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. 2017 Mar 1;64(5):537-543.
doi: 10.1093/cid/ciw780.

What Is the More Effective Antibiotic Stewardship Intervention: Preprescription Authorization or Postprescription Review With Feedback?

Pranita D Tamma  1 , Edina Avdic  2 , John F Keenan  3 , Yuan Zhao  4 , Gobind Anand  5 , James Cooper  6 , Rebecca Dezube  7 , Steven Hsu  8 , Sara E Cosgrove  9
Affiliations

What Is the More Effective Antibiotic Stewardship Intervention: Preprescription Authorization or Postprescription Review With Feedback?

Pranita D Tamma et al. Clin Infect Dis. .

Erratum in

  • Erratum.
    [No authors listed] [No authors listed] Clin Infect Dis. 2017 Nov 13;65(11):1961. doi: 10.1093/cid/cix758. Clin Infect Dis. 2017. PMID: 29140518 Free PMC article. No abstract available.

Abstract

Background: The optimal approach to conducting antibiotic stewardship interventions has not been defined. We compared days of antibiotic therapy (DOT) using preprescription authorization (PPA) vs postprescription review with feedback (PPRF) strategies.

Methods: A quasi-experimental, crossover trial comparing PPA and PPRF for adult inpatients prescribed any antibiotic was conducted. For the first 4 months, 2 medicine teams were assigned to the PPA arm and the other 2 teams to the PPRF arm. The teams were then assigned to the alternate arm for an additional 4 months. Appropriateness of antibiotic use was adjudicated by at least 2 infectious diseases-trained clinicians and according to institutional guidelines.

Results: There were 2686 and 2693 patients admitted to the PPA and PPRF groups, with 29% and 27% of patients prescribed antibiotics, respectively. Initially, antibiotic DOTs remained relatively unchanged in the PPA arm. When changed to the PPRF arm, antibiotic use decreased (-2.45 DOT per 1000 patient-days [PD]). In the initial PPRF arm, antibiotic use decreased (slope of -5.73 DOT per 1000 PD) but remained constant when changed to the PPA arm. Median patient DOTs in the PPA and PPRF arms were 8 and 6 DOT per 1000 PD, respectively (P = .03). Antibiotic therapy was guideline-noncompliant in 34% and 41% of patients on days 1 and 3 in the PPA group (P < .01) and in 57% and 36% of patients on days 1 and 3 in the PPRF group (P = .03).

Conclusions: PPRF may have more of an impact on decreasing antibiotic DOTs compared with PPA. This information may be useful for institutions without sufficient resources to incorporate both stewardship approaches.

Keywords: ASP; antibiotics; antimicrobial stewardship.; days of therapy.

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Figures

Figure 1.
Figure 1.
Anti-infectives reviewed by the antibiotic stewardship team as part of the current study. *Anti-infectives that were restricted as part of the preprescription authorization policy.
Figure 2.
Figure 2.
Study design comparing antibiotic use among providers receiving preprescription authorization vs postprescription review with feedback antibiotic stewardship strategies.
Figure 3.
Figure 3.
Time-series analyses comparing days of antibiotic therapy per 1000 patient-days during the study period. Dotted lines indicate preprescription authorization and solid lines indicate postprescription review with feedback. Dotted vertical line represents the four week washout period, during which antibiotics were not adjudicated.
See this image and copyright information in PMC

Comment in

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