RESUMO
The emergence of hypervirulent Clostridioides difficile strains has decreased the efficacy of metronidazole in the treatment of C. difficile infection (CDI). Therefore, revised guidelines no longer recommend the use of metronidazole as a first-line regimen for CDI and restrict its use for non-severe CDI, only when vancomycin and fidaxomicin are unavailable. In Korea, an epidemic caused by a hypervirulent C. difficile strain or the emergence of metronidazole resistant C. difficile strains have not been reported. This review article aims to compare the treatment outcomes and adverse effects of vancomycin and metronidazole and discuss the validity of the guidelines of various agencies, which restrict the use of metronidazole, for Korean patients. There are no substantial adverse effects of metronidazole, and its clinical outcomes against non-severe CDI are similar to those of vancomycin. Based on these findings, we recommend that the use of metronidazole for the treatment of non-severe CDI is still an appropriate option in Korea.
RESUMO
No abstract available.
RESUMO
Oral aphthous ulcer is a common lesion characterized by loss of dermal tissue of various shapes in many diseases. It is not serious, but may affect quality of life through pain and discomfort. In many cases, it heals spontaneously without treatment or with topical agents such as antiseptics, analgesics and corticosteroid in a few days. However, rarely, there are a few cases of aphthous ulcer that remain refractory despite appropriate treatment. Tumor necrosis factor-α inhibitors have recently been used in treatment of severe mucosal ulcer in Behçet's disease. Herein, we report a patient suffering from refractory oral aphthous ulcers that were resistant to topical and systemic agents, but were successfully treated with adalimumab.