Skip to main content
    • Aa
    • Aa

Evaluation of Postprescription Review and Feedback as a Method of Promoting Rational Antimicrobial Use: A Multicenter Intervention

  • Sara E. Cosgrove (a1), Susan K. Seo (a2), Maureen K. Bolon (a3), Kent A. Sepkowitz (a2), Michael W. Climo (a4), Daniel J. Diekema (a5), Kathleen Speck (a6), Vidhya Gunaseelan (a7), Gary A. Noskin (a3), Loreen A. Herwaldt (a5), Edward Wong (a4) and Trish M. Perl (a1)...

To evaluate the impact of postprescription review of broad-spectrum antimicrobial (study-ABX) agents on rates of antimicrobial use.


Quasi-experimental before-after study.


Five academic medical centers.


Adults receiving at least 48 hours of study-ABX.


The baseline, intervention, and follow-up periods were 6 months each in 2 units at each of 5 sites. Adults receiving at least 48 hours of study-ABX entered the cohort as case-patients. During the intervention, infectious-diseases physicians reviewed the cases after 48 hours of study-ABX. The provider was contacted with alternative recommendations if antimicrobial use was considered to be unjustified on the basis of predetermined criteria. Acceptance rates were assessed 48 hours later. The primary outcome measure was days of study-ABX per 1,000 study-patient-days in the baseline and intervention periods.


There were 1,265 patients in the baseline period and 1,163 patients in the intervention period. Study-ABX use decreased significantly during the intervention period at 2 sites: from 574.4 to 533.8 study-ABX days/1,000 patient-days (incidence rate ratio [IRR], 0.93; 95% confidence interval [CI], 0.88-0.97; P = .002) at hospital В and from 615.6 to 514.4 study-ABX days/1,000 patient-days (IRR, 0.83; 95% CI, 0.79-0.88; P < .001) at hospital D. Both had established antimicrobial stewardship programs (ASP). Study-ABX use increased at 2 sites and stayed the same at 1 site. At all institutions combined, 390 of 1,429 (27.3%) study-ABX courses were assessed as unjustified; recommendations to modify or stop therapy were accepted for 260 (66.7%) of these courses.


Postprescription review of study-ABX decreased antimicrobial utilization in some of the study hospitals and may be more effective when performed as part of an established ASP.

Corresponding author
Osler 425, Johns Hopkins Hospital, 600 North Wolfe Street, Baltimore, MD 21287 (
Linked references
Hide All

This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

1.TH Dellit , RC Owens , JE McGowan Jr., et al.Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Clin Infect Dis 2007;44(2): 159177.

2.MT Hecker , DC Aron , NP Patel , MK Lehmann , CJ Donskey . Unnecessary use of antimicrobials in hospitalized patients: current patterns of misuse with an emphasis on the antianaerobic spectrum of activity. Arch Intern Med 2003;163(8):972978.

6.R Gross , AS Morgan , DE Kinky , M Weiner , GA Gibson , NO Fishman . Impact of a hospital-based antimicrobial management program on clinical and economic outcomes. Clin Infect Dis 33; 33(3):289295.

7.AC White Jr, RL Atmar , J Wilson , TR Cate , CE Stager , SB Greenberg . Effects of requiring prior authorization for selected antimicrobials: expenditures, susceptibilities, and clinical outcomes. Clin Infect Dis 1997;25(2):230239.

8.AL Pakyz , C MacDougall , M Oinonen , RE Polk . Trends in antibacterial use in US academic health centers: 2002 to 2006. Arch Intern Med 2008;168(20):22542260.

9.JH Kim , HA Gailis . Observations on spiraling empiricism: its causes, allure, and perils, with particular reference to antibiotic therapy. Am J Med 1989;87(2):201206.

10.DM Patrick , F Marra , J Hutchinson , DL Monnet , H Ng , WR Bowie . Per capita antibiotic consumption: how does a North American jurisdiction compare with Europe? Clin Infect Dis 2004;39(1):1117.

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Infection Control & Hospital Epidemiology
  • ISSN: 0899-823X
  • EISSN: 1559-