Colitis and pseudomembranous colitis associated with cephazolin prophylaxis

Three patients suffering from colitis associated with cephalexin therapy are reported. All had undergone surgery and had previously suffered severe associated medical problems. Their presenting symptoms included profuse diarrhea, vague abdominal pain, fever and leukocytosis, but all stool cultures were negative. In one case, a pseudomembrane was present; in another only acute inflammatory changes, and in the third patient, no proctosigmoidoscopy or biopsy was done. Cephalosporin therapy was halted and bowel rest as well as intravenous hydration were instituted. All three patients survived. Inasmuch as four cases of colitis associated with cephalosporin therapy have now been treated at UCLA Hospital, the authors believe that this diagnosis should be strongly considered when patients on cephalosporin develop diarrhea.