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Minocycline-containing therapy in Helicobacter pylori infection: a systematic review and meta-analysis
Zhihua Tian1, Yanjiao Zhang1, Nan Luo1
1Department of Gastroenterology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China.
Background:
Helicobacter pylori (H. pylori) infection and its related diseases constitute a significant global public health issue, and the growing antibiotic resistance of H. pylori poses a serious challenge.
Objectives:
Consequently, the search for sensitive, safe, economical, and readily available therapeutic drugs has become a core challenge in contemporary research.
Design:
This systematic review and meta-analysis of randomized controlled trials and observational studies followed the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (2020).
Data Sources And Methods:
This study conducted a thorough and systematic literature review of PubMed, Web of Science, EMBASE, China National Knowledge Infrastructure, Chinese Scientific Journal Database, and Wanfang Data up to October 16, 2025, using keywords such as minocycline and H. pylori. The included studies were assessed for risk of bias, and meta-analyses were conducted using Review Manager 5.3 and Stata/MP 14.0 to estimate the pooled effect sizes. Risk ratios (RR) were used for statistical analysis, and the corresponding 95% confidence intervals (CI) were calculated.
Results:
Minocycline exhibits pharmacokinetic characteristics including high absorption, strong lipophilicity, tissue permeability, and a prolonged half-life. Beyond its antibacterial effects, it also possesses non-antimicrobial activities such as anti-inflammatory, immunomodulatory, antioxidant, and anti-apoptotic properties. Eighteen studies from six countries indicate that H. pylori is sensitive to minocycline. This study included 33 clinical trials that evaluated minocycline-containing eradication regimens for H. pylori infection. Based on pairwise meta-analysis, both the intention-to-treat (ITT; RR = 1.04, 95% CI: 0.99-1.08, p = 0.15) and per-protocol (PP; RR = 1.04, 95% CI: 1.00-1.08, p = 0.06) analyses showed no significant difference in H. pylori eradication rates between the minocycline-containing eradication regimen and the control group; however, the overall incidence of adverse reactions was significantly lower (RR = 0.85, 95% CI: 0.78-0.92, p < 0.05), while compliance rate was comparable to that of the control group (RR = 1.01, 95% CI: 1.00-1.03, p = 0.15). Based on meta-analysis of proportions, the ITT analysis indicated the H. pylori eradication rate was 83% (95% CI: 79%-87%), while the PP analysis showed an eradication rate of 88% (95% CI: 83%-92%), an adverse reaction incidence of 29% (95% CI: 23%-36%), and compliance rates of 94% (95% CI: 91%-96%). The analysis revealed that minocycline-containing regimens exhibited favorable efficacy, safety, and patient compliance.
Conclusion:
Minocycline may be considered a viable antibiotic option for the eradication of H. pylori. Further multicenter, large-scale, high-quality clinical studies are still required to validate this conclusion.
Trial Registration:
The review was not registered in PROSPERO, we will do so in future studies.
Insights
Minocycline shows promise for eradicating Helicobacter pylori (H. pylori) infections, demonstrating lower adverse reactions and good compliance. Further research is needed to confirm its efficacy as a viable treatment option.
Area of Science:
- Infectious Diseases
- Pharmacology
- Microbiology
Background:
- Helicobacter pylori (H. pylori) infection is a global health concern.
- Increasing antibiotic resistance in H. pylori presents a significant challenge.
- Developing new, effective, and safe treatments is crucial.
Purpose of the Study:
- To systematically review and meta-analyze the efficacy and safety of minocycline-containing regimens for H. pylori eradication.
- To assess treatment success rates, adverse events, and patient compliance.
- To identify minocycline as a potential therapeutic agent against H. pylori.
Main Methods:
- Systematic literature review of multiple databases (PubMed, Web of Science, EMBASE, etc.) up to October 2025.
- Inclusion of randomized controlled trials and observational studies.
- Meta-analysis using Review Manager 5.3 and Stata/MP 14.0, calculating risk ratios and confidence intervals.
Main Results:
- Minocycline-containing regimens showed comparable H. pylori eradication rates to control groups (ITT: 83%, PP: 88%).
- Significantly lower incidence of adverse reactions (29%) was observed with minocycline.
- Patient compliance rates were comparable (94%) to control groups.
Conclusions:
- Minocycline-containing regimens exhibit favorable efficacy, safety, and patient compliance for H. pylori eradication.
- Minocycline is a potential antibiotic option for H. pylori treatment.
- Further large-scale, multicenter clinical studies are recommended to validate these findings.
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