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This paper evaluates the effect of a policy change on the use of cephalosporins in an acute hospital. The main outcome measures (timeliness and appropriateness of administrationof antibiotics, infection rates, length of hospital stay and readmission rate) showed significant improvements. The change of policy from three doses a day to a once-a-day dose improved the prescribing, preparation and administration of all cephalosporins in the short term and resulted in a shorter length of hospital stay, lower readmission rates and a reduction in bacteriologically confirmed infections. This pilot study could be used as the basis for further research.

Two weeks following a renal arteriogram a 56-year-old man with severe hypertension developed a staphylococcal septicaemia. After six weeks treatment with intravenous fusidic acid and cloxacillin he became icteric, confused and disorientated. The fusidic acid was stopped and the serum bilirubin fell to normal. His confusion persisted and serum cloxacillin levels were found to be grossly elevated. The patient's mental state returned to normal following withdrawal of cloxacillin.We attribute his jaundice to treatment with fusidic acid and his acute confusional state to cloxacillin neurotoxicity.