¤ these drugs have not been evaluated for safety, quality or efficacy by the TGA

¤ there are some risks and side-effects,

¤ there is a possibility of unknown risks and late side-effects.

With these and other drugs we find that many patients do not suffer any side-effects, a few suffer mild side-effects and rarely side-effects can be severe.

For more information about the side effects of these and other drugs prescribed by Prof Marshall please click here.

If you experience a severe side-effect please gain the advice of your GP or go straight to Emergency.



Adverse Side Effects


Antibiotic; as penicillin; bacterial infections

Hypersensitivity; infection; severe skin reactlons/rash


Antibacterial; antibiotic; infections

Agitation; anorexia; depression; dizziness; headache; impaired alterness; superinfection; tendon rupture


Antibiotic; Infections

Altered taste; dizziness; fever; headache; severe skin reactions/rash; superinfection



Black bowel motions; constipation; diarrhoea; nausea; vomiting


Antibacterial; antibiotic; infections

Diarrhoea; discoloured urine; headache; nausea; stomach or abdominal pain; vomiting


Antibacterial; antibiotic; infections (anaerobic)

Dark urine; dry mouth; hypersensitivity; metallic, unpleasant taste; nasal congestion; superinfection; visual disorder


Antiulcer; hyperacidity; reflux

Back or chest pain; cough; dizziness; dry mouth; flu-like syndrome; headache; hypersensitivity; infection; insomnia


Bactericidal antibiotic; often for tuberculosis

Discoloured urine; GI symptoms; rash


Antibiotic; bacterial infections

Anorexia; hypersensitivity; hypertension; rash; skin photosensitivity; superinfection; tooth discolouration


Generic Name

Brand Name

Common Uses

Possible Side Effects

Mechanism of action




Streptococcal infections, syphilis, upper
respiratory tract infections, lower respiratory tract infections, mycoplasmal infections, Lyme disease.

Nausea, vomiting and diarrhea (especially at higher doses).

Inhibition of bacterial protein biosynthesis by binding reversibly to the subunit 50S of the bacterial ribosomal, thereby inhibiting translocation of peptidyl tRNA.



Prolonged QT interval (especially













Bacterial or protozoal diarrhea or

Diarrhea, discolored urine, headache,
nausea, stomach or abdominal pain, vomiting.



Infections caused by anaerobic bacteria; also amoebiasis, trichomoniasis, Giardiasis.

Discolored urine, headache, metallic taste, nausea; alcohol is contraindicated.

Produces toxic free radicals which disrupt DNA and proteins. This non-specific mechanism is responsible for its activity against a variety of bacteria, amoebae, and protozoa.



Anti-parasitic drug used against protozoan infections. Infections from amoebae, giardia and trichomonas. Bacterial infections.

Tinidazole has similar side effects as
Metronidazole. Upset stomach, bitter taste and itchiness. Other side effects
which occur are headache, physical fatigue, and dizziness.







Wide range of infections; penicillin used for streptococcal infections, syphilis, and Lyme disease.

Gastrointestinal upset and diarrhea.
Allergy with serious anaphylactic reactions. Brain and kidney damage (rare).

Same mode of action as other beta-lactam antibiotics: disrupt the synthesis of the peptidoglycan layer of bacterial cell walls.





Urinary tract infections, bacterial
prostatitis, community-acquired pneumonia, bacterial diarrhea, mycoplasmal infections, gonorrhea.

Nausea (rare), irreversible damage to
central nervous system (uncommon), tendinosis (rare).

Inhibit the bacterial DNA gyrase or the topoisomerase IV enzyme, thereby inhibiting DNA replication and transcription.








Syphilis, chlamydial infections, Lyme
disease, mycoplasmal infections, acne rickettsial infections, *malaria* Note:
Malaria is caused by protist and not a bacterium.

Gastrointestinal upset.

Inhibiting the binding of aminoacyl-tRNA to the mRNA-ribosome complex. They do so mainly by binding to the 30S ribosomal subunit in the mRNA translation complex.

Sensitivity to sunlight.

Potential toxicity to mother and fetus
during pregnancy.

Enamel hypoplasia (staining of teeth;
potentially permanent).


Achromycin V


Transient depression of bone growth.


Drugs against mycobacteria

Rifampicin (Rifamycin)


Mostly Gram-positive and mycobacteria

Reddish-orange sweat, tears, and urine.

Binds to the b subunit of RNA polymerase to inhibit transcription.


Mycobacterium avium complex.



Rash, discolored urine, GI symptoms.




Anti-diarrheal, antiulcer, eye infections,

Black bowel motions, constipation, diarrhea, nausea, vomiting.



Antiulcer, GERD, heartburn, hyperacidity, reflux.

Anxiety, back or chest pain, bone or muscle pain, constipation, cough diarrhea, dizziness, dry mouth, flu-like syndrome, headache, hypersensitivity, infection, insomnia, nausea, vomiting.


Proton Pump Inhibitor (PPI)


What is the best treatment for H. pylori?

Standard triple therapy is always the first choice. It’s either PPI + Amoxicillin + Clarithromycin or PPI + Amoxicillin + Metronidazole or PPI + Clarithromycin + Metronidazole.

For regions such as China and other Asia countries, where Metronidazole resistance is abundant, PPI + Amoxicillin + Clarithromycin would be the preferable choice.

For regions such as Australia and other European countries, where Clarithromycin resistance is abundant, PPI + Amoxicillin + Metronidazole would be the preferable choice.

For patients who are sensitive to amoxicillin, PPI + Clarithromycin + Metronidazole would be the preferable choice.

For patients who failed the first line treatment, they can always try another combination without repeating the same antibiotics (except for Amoxicillin).

For patients who failed twice the first line treatment, they can then try other non-standard triple therapy or the quadruple therapy.

