Minocycline-Containing Bismuth Quadruple Therapy for Helicobacter pylori Treatment: A Multicenter Real-World Observational Study

Background/Aims: Minocycline is a semisynthetic tetracycline with potent antimicrobial activity against Helicobacter pylori (H. pylori) and favorable pharmacokinetic properties. Although minocycline-based bismuth quadruple therapy (BQT) has shown encouraging eradication rates in controlled studies, evidence from real-world practice remains limited. This study assessed the effectiveness, safety, and cost-effectiveness of minocycline-containing BQT in a real-world setting. Materials and Methods: In this multicenter, real-world observational study conducted at 25 hospitals in Fujian Province, China, between January and March 2025, adults with confirmed H. pylori infection were treated with 1 of 3 14-day BQT regimens: PBAC (amoxicillin– clarithromycin), PBMC (minocycline–clarithromycin), or PBML (minocycline levofloxacin), each combined with esomeprazole and bismuth. The primary endpoint was H. pylori eradication confirmed by a 13C-urea breath test after treatment. Secondary endpoints included adverse events, treatment adherence, and cost-effectiveness.