{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,14]],"date-time":"2026-02-14T05:32:56Z","timestamp":1771047176314,"version":"3.50.1"},"reference-count":49,"publisher":"MDPI AG","issue":"23","license":[{"start":{"date-parts":[[2022,11,28]],"date-time":"2022-11-28T00:00:00Z","timestamp":1669593600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Medical and Health Science and Technology Project of Zhejiang Province","award":["2020RC064"],"award-info":[{"award-number":["2020RC064"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Helicobacter pylori (HP) infection is closely associated with the development of chronic gastritis, peptic ulcer, and gastric cancer. However, the resistance rate of H. pylori strains to antibiotics such as clarithromycin, metronidazole, and levofloxacin has increased significantly, resulting in a significant decrease in the eradication efficacy of commonly used regimens. Tetracycline has received the attention of domestic and foreign scholars because of its low resistance. The purpose of this review is to provide an update on the tetracycline-containing bismuth quadruple eradication therapy for H. pylori infection and review the efficacy and safety of the regimens, hoping to provide guidance for clinical practice.<\/jats:p>","DOI":"10.3390\/jcm11237040","type":"journal-article","created":{"date-parts":[[2022,11,28]],"date-time":"2022-11-28T09:09:42Z","timestamp":1669626582000},"page":"7040","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Multiple Bismuth Quadruple Therapy Containing Tetracyclines Combined with Other Antibiotics and Helicobacter pylori Eradication Therapy"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2514-7848","authenticated-orcid":false,"given":"Yingchao","family":"Sun","sequence":"first","affiliation":[{"name":"Department of Gastroenterology, Sir Run Run Shaw Hospital, Medical School, Zhejiang University, Hangzhou 310016, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8418-7209","authenticated-orcid":false,"given":"Mengjia","family":"Zhu","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Sir Run Run Shaw Hospital, Medical School, Zhejiang University, Hangzhou 310016, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8595-4254","authenticated-orcid":false,"given":"Lei","family":"Yue","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Sir Run Run Shaw Hospital, Medical School, Zhejiang University, Hangzhou 310016, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9145-7027","authenticated-orcid":false,"given":"Weiling","family":"Hu","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Sir Run Run Shaw Hospital, Medical School, Zhejiang University, Hangzhou 310016, China"},{"name":"Institute of Gastroenterology, Zhejiang University (IGZJU), Hangzhou 310027, China"},{"name":"Zhejiang University Cancer Center, Hangzhou 310029, China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,11,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1053\/j.gastro.2015.09.004","article-title":"Pathobiology of Helicobacter pylori-Induced Gastric Cancer","volume":"150","author":"Amieva","year":"2016","journal-title":"Gastroenterology"},{"key":"ref_2","first-page":"352","article-title":"The peel away introducer for the peritoneal limb of peritoneal venous shunt placement","volume":"166","author":"Gaskin","year":"1988","journal-title":"Surg. Gynecol. Obstet."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1353","DOI":"10.1136\/gutjnl-2015-309252","article-title":"Kyoto global consensus report on Helicobacter pylori gastritis","volume":"64","author":"Sugano","year":"2015","journal-title":"Gut"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1177\/0267659112464098","article-title":"Translational research is a necessity for selecting the best components of the extracorporeal circuitry for neonatal and pediatric CPB patients","volume":"28","author":"Undar","year":"2013","journal-title":"Perfusion"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1128\/MMBR.65.2.232-260.2001","article-title":"Tetracycline antibiotics: Mode of action, applications, molecular biology, and epidemiology of bacterial resistance","volume":"65","author":"Chopra","year":"2001","journal-title":"Microbiol. Mol. Biol. Rev."},{"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":"1153","DOI":"10.1016\/j.dld.2022.06.019","article-title":"Management of Helicobacter pylori infection: Guidelines of the Italian Society of Gastroenterology (SIGE) and the Italian Society of Digestive Endoscopy (SIED)","volume":"54","author":"Romano","year":"2022","journal-title":"Dig. Liver Dis."