{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T02:53:22Z","timestamp":1782874402507,"version":"3.54.5"},"reference-count":29,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2026,2,6]],"date-time":"2026-02-06T00:00:00Z","timestamp":1770336000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Infectious Disease Reports"],"abstract":"<jats:p>Background: Growing antibiotic resistance and the limited availability of key components in standard Helicobacter pylori treatments have driven the search for effective alternatives. Minocycline, with its broad-spectrum activity and favorable pharmacokinetics, has emerged as a promising substitute. This meta-analysis compares the safety and efficacy of minocycline-containing bismuth quadruple therapy (MBQT) to conventional first-line BQT regimens, incorporating data from the recent study by Lin et al. Methods: The inclusion criteria were randomized controlled trials (RCTs) with a target population of both treatment-na\u00efve and previously treated patients diagnosed with Helicobacter pylori (H. pylori) infection. The intervention received by eligible patients was a minocycline\u2013bismuth quadruple therapy (MBQT) regimen containing bismuth, minocycline, proton pump inhibitors (PPI), and any additional antibiotic with a minimum period of 2 weeks of administration. We excluded study designs other than RCT and clinical trials that include patients without confirmed H. pylori infection, animal populations, in vitro experiments, and reports of other outcomes that did not include a minimum intervention duration of 2 weeks. A comprehensive literature search was conducted on PubMed, EMBASE, Cochrane Library, and ScienceDirect from inception to 20 May 2025. After screening via Rayyan, data were extracted on an Excel spreadsheet. Quality was assessed using the Cochrane RoB 2.0 tool. Eligible randomized controlled trials (RCTs) were included and analyzed using RevMan 5.4. Outcomes assessed were intention-to-treat and per-protocol eradication rates. Adverse effects were compared among therapies. A random-effects model was used; an I2 &lt; 50% and p-value &lt; 0.05 indicated homogeneity and significant results respectively. Results: Five RCTs with 7 interventions involving 2812 patients were included. The pooled odds ratio (OR) for MBQT in intention-to-treat (ITT) analysis was 1.25 (95% CI: 0.96\u20131.61), showing a non-significant trend. No heterogeneity was detected (I2 = 0.0%). In the modified ITT (mITT) analysis (2 studies), MBQT showed higher eradication (OR: 1.70, 95% CI: 0.00\u20131042.90), but wide CI and high heterogeneity (I2 = 70.7%) limited interpretation. All studies were included in the per-protocol (PP) analysis, which showed a statistically significant improvement with MBQT (OR: 1.67, 95% CI: 1.14\u20132.45) and low heterogeneity (I2 = 5.2%), suggesting consistent results. Although not statistically significant, MBQT was associated with a slightly lower rate of adverse events compared to standard therapy (OR: 0.81, 95% CI: 0.59\u20131.12). I2 = 50.6% showed moderate heterogeneity in safety outcomes. Discussion: the number of included RCTs was modest, with only five studies meeting eligibility criteria, and only two contributing to the modified intention-to-treat analysis. The risk-of-bias assessment showed variation in methodological quality across the included studies. Several studies exhibited high risk judgments in critical domains. particularly randomization, deviations from intervention, and selective reporting. Patients who completed the treatment benefited more from MBQT, which also had a comparable safety profile to conventional BQT regimens. In the treatment of H. pylori infection, MBQT may be considered a safe alternative for first-line treatment.<\/jats:p>","DOI":"10.3390\/idr18010016","type":"journal-article","created":{"date-parts":[[2026,2,6]],"date-time":"2026-02-06T10:05:47Z","timestamp":1770372347000},"page":"16","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Efficacy and Safety of Minocycline-Containing Bismuth Quadruple Therapies Versus Standard First-Line Bismuth Quadruple Therapies for Helicobacter pylori Eradication: A Systematic Review and Meta-Analysis"],"prefix":"10.3390","volume":"18","author":[{"given":"Hakim Ullah","family":"Wazir","sequence":"first","affiliation":[{"name":"Gajju Khan Medical College, Swabi 23561, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdul Muqeet","family":"Khuram","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Connecticut Health, Farmington, CT 06030, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1442-7422","authenticated-orcid":false,"given":"I M Khalid","family":"Reza","sequence":"additional","affiliation":[{"name":"Department of Medicine, Enam Medical College and Hospital, Dhaka 1340, Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-4701-8814","authenticated-orcid":false,"given":"Hafsa","family":"Ajmal","sequence":"additional","affiliation":[{"name":"Department of Medicine, Mayo Hospital, Lahore 54000, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hafsa","family":"Parveen","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Louisville, Louisville, KY 