is the leading cause of antibiotic‐associated diarrhoea and is a major burden to healthcare services worldwide. Fidaxomicin is a first‐in‐class macrocyclic antibiotic that was approved for the treatment of infection (CDI) in 2011, demonstrating a narrow spectrum of activity and comparable efficacy to vancomycin in clinical trials.

Case presentation:

We present the case of a patient with recurrent CDI who was non‐responsive to standard treatment with metronidazole and vancomycin. The patient subsequently developed toxic megacolon, which had to be treated surgically by subtotal colectomy. Fidaxomicin at 200 mg twice daily was delivered in small‐volume enemas directly to the oral part of the sigmoid colon to preserve the remaining rectosigmoid colon and improve the chances of restoring gastrointestinal tract continuity. After 11 days of local fidaxomicin therapy, diagnostic tests revealed that the patient was negative and no recurrence of CDI was observed. Restoration of the gastrointestinal tract was successfully completed 5 months after hospital discharge.


This report describes a novel concept of local fidaxomicin delivery to the rectosigmoid colon, with an improved clinical outcome compared with metronidazole and vancomycin treatment. The study suggests that topical application of fidaxomicin may be beneficial in some CDI patients following surgical treatment for toxic megacolon.

  • This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0/).

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