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He was not considered a surgical candidate due to the severity of his underlying recurrent non-Hodgkin lymphoma. The patient was subsequently started on oral rifampin 600 mg twice daily, and resolution of both fever and diarrhea was noted within several days. However, a prospective randomized study published in 2006 compared metronidazole and rifampin combination therapy with metronidazole alone and found no significant difference in time to symptom resolution, though there was a significant increase in mortality in the metronidazole plus rifampin group.
30 It should be noted that this study excluded patients with ileus and toxic megacolon, and it was halted early due to study futility. Another, more detailed, analysis was undertaken by Juang and colleagues, who retrospectively evaluated a population of patients with severe CDAD during an epidemic period between July 2001 and July 2003.