Post-script review, feedback curtails antibiotic use

Physician buy-in is the key

A new multicenter study shows that antimicrobial stewardship expressed as a post-prescription review and feedback intervention can decrease antimicrobial use, especially when it's part of an established antimicrobial program.1

This was the first study to look at performing the same antimicrobial stewardship intervention at multiple academic hospitals, says Sara Cosgrove, MD, MS, an associate professor of medicine in the division of infectious diseases at Johns Hopkins University School of Medicine in Baltimore, MD.

"We took five different academic medical centers and came up with standardized data collection materials and interventions," Cosgrove explains. "The intervention was that at 48-72 hours we had an infectious disease physician review the use of broad spectrum antibiotic use on some medical and surgical floors of the hospital."

If the ID physician did not believe broad spectrum antibiotics was appropriate, the doctor would call the medical teams to recommend stopping the antibiotic.

The study's end point was to see if antibiotic use changed from the baseline, before calls were made, to the time after the intervention occurred.

"There was a mixed benefit," Cosgrove says.

"In hospitals where there was an established antimicrobial program that included salary support and intellectual support of stewardship, there was a decrease in antimicrobial use in the follow-up period," she says. "In other hospitals, where programs had just started or did not exist, we didn't see any reduction in antibiotic use."

The study's findings suggest that health systems that have a comprehensive antimicrobial stewardship program in place with financial and moral support from the institution have clinicians who are more likely to accept the recommendations of an infectious disease doctor.

"This lends support to the notion that hospitals should support and endorse stewardship programs, and there needs to be some kind of organized approach," Cosgrove says. "If it were mandated and everyone did it, then it would be even easier to convince physicians to make changes because it would be normal."

When investigators looked closely at prescribers' actions, they found that they were much more likely to take a recommendation to change the patient's antimicrobial than they were to stop the antibiotic, she notes.

"There might be some nervousness about stopping antibiotics with doctors thinking there might be an infection that has not been discovered," she explains. "In stewardship, you'd much rather have them stop the drug if it's not indicated, and stopping antibiotics is how we'll improve resistance."


  1. Evaluation of postprescription review and feedback as a method of promoting rational antimicrobial use: a multicenter intervention. Infect Contr & Hosp Epid. 2012;33(4):374-380.