Minocycline-containing therapy in Helicobacter pylori infection: a systematic review and meta-analysis

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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.