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The increasing pattern of drug resistance among\n                      <jats:italic>H. pylori<\/jats:italic>\n                      limits available treatment options. To overcome this challenge, drug repurposing and the use of current medications as adjuvant therapies have emerged as a valuable alternative strategy. Metformin is a commonly prescribed antidiabetic drug for Type 2 diabetes mellitus (T2DM); it has been shown to have antibacterial properties. This study aimed to investigate the anti\u2010\n                      <jats:italic>H. pylori<\/jats:italic>\n                      activity of metformin and evaluate its potential to enhance the efficacy of six conventional antibiotics used to treat\n                      <jats:italic>H. pylori<\/jats:italic>\n                      infections.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      The antibacterial effect of metformin on\n                      <jats:italic>H. pylori<\/jats:italic>\n                      was evaluated using both clinical and reference laboratory strains by detecting the minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC). Furthermore, a checkerboard assay was conducted to assess the combined effect of metformin with six conventional antibiotics used to treat\n                      <jats:italic>H. pylori<\/jats:italic>\n                      infection.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Metformin showed limited antibacterial activity against\n                      <jats:italic>H. pylori,<\/jats:italic>\n                      with MIC and MBC values ranging between 6.83 and 9.75\u2009mM (1131\u20131615\u2009\u03bcg\/mL). MIC\/MBC ratios and time\u2010kill study suggested a bactericidal effect against the tested\n                      <jats:italic>H. pylori<\/jats:italic>\n                      strains. The fractional inhibitory concentration index (FICI) findings for the tested combinations were 0.52\u20131.0, including the MDR strain, indicating an additive effect. No synergistic or antagonistic interactions were observed.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      The additive effect and the bactericidal activity of metformin suggest a potential clinical relevance for diabetic patients already receiving this medication. However, comprehensive studies are needed to further evaluate safety, efficacy, and the underlying killing mechanism of metformin against\n                      <jats:italic>H. pylori<\/jats:italic>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1155\/cjid\/3542284","type":"journal-article","created":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T09:23:06Z","timestamp":1778577786000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Antimicrobial and Synergistic Activity of Metformin Against\n                    <i>Helicobacter pylori<\/i>"],"prefix":"10.1155","volume":"2026","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-1549-205X","authenticated-orcid":false,"given":"Walaa Hashem","family":"Rajab","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2291-6821","authenticated-orcid":false,"given":"Nidal","family":"Jaradat","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qusay","family":"Abdo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5259-1293","authenticated-orcid":false,"given":"Nour","family":"Aljouda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1823-8004","authenticated-orcid":false,"given":"Mohammad","family":"Qadi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,5,12]]},"reference":[{"key":"e_1_2_15_1_2","volume-title":"Saturday","author":"Barry J.","year":"1984"},{"key":"e_1_2_15_2_2","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2017.04.022"},{"key":"e_1_2_15_3_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12879-023-08504-5"},{"key":"e_1_2_15_4_2","doi-asserted-by":"publisher","DOI":"10.1056\/nejmoa001999"},{"key":"e_1_2_15_5_2","article-title":"Biological Agents. 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