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1046\/j.1365-2036.11.s1.13.x","article-title":"The actions of bismuth in the treatment of Helicobacter pylori infection","volume":"11","author":"Lambert","year":"1997","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"992","DOI":"10.1016\/j.cgh.2018.03.013","article-title":"Houston Consensus Conference on Testing for Helicobacter pylori Infection in the United States","volume":"16","author":"Kao","year":"2018","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2093","DOI":"10.1136\/gutjnl-2020-322368","article-title":"Screening and eradication of Helicobacter pylori for gastric cancer prevention: The Taipei global consensus","volume":"69","author":"Liou","year":"2020","journal-title":"Gut"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1146\/annurev-med-042220-020814","article-title":"Diagnosis and Treatment of Helicobacter pylori Infection","volume":"73","author":"Lee","year":"2022","journal-title":"Annu. Rev. Med."},{"key":"ref_12","first-page":"1134","article-title":"Bismuth-containing quadruple therapy for Helicobacter pylori: Lessons from China","volume":"25","author":"Lu","year":"2013","journal-title":"Eur. J. Gastroenterol. Hepatol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1111\/j.1751-2980.2010.00457.x","article-title":"Comparison of the efficacy of triple versus quadruple therapy on the eradication of Helicobacter pylori and antibiotic resistance","volume":"11","author":"Zheng","year":"2010","journal-title":"J. Dig. Dis."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e12722","DOI":"10.1111\/hel.12722","article-title":"Bismuth quadruple regimen with tetracycline or doxycycline versus three-in-one single capsule as third-line rescue therapy for Helicobacter pylori infection: Spanish data of the European Helicobacter pylori Registry (Hp-EuReg)","volume":"25","author":"Nyssen","year":"2020","journal-title":"Helicobacter"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"802","DOI":"10.1016\/j.cgh.2013.01.008","article-title":"Efficacy of bismuth-containing quadruple therapies for clarithromycin-, metronidazole-, and fluoroquinolone-resistant Helicobacter pylori infections in a prospective study","volume":"11","author":"Liang","year":"2013","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e12694","DOI":"10.1111\/hel.12694","article-title":"Non-bismuth and bismuth quadruple therapies based on previous clarithromycin exposure are as effective and safe in an area of high clarithromycin resistance: A real-life study","volume":"25","author":"Romano","year":"2020","journal-title":"Helicobacter"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Wasielica-Berger, J., Gugnacki, P., Mlynarczyk, M., Rogalski, P., Swidnicka-Siergiejko, A., Antonowicz, S., Krzyzak, M., Maslach, D., Dabrowski, A., and Daniluk, J. (2022). Comparative Effectiveness of Various Eradication Regimens for Helicobacter pylori Infection in the Northeastern Region of Poland. Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph19116921"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"e12570","DOI":"10.1111\/hel.12570","article-title":"Meta-analysis of three-in-one single capsule bismuth-containing quadruple therapy for the eradication of Helicobacter pylori","volume":"24","author":"Nyssen","year":"2019","journal-title":"Helicobacter"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"e12502","DOI":"10.1111\/hel.12502","article-title":"The \"three-in-one\" formulation of bismuth quadruple therapy for Helicobacter pylori eradication with or without probiotics supplementation: Efficacy and safety in daily clinical practice","volume":"23","author":"Zagari","year":"2018","journal-title":"Helicobacter"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1159\/000487391","article-title":"Effectiveness and Safety of Pylera(R) in Patients Infected by Helicobacter pylori: A Multicenter, Retrospective, Real Life Study","volume":"36","author":"Tursi","year":"2018","journal-title":"Dig. Dis."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"129","DOI":"10.15403\/jgld.2014.1121.262.itl","article-title":"Eradication rates in Italian subjects heterogeneously managed for Helicobacter pylori infection. Time to abandon empiric treatments in Southern Europe","volume":"26","author":"Scaccianoce","year":"2017","journal-title":"J. Gastrointest. Liver Dis."},{"key":"ref_22","first-page":"467","article-title":"Compliance, adverse effects and effectiveness of first line bismuth-containing quadruple treatment (Pylera(R)) to eradicate Helicobacter pylori infection in 200 patients","volume":"111","year":"2019","journal-title":"Rev. Esp. Enferm. Dig."