40202, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zeeshan","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Department of Medicine, King Edward Medical University, Lahore 06117, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-7919-9594","authenticated-orcid":false,"given":"Yousra","family":"Iftequar","sequence":"additional","affiliation":[{"name":"Department of Medicine, VRK Women\u2019s Medical College, Hyderabad 500075, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noora","family":"Inam","sequence":"additional","affiliation":[{"name":"Gajju Khan Medical College, Swabi 23561, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ilyas Muhammad","family":"Sulaiman","sequence":"additional","affiliation":[{"name":"Gajju Khan Medical College, Swabi 23561, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nayanika","family":"Tummala","sequence":"additional","affiliation":[{"name":"Department of Medicine, New York Medical College ST Marys St. Clares, Denville, NJ 07834, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-6597-4852","authenticated-orcid":false,"given":"Hafiz Muhammad Moaaz","family":"Sajid","sequence":"additional","affiliation":[{"name":"Punjab Medical College, Faisalabad Medical University, Faisalabad 38800, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anum Zia","family":"Khan","sequence":"additional","affiliation":[{"name":"Department of Medicine, Jinnah Sindh Medical University, Karachi 75510, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ussama","family":"Shafaqat","sequence":"additional","affiliation":[{"name":"Department of Medicine, King Edward Medical University, Lahore 06117, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,2,6]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"553","DOI":"10.1016\/S2468-1253(23)00070-5","article-title":"Global prevalence of Helicobacter pylori infection between 1980 and 2022: A systematic review and meta-analysis","volume":"8","author":"Li","year":"2023","journal-title":"Lancet Gastroenterol. Hepatol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"449","DOI":"10.1128\/CMR.00054-05","article-title":"Pathogenesis of Helicobacter pylori Infection","volume":"19","author":"Kusters","year":"2006","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"587","DOI":"10.1002\/ijc.2910600502","article-title":"Working group report on schistosomes, liver flukes and Helicobacter pylori. Meeting held at IARC, LYON, 7\u201314 June 1994","volume":"60","author":"Heseltine","year":"1995","journal-title":"Int. J. Cancer"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1353","DOI":"10.1136\/gutjnl-2015-309252","article-title":"Kyoto global consensus report on Helicobacter pylorigastritis","volume":"64","author":"Sugano","year":"2015","journal-title":"Gut"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1372","DOI":"10.1053\/j.gastro.2018.07.007","article-title":"Prevalence of Antibiotic Resistance in Helicobacter pylori: A Systematic Review and Meta-analysis in World Health Organization Regions","volume":"155","author":"Savoldi","year":"2018","journal-title":"Gastroenterology"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1724","DOI":"10.1136\/gutjnl-2022-327745","article-title":"Management of Helicobacter pylori infection: The Maastricht VI\/Florence consensus report","volume":"71","author":"Malfertheiner","year":"2022","journal-title":"Gut"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"212","DOI":"10.1038\/ajg.2016.563","article-title":"ACG Clinical Guideline: Treatment of Helicobacter pylori Infection","volume":"112","author":"Chey","year":"2017","journal-title":"Am. J. Gastroenterol."},{"key":"ref_8","unstructured":"Nazarian, S., and Akhondi, H. (2025, December 29). Minocycline, StatPearls, Available online: http:\/\/www.ncbi.nlm.nih.gov\/books\/NBK554519\/."},{"key":"ref_9","first-page":"e98\u2013108","article-title":"Room for Improvement in the Treatment of Helicobacter pylori Infection","volume":"56","author":"Nyssen","year":"2021","journal-title":"J. Clin. Gastroenterol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"12471","DOI":"10.1111\/hel.12471","article-title":"Natural fruits, flowers, honey, and honeybees harborHelicobacter pylori-positive yeasts","volume":"23","author":"Siavoshi","year":"2018","journal-title":"Helicobacter"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"514","DOI":"10.1111\/apt.13497","article-title":"Review article: The global emergence of Helicobacter pylori antibiotic resistance","volume":"43","author":"Thung","year":"2015","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e13138","DOI":"10.1111\/hel.13138","article-title":"Optimization of Minocycline-Containing Bismuth Quadruple Therapy for Helicobacter pylori Rescue Treatment: A Real-World Evidence Study","volume":"29","author":"Huang","year":"2024","journal-title":"Helicobacter"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"633","DOI":"10.1007\/s00535-023-01991-y","article-title":"Minocycline vs. tetracycline in bismuth-containing quadruple therapy for Helicobacter pylori rescue treatment: A multicentre, randomized controlled trial","volume":"58","author":"Huang","year":"2023","journal-title":"J. Gastroenterol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2354","DOI":"10.3748\/wjg.v30.i17.2354","article-title":"Minocycline in the eradication of Helicobacter pylori infection: A systematic review and meta-analysis","volume":"30","author":"Zhou","year":"2024","journal-title":"World J. Gastroenterol."