[Use of the immunopotentiator N-acetyl-glucosamine-N-acetylmuramyl dipeptide during triple anti-Helicobacter pylori therapy]

Abstract

Aim: To evaluate the efficiency of first-line Helicobacter pylori eradication therapy with glucosaminylmuramyldipeptide (Licopid JSC "Peptek", Russia).

Subjects and methods: Eradication therapy was performed in 128 patients (84 men and 34 women; mean age 44.1 +/- 13.5 years) with duodenal bulb ulcer associated with H. pylori. The latter was detected in the gastroduodenal mucosa by a morphological study and rapid urease test before and 6-8 weeks after treatment and discontinuation of all drugs. Gastric metaplasia areas in the duodenum were revealed by periodic acid-Schiff and Alcian blue staining. The patients were divided into 4 groups according to the treatment protocol: 1) omeprazole (O) 0.04 g/day, clarithromycin (C) 1 g/day, amoxicillin (A) 2 g/day for 7 days (OCA7; n = 33); 2) the above drugs for 14 days (OCA14; n = 34); 3) O 0.04 g/day, C 1 g/day, A 2.0 g/day for 7 days, and glucosaminylmuramyldipeptide (Licopid) (L) 0.001 g/day for a day (OCA7L1; n = 34) and 4) the above drugs and L 0.01 g/day for 10 (OCA7L10; n = 27).

Results: According to the data of intention-to-treat analysis and per protocol, the H. pylori eradication rate was 81.8 and 87.1% for OCA7; 82.4 and 93.3% for OCA14; 88.2 and 93.8% for OCA7L1; 88.9 and 96% for OCA7L10 after PT and RRT, respectively. The rate of side effects was as follows: 6.1% for OCA7; 17.6% for OCA14 (5.9% stopped treatment); 5.9% for OCA7L1; 7.4% for OCA7L10. The cost of the treatment protocols was $ 32 for OCA7; $ 64 for OCA14; $ 40 for OCA7L1; $ 67 for OCA7L10. The intake of glucosaminylmuramyldipeptide (licopid) 0.001 g/day during 7-day triple anti-Helicobacter pylori therapy increased eradication by 6.4% (ITT) and 6.7% (PP), without raising the rate of side effects.

Conclusion: H. pylori-positive patients with duodenal bulb ulcer should be given glucosaminylmuramyldipeptide (Licopid) 0.001 g/day during 7-day first-line eradication therapy as alternative to the 14-day treatment regimen.