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"667584","DOI":"10.3389\/fphar.2021.667584","article-title":"Single Capsule Bismuth Quadruple Therapy for Eradication of H. pylori Infection: A Real-Life Study","volume":"12","author":"Gravina","year":"2021","journal-title":"Front. Pharmacol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"860","DOI":"10.3748\/wjg.15.860","article-title":"Furazolidone, amoxicillin, bismuth and rabeprazole quadruple rescue therapy for the eradication of Helicobacter pylori","volume":"15","author":"Cheng","year":"2009","journal-title":"World J. Gastroenterol."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Eisig, J.N., Silva, F.M., Barbuti, R.C., Rodriguez, T.N., Malfertheiner, P., Moraes Filho, J.P., and Zaterka, S. (2009). Efficacy of a 7-day course of furazolidone, levofloxacin, and lansoprazole after failed Helicobacter pylori eradication. BMC Gastroenterol., 9.","DOI":"10.1186\/1471-230X-9-38"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"382","DOI":"10.1111\/hel.12143","article-title":"Tetracycline- and furazolidone-containing quadruple regimen as rescue treatment for Helicobacter pylori infection: A single center retrospective study","volume":"19","author":"Zhang","year":"2014","journal-title":"Helicobacter"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"256","DOI":"10.1111\/1751-2980.12870","article-title":"A randomized, multicenter and noninferiority study of amoxicillin plus berberine vs tetracycline plus furazolidone in quadruple therapy for Helicobacter pylori rescue treatment","volume":"21","author":"Zhang","year":"2020","journal-title":"J. Dig. Dis."},{"key":"ref_28","first-page":"347","article-title":"Rescue therapy for treatment failure of Helicobacter pylori infection","volume":"7","author":"Yang","year":"2002","journal-title":"Chin. J. Gastroenterol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"78","DOI":"10.4103\/sjg.SJG_589_19","article-title":"Treatment with compound Lactobacillus acidophilus followed by a tetracycline- and furazolidone-containing quadruple regimen as a rescue therapy for Helicobacter pylori infection","volume":"26","author":"Liu","year":"2020","journal-title":"Saudi J. Gastroenterol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"2522","DOI":"10.3748\/wjg.v21.i8.2522","article-title":"Meta-analysis: Is combination of tetracycline and amoxicillin suitable for Helicobacter pylori infection?","volume":"21","author":"Lv","year":"2015","journal-title":"World J. Gastroenterol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"e00432-18","DOI":"10.1128\/AAC.00432-18","article-title":"Ten-Day Quadruple Therapy Comprising Low-Dose Rabeprazole, Bismuth, Amoxicillin, and Tetracycline Is an Effective and Safe First-Line Treatment for Helicobacter pylori Infection in a Population with High Antibiotic Resistance: A Prospective, Multicenter, Randomized, Parallel-Controlled Clinical Trial in China","volume":"62","author":"Xie","year":"2018","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Lee, J.Y., Kim, N., Park, K.S., Kim, H.J., Park, S.M., Baik, G.H., Shim, K.N., Oh, J.H., Choi, S.C., and Kim, S.E. (2016). Comparison of sequential therapy and amoxicillin\/tetracycline containing bismuth quadruple therapy for the first-line eradication of Helicobacter pylori: A prospective, multi-center, randomized clinical trial. BMC Gastroenterol., 16.","DOI":"10.1186\/s12876-016-0490-8"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"274","DOI":"10.1111\/hel.12046","article-title":"Antibiotic resistance of Helicobacter pylori isolated in the Southeast Coastal Region of China","volume":"18","author":"Su","year":"2013","journal-title":"Helicobacter"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"e12475","DOI":"10.1111\/hel.12475","article-title":"Fifth Chinese National Consensus Report on the management of Helicobacter pylori infection","volume":"23","author":"Liu","year":"2018","journal-title":"Helicobacter"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1111\/hel.12085","article-title":"Ten-day Quadruple therapy comprising proton-pump inhibitor, bismuth, tetracycline, and levofloxacin achieves a high eradication rate for Helicobacter pylori infection after failure of sequential therapy","volume":"19","author":"Hsu","year":"2014","journal-title":"Helicobacter"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"e12683","DOI":"10.1111\/hel.12683","article-title":"Efficacy and safety of twice a day, bismuth-containing quadruple therapy using high-dose tetracycline and metronidazole for