Fidaxomicin as a Salvage Therapy for Fulminant Clostridioides difficile Infection

Few studies have demonstrated the efficacy of fidaxomicin in the treatment of fulminant Clostridioides difficile infection (CDI). Fidaxomicin has been used as part of the standard treatment for nonsevere and severe CDI according to the guidelines by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America, but not in severe fulminant CDI due to lack of randomized clinical trials supporting its use. We present the case of a patient who developed severe fulminant colitis initially refractory to treatment with oral vancomycin and intravenous metronidazole that had an impressive improvement within 24-hour of starting fidaxomicin. The patient had a complete resolution of the symptoms at the end of the therapy without requiring a surgical approach. There are few case reports of fulminant CDI treated with fidaxomicin as a salvage therapy for fulminant CDI. In this challenging scenario, information about the use of fidaxomicin is still limited and more clinical trials are needed to support its widespread use.