Cephalosporins

conus associated witb C. difficile A 65-year-old farmer. hospitalized for a 'shaking chill,' was started on cefazolin sodium Ig IV every \\ hours after Staphylococcus aureus was observed in 3 blood cultures. Watery diarrhea began 2 days later. His drug therapy was then changed to cephalothin sodium 2g IV every 4 hours. whereupon within 3 days increasing watery diarrhea of 10 stools per day developed. He was afebrile and no other symptoms were present. Stool cultures did not reveal Closlridium d![(icile directly. but both gas gangrene antitoxin and the more specific anti C. di/ficile toxin neutralized colitis-inducing activities in tissue cultures, suggesting that C. dij!icife was. indeed. responsible. Cephalothin was discontinued and IV vancomycin HCI 0.5g every 6 hours begun on the tenth hospital day. The following day, sigmoidoscopy revealed an eI)1.hematous, granular mucosa with many WBC·s. Radiographic examination 2 days later showed multiple ulcerations and plaques throughout the colon. Four days after the change in antibiotics. the diarrbea was much improved. This is the second repon of a cephalosporin-induced colitis where C. difflcile may have been implicated. Uon(;o. s:r. .1 aJ , Arc!>ives of IntJ:rllaJ Medicine 140 574 IApr 1980)

4 Reactions 13 Jun 1980 0157-7271/80/0613-000410 $00.50/0 ~. ADIS Press