REVIEW article
Front. Microbiol.
Sec. Antimicrobials, Resistance and Chemotherapy
Volume 16 - 2025 | doi: 10.3389/fmicb.2025.1667516
Amoxicillin or tetracycline in bismuth-containing quadruple therapy for Helicobacter pylori eradication: A systematic review and meta-analysis
Provisionally accepted
- 1Qilu Hospital of Shandong University, Jinan, China
- 2Qingdao University Affiliated Qingdao Third People's Hospital, Qingdao, China
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Background: Amoxicillin and tetracycline have been widely used in Helicobacter pylori (H. pylori) eradication therapy, and the priority of their efficacy and safety in bismuth-containing quadruple therapy (BQT) remain controversial. Materials and Methods: A comprehensive systematic review was conducted by searching databases from their inception until June 2025. Studies that compared BQT arms containing amoxicillin with those containing tetracycline were included. Pooled relative risks (RR) and 95% confidence intervals (CI) of the efficacy and safety outcomes were reported. Results: Seven randomized controlled trials and 2 observational studies were included in the meta-analysis. The pooled eradication rates of amoxicillin-containing BQT versus tetracycline-containing BQT in the first-line treatment were not statistically different in the intention-to-treat (86.5% vs 81.4%, RR: 1.07, 95% CI: 0.99 - 1.17, P = 0.10) and per-protocol (93.3% vs 90.7%, RR: 1.03, 95% CI: 0.97 - 1.10, P = 0.34) analyses. The eradication rates for rescue therapy yielded similar results in the ITT (81.1% vs 89.7%, RR: 0.90, 95% CI: 0.79 - 1.03, P = 0.13) and PP (85.1% vs 93.4%, RR: 0.91, 95% CI: 0.80 - 1.03, P = 0.14) analyses. The risk of total adverse events was lower in the amoxicillin-containing BQT than in the tetracycline group (26.8% vs 37.1%, P < 0.00001). No difference in total compliance (94.8% vs 92.8%, P = 0.20). Conclusion: The efficacy of both amoxicillin-and tetracycline-containing BQT demonstrated comparable eradication rates and compliance, while the amoxicillin group exhibited fewer adverse events.
Keywords: Amoxicillin, Bismuth-containing quadruple therapy, efficacy, Helicobacter pylori, Tetracycline
Received: 17 Jul 2025; Accepted: 02 Sep 2025.
Copyright: © 2025 Ju, Kong, Zhang and Zhu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Shanling Zhang, Qingdao University Affiliated Qingdao Third People's Hospital, Qingdao, China
Liangrun Zhu, Qingdao University Affiliated Qingdao Third People's Hospital, Qingdao, China
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