s 131 Design and implementation of an antibiotic usage review J. B. Babcock, G. J. Damert,*t J. E. Cooper,f and T. R. Franson* Ofice of Chief of Staff and Departments of *Medicine and 7 Nursing, Veterans Administration Medical Center, 5000 West National Avenue, Wood (Milwaukee), Wisconsin 53193, USA To have an integrated and effective hospital quality assurance programme, there should ideally be active communication and sharing of audit data and information among a variety of disciplines. Appropriate committtee structure and membership can promote interaction between hospital infection control., antibiotic usage review, pharmacy and therapeutics and quality assurance committees. The antibiotic usage review committee decided to use an antibiotic order sheet similar to that described by Durbin, Lapida and Goldmann (1981). The order form requires the physician to categorize antibiotic usage as to prophylactic (i.e. anticipated invasive procedure), empiric (i.e. suspected infection but no pathogen identified), or therapeutic (i.e. known infection with identified pathogen). Depending upon the category chosen, automatic stop dates of 2 days (prophylactic), 3 days (empiric) or 7 days (therapeutic) were established for inpatients and were adhered to, unless the prescription order is rewritten. Experience using the antibiotic prescription order sheet was studied by sampling 7 consecutive days in July and August 1984. A total of 487 antibiotic prescription order sheets were reviewed from 257 patients during a 14-day period. An analysis of 489 antibiotic prescription forms from 257 patients during two sample periods over a total of 14 days showed that the frequency of antibiotic orders was 28 per cent prophylactic use, 47 per cent empiric use and 25 per cent therapeutic use. The antibiotic form was used without exception for inpatients because of strict enforcement by Pharmacy Service. Although it is premature to assess long-range benefits at this point, the use of an antibiotic order form allows concurrent audit processes, discourages inappropriate or inadvertent antibiotic use (with projected cost savings), prevents changes in bacterial flora from casual antibiotic use, and provides a mechanism for multidisciplinary co-operation in quality assurance. References Durbin, W. A., Jr, Lapida, B. & Goldmann, D. A. (1981). Improved antibiotic usage following introduction of a novel prescription system. Journal of the American Medical Association 246, 1796-l 800. t Present address: Kaiser-Foundation Hospital, Cleveland, Ohio, USA. Revolution in rabies prevention: a public health perspective L. Y. Altmayer, C. V. Trimarchi* and N. B. Schellt 480 Parker Avenue, Levittown, New York 117.56 *New York State Department of Health, Albany, New York 12201 and TNassau County Department of Health, 240 Old C ountry Road, Mineola, New York 11.501, USA In 1884, Louis Pasteur presented to an international audience in Copenhagen his original report on the use of a vaccine for the prophylaxis of rabies. It is fitting, in 1984 and at another international meeting, to pay tribute to him and to the workers who have followed him in this field.