Other choice of antibiotics include: Quinolones (ciprofloxacin or levofloxacin),Tetracycline, Rifabutin, Furazolidone and Bismuth.


  1. H. pylori can never become resistant to Amoxicillin and Bismuth. So patients can always repeat PPI + Amoxicillin + Bismuth + one other antibiotic.
  2. Bismuth is a good supplement in the treatment because it prevents C. difficile complications.
  3. A higher dose of PPI always gives better results. So ask your doctor to give a higher PPI dose.
  4. 14 days of treatment is better than 10 days and 10 days is better than 7 days.
  5. If you stop your treatment after less than 7 days, it is very likely that your H. pylori will become resistant to those antibiotics.

What treatments does Prof Barry Marshall use?

Prof Barry Marshall only sees patients who failed at least twice on the standard triple therapy. So he would normally prescribe a quadruple therapy such as PARC (PPI, Amoxicillin, Rifabutin and Ciprofloxacin) or PBRC (PPI, Bismuth, Rifabutin and Ciprofloxacin).

For patients who failed PARC or PBRC or found resistance to Rifabutin or Ciprofloxacin, PBTF (PPI, Bismuth, Tetracycline and Furazolidone), or PBMT (PPI, Bismuth, Tetracycline and high dose Metronidazole) would then be the rescue therapy.

Please see the article that he and his team published with such combinations.

Helicobacter pylori eradication in Western Australia using novel quadruple therapy combinations.

What is antibiotic sensitivity testing?

Some laboratories provide a bacterial culture service where they can perform antibiotic sensitivity testing on the H. pylori to find out exactly which antibiotics it is sensitive to. With such guidance, the doctor is able to provide the most effective antibiotics combination. This is recommended for patients who have failed multiple antibiotic treatments.

Because Prof Barry Marshall’s patients are usually infected with multidrug resistant H. pylori, he and his team culture all patients’ H. pylori strains. With the guidance of the antibiotic sensitivity testing results, Prof Barry Marshall is able achieve a cure rate of over 90%.

Can I treat H. pylori with something other than antibiotics?

Unfortunately, only use of antibiotics is backed by solid evidence for killing H. pylori once and for all. Alternative treatment such as mastic gum, manuka honey, chili, garlic, onion, broccoli, only work in the laboratory. Some of them may improve the symptoms, but they do not eradicate the H. pylori. Nevertheless, one or two members of this forum have claimed that mastic gum eradicated their H. pylori. I think they are just lucky, and there are far more members that verified that mastic gum didn’t work for them.

How long do I have to wait to feel better?

Some people feel immediate improvement even before finishing the treatment. But some people take a little longer, perhaps weeks or months, before feeling improvement. Nevertheless, it is very important for everyone to get a follow up breath/stool test to find out if their treatment was successful. Only when the H. pylori is proven eradicated, is there a chance for the stomach to return to healthy state.

It is also very important stay positive. Usually the more you think about it, the more you feel that there is something wrong with the stomach. So, try not to think too much about it and distract yourself with work or entertainment.

Is it normal to develop reflux symptoms after antibiotic treatment?

It is unfortunate that some patients do develop reflux symptom (or GERD) after eradication of H. pylori. The reason is unknown and there is no way to prevent it. Those who develop GERD, should take PPI daily to prevent acid damage on the throat or the oesophagus. Some lucky patients, do return to normal after a few months (or years).

How long should I wait, after my treatment, to do a follow up breath test?

Please follow the guideline HERE

Should children be treated?

This could be the most controversial question. We don’t think children below 12 (or even 15 years old) should be treated. Because

  1. Most children are asymptomatic.
  2. The microbiome is growing and antibiotics may damage the microbiome.
  3. The side effects of antibiotics may do more harm than good.
  4. The immune system is building, learning what’s good and bad. Disturbing the microbiome may develop unforeseen future problems.
  5. It is easier for young children to become reinfected because they often putthings in their mouths.
  6. It is hard for adults to catch H. pylori from children because adult are more aware of personal hygiene.

Of course, if the child is suffering from some severe complication due to H. pylori, a carefully measured antibiotic dose can be administered.

How easily can I be reinfected with H. pylori?

It is actually very hard for adults to be reinfected with H. pylori. We believe most of the people are infected when they are very young. Studies have shown that children as young as 2 years old are readily infected with H. pylori. As you get older, you are more aware of personal hygiene and you become less likely to be infected with H. pylori.

H. pylori does not survive very well outside human body. It is rarely present in the mouth (unless you have reflux symptom) and it dies very quickly in contact with oxygen, salt, and other spices.

Although it is rare to be reinfected, it doesn’t mean you will never get reinfected. People living under the same roof, because of the constant “intimate” contact and sharing food and utensils, are most likely to pass H. pylori around. So, it is a good idea to have all the adults living under the same roof checked and treated if one is positive.

Many of the reported H. pylori reinfection cases are actually positive because of treatment failure. Many patients feel better immediately after the first treatment and never check to confirm that the H. pylori is truly eradicated. They may feel better because the number of H. pylori present has dropped. However, after a few months, the numbers of H, pylori recover, and the symptoms return, and the patients claim that they have been reinfected.

Is H. pylori the only culprit for stomach ulcer?

H. pylori is only responsible for about 50% of the stomach ulcers. Another 50% are caused by NSAIDs (Non-Steroidal Anti-Inflammatory Drugs), such as aspirin, ibuprofen, Voltaren, Naprogesic and others. These NSAIDs inhibit the stomach producing mucous, and then the gastric juice (pH 1-2) starts digesting the stomach. Hence, ulcer. Many elderly people take small amount of NSAIDs to thin the blood to prevent stroke and unfortunately, end up developing peptic ulcer disease.