ORGANIZATION: Healthsouth Sunrise Rehabilitation Hospital. PROBLEM OR ISSUE ADDRESSED: Increasing costs of Antibiotics. GOALS: To determine the reasons for increased costs of antibiotics at a rehabilitation hospital, and to determine whether interventions were necessary to reduce costs and improve outcomes. OUTCOMES ITEMS USED IN THE DECISION: (a) organism susceptibility per cultures when compared to empiric antibiotics selected, (b) proportion of empiric antibiotics subsequently determined to be resistant, (c) incidence of intravenous medications when patient was receiving oral medications, (d) duration of antibiotic therapy when patient was asymptomatic (and compared to recommended duration of therapy), and (e) appropriate dose and interval based on patient's renal function. IMPLEMENTATION STRATEGY: Random sampling of patients receiving antibiotics used in the previous 12 months. RESULTS: 1. More cost-effective medication were available empirically in the treatment of UTI and Cellulitus. 2. Selection of resistant antibiotics occurred infrequently, but when encountered, the change in antibiotics was delayed at times. 3. Some asymptomatic patients who were receiving all other medications oral could have been switched from IV to PO antibiotics. 4.Some excess duration because of antibiotic use at prior facility. 5. Dose and interval appropriate with some adjustments require for renal function, readily accepted by physicians. LESSONS LEARNED: Antibiotic selection needs some intervention. Three part program will be implemented: 1. Some restrictions on availability of ordering IV antibiotics without ID consult. 2. Physician education as to proper dose, interval, and frequency. 3. A pharmacy-run infectious disease service to guide empiric selection and ensure quick review of cultures.