This　study　evaluated　the　efficacy,　safety,　and　cost　of　minocycline,　ornidazole,　esomeprazole,　and　bismuth　(MOEB)　therapy　versus　classical　therapy　(amoxicillin,　clarithromycin,　esomeprazole,　and　bismuth　potassium　citrate,　ACEB)　for　Helicobacter　pylori　eradication.　In　a　randomized　trial　of　390　patients,　MOEB　demonstrated　superior　eradication　rates　(93.2%　per-protocol,　78.5%　intention-to-treat)　compared　to　ACEB　(82.5%　per-protocol,　72.8%　intention-to-treat).　Adverse　events　were　significantly　lower　with　MOEB　(19.3%　vs.　33.8%,　p　=　0.0019).　MOEB　was　also　more　cost-effective,　with　a　direct　cost　of　675.7　CNY　versus　970.1　CNY　for　ACEB,　yielding　an　incremental　cost-effectiveness　ratio　of　-27.5　CNY　per　eradication　rate.　MOEB　is　a　safe,　effective,　and　cost-efficient　first-line　regimen　for　H.　pylori　eradication.