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Kim, S.Y., and Chung, J.W. (2020). Best Helicobacter pylori Eradication Strategy in the Era of Antibiotic Resistance. Antibiotics, 9.","DOI":"10.3390\/antibiotics9080436"},{"key":"ref_16","unstructured":"Ding, Y., Zuo, X., and Li, Y. (2021). Systematic Review and Meta-Analysis of 10 and 14 Days Bismuth-Containing Quadruple Therapy for Helicobacter Pylori Eradication, INPLASY\u2014International Platform of Registered Systematic Review and Meta-Analysis Protocols."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"5097","DOI":"10.3748\/wjg.v25.i34.5097","article-title":"Optimizing proton pump inhibitors in Helicobacter pylori treatment: Old and new tricks to improve effectiveness","volume":"25","author":"Ierardi","year":"2019","journal-title":"World J. Gastroenterol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: An updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"ref_19","first-page":"1013","article-title":"Minocycline quadruple versus tailored therapy in retreatment of Helicobacter pylori infection","volume":"54","author":"Zhang","year":"2015","journal-title":"Zhonghua Nei Ke Za Zhi"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"16318","DOI":"10.1038\/s41598-025-01117-9","article-title":"Randomized multicenter trial comparing minocycline and ornidazole with classical quadruple therapy in Helicobacter pylori treatment","volume":"15","author":"Lin","year":"2025","journal-title":"Sci. Rep."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"9251879","DOI":"10.1155\/2019\/9251879","article-title":"Application of Minocycline-Containing Bismuth Quadruple Therapies as First-Line Regimens in the Treatment of Helicobacter pylori","volume":"2019","author":"Zhang","year":"2019","journal-title":"Gastroenterol. Res. Pract."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"933","DOI":"10.1097\/CM9.0000000000002629","article-title":"Bismuth, esomeprazole, metronidazole, and minocycline or tetracycline as a first-line regimen for Helicobacter pylori eradication: A randomized controlled trial","volume":"136","author":"Suo","year":"2023","journal-title":"Chin. Med. J."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"e12956","DOI":"10.1111\/hel.12956","article-title":"New regimens as first-line eradication therapy for Helicobacter pylori infection in patients allergic to penicillin: A randomized controlled trial","volume":"28","author":"Zhang","year":"2023","journal-title":"Helicobacter"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"You, S., Tang, X., Zhou, J., Shen, Y., Song, X., Benghezal, M., Marshall, B.J., Tang, H., and Li, H. (2024). Minocycline\/Amoxicillin-Based Bismuth Quadruple Therapy for Helicobacter pylori Eradication: A Pilot Study. Microorganisms, 12.","DOI":"10.3390\/microorganisms12030429"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1093\/ajhp\/34.1.49","article-title":"Antimicrobial spectrum, pharmacology and therapeutic use of antibiotics, Part 1: Tetracyclines","volume":"34","author":"Barza","year":"1977","journal-title":"Am. J. Health Syst. Pharm."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"462","DOI":"10.1111\/hel.12313","article-title":"Rabeprazole, Minocycline, Amoxicillin, and Bismuth as First-Line and Second-Line Regimens for Helicobacter pylori Eradication","volume":"21","author":"Song","year":"2016","journal-title":"Helicobacter"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"2513","DOI":"10.2147\/IDR.S457618","article-title":"The Efficacy and Safety of Minocycline-Containing Quadruple Therapies Against Helicobacter pylori Infection: A Retrospective Cohort Study","volume":"17","author":"Si","year":"2024","journal-title":"Infect. Drug Resist."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Martins, A.M., Marto, J.M., Johnson, J.L., and Graber, E.M. (2021). A Review of Systemic Minocycline Side Effects and Topical Minocycline as a Safer Alternative for Treating Acne and Rosacea. Antibiotics, 10.","DOI":"10.3390\/antibiotics10070757"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1111\/j.1523-5378.2007.00518.x","article-title":"A report card to grade Helicobacter pylori therapy","volume":"12","author":"Graham","year":"2007","journal-title":"Helicobacter"}],"container-title":["Infectious Disease Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2036-7449\/18\/1\/16\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,6]],"date-time":"2026-02-06T10:44:42Z","timestamp":1770374682000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2036-7449\/18\/1\/16"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,6]]},"references-count":29,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,2]]}},"alternative-id":["idr18010016"],"URL":"https:\/\/doi.org\/10.3390\/idr18010016","relation":{},"ISSN":["2036-7449"],"issn-type":[{"value":"2036-7449","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,6]]}}}