Audit of an official recommendation on screening for congenital dislocation of the hip.

patients, but only one ofthe "secondary" cases occurred within 30 days of the index case; the others were two months and three months apart. Although rifampicin prophylaxis is of limited value, the relatively poor compliance with the current recommendations suggests that its value is commonly reduced even further by incorrect use. There has been concern that widespread use of rifampicin might lead to the development of rifampicin resistant strains ofH influenzae type b.'0 However, in our laboratory all of 120 strains of H influenzae type b tested by agar dilution were inhibited by <0:03 mg/l rifampicin (unpublished data). Other objections to the use of rifampicin are that it sometimes fails to prevent secondary H influenzae type b disease9 and that it is associated with significant cost and risk of toxicity. A four day course for a family of two adults and three children is $A50 and the risk of toxicity is small if suitable precautions are observed. At present there is no alternative to rifampicin for contacts in whom its use is contraindicated-for example, pregnant women. Ceftriaxone is effective in eliminating Neissenra meningitidis from the throats of carriers.22 With the more widespread use of this agent for treal:ing invasive H influenzae type b disease it would be useful to determine whether it can also eliminate this organism from the throats of patients; if so, it may be an alternative to rifampicin for selected contacts. This study has emphasised the limitations of antibiotic prophylaxis in preventing H influenzae type b disease. A significant impact on its incidence can be achieved only by immunisation,' which should be introduced as soon as possible for protection of children at risk.