second-line Helicobacter pylori eradication","volume":"25","author":"Kim","year":"2020","journal-title":"Helicobacter"},{"key":"ref_37","first-page":"1536","article-title":"Tetracycline and metronidazole based quadruple regimen as first line treatment for penicillin allergic patients with Helicobacter pylori infection","volume":"99","author":"Gao","year":"2019","journal-title":"Zhonghua Yi Xue Za Zhi"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1111\/j.1440-1746.2006.04171.x","article-title":"Tetracycline, metronidazole and amoxicillin-metronidazole combinations in proton pump inhibitor-based triple therapies are equally effective as alternative therapies against Helicobacter pylori infection","volume":"21","author":"Matsushima","year":"2006","journal-title":"J. Gastroenterol. Hepatol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"634","DOI":"10.1007\/s10620-005-2549-1","article-title":"High eradication rates of Helicobacter pylori infection with first- and second-line combination of esomeprazole, tetracycline, and metronidazole in patients allergic to penicillin","volume":"50","year":"2005","journal-title":"Dig. Dis. Sci."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1047","DOI":"10.1046\/j.1365-2036.2002.01276.x","article-title":"Review article: Helicobacter pylori \"rescue\" regimen when proton pump inhibitor-based triple therapies fail","volume":"16","author":"Gisbert","year":"2002","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"458","DOI":"10.1007\/s10620-014-3365-2","article-title":"Helicobacter pylori first-line and rescue treatments in the presence of penicillin allergy","volume":"60","author":"Gisbert","year":"2015","journal-title":"Dig. Dis. Sci."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"e12686","DOI":"10.1111\/hel.12686","article-title":"Helicobacter pylori first-line and rescue treatments in patients allergic to penicillin: Experience from the European Registry on H pylori management (Hp-EuReg)","volume":"25","author":"Nyssen","year":"2020","journal-title":"Helicobacter"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1041","DOI":"10.1111\/j.1365-2036.2005.02687.x","article-title":"Helicobacter pylori first-line treatment and rescue options in patients allergic to penicillin","volume":"22","author":"Gisbert","year":"2005","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1111\/hel.12242","article-title":"Tailored versus Triple plus Bismuth or Concomitant Therapy as Initial Helicobacter pylori Treatment: A Randomized Trial","volume":"21","author":"Zhou","year":"2016","journal-title":"Helicobacter"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1385","DOI":"10.1111\/apt.15273","article-title":"Randomised controlled trial: Susceptibility-guided therapy versus empiric bismuth quadruple therapy for first-line Helicobacter pylori treatment","volume":"49","author":"Chen","year":"2019","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"799","DOI":"10.5009\/gnl20242","article-title":"Is a Potassium-Competitive Acid Blocker Truly Superior to Proton Pump Inhibitors in Terms of Helicobacter pylori Eradication?","volume":"15","author":"Sue","year":"2021","journal-title":"Gut Liver"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"153","DOI":"10.2169\/internalmedicine.2521-18","article-title":"Efficacy of Vonoprazan for Helicobacter pylori Eradication","volume":"59","author":"Kiyotoki","year":"2020","journal-title":"Intern. Med."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"636","DOI":"10.1111\/apt.13121","article-title":"Randomised clinical trial: Safety, tolerability, pharmacokinetics and pharmacodynamics of repeated doses of TAK-438 (vonoprazan), a novel potassium-competitive acid blocker, in healthy male subjects","volume":"41","author":"Jenkins","year":"2015","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1111\/apt.14130","article-title":"Systematic review with meta-analysis: The efficacy of vonoprazan-based triple therapy on Helicobacter pylori eradication","volume":"46","author":"Jung","year":"2017","journal-title":"Aliment. Pharmacol. Ther."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/23\/7040\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:28:41Z","timestamp":1760146121000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/23\/7040"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,11,28]]},"references-count":49,"journal-issue":{"issue":"23","published-online":{"date-parts":[[2022,12]]}},"alternative-id":["jcm11237040"],"URL":"https:\/\/doi.org\/10.3390\/jcm11237040","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,11,28]]}}}