High Eradication Rate of a Potassium-Competitive Acid Blocker-Based Minocycline, Furazolidone, and Bismuth Regimen for Refractory Helicobacter pylori Infection: A Real-World Study.

Abstract

Background: Management of refractory Helicobacter pylori (H. pylori) infection remains challenging due to increasing antibiotic resistance and limited effective rescue options. Minocycline and furazolidone retain low resistance rates, while potassium-competitive acid blockers (P-CABs) provide potent and sustained acid suppression. This study aimed to evaluate the efficacy and safety of a 14-day P-CAB-based regimen combining minocycline, furazolidone, and bismuth in patients with refractory H. pylori infection.

Methods: From January 2023 to October 2025, clinical data were collected from patients with refractory H. pylori infection who received the above regimen at Tongji Hospital, Wuhan, China. Eradication was assessed by a urea breath test performed at least 4 weeks after treatment. Adverse events during treatment were recorded.

Results: A total of 368 patients were included in modified intention-to-treat analysis. Of them, 183 (49.7%) had two previous eradication failures, 165 (44.8%) had three to four failures, and 20 (5.4%) had five or more failures. Among the 143 patients who underwent antibiotic resistance gene testing, the resistance rates to clarithromycin and quinolones were 96.5% and 79.7%, respectively. The H. pylori eradication rate was 92.7% (95% CI 89.5%-94.9%) in modified intention-to-treat analysis and 96.4% (95% CI 93.8%-97.9%) in per-protocol analysis. Adverse events occurred in 25.8% of patients and were predominantly mild to moderate, with dizziness (9.5%), nausea (5.2%), and abdominal distension (5.2%) most common. Poor compliance (OR = 18.14, 95% CI 6.39-51.51) and peptic ulcer (OR = 4.34, 95% CI 1.27-14.82) were independently associated with eradication failure.

Conclusions: The 14-day regimen of P-CAB, minocycline, furazolidone, and bismuth is highly effective and well tolerated in patients with refractory H. pylori infection. This regimen represents a promising empirical rescue therapy, particularly in settings where antimicrobial susceptibility testing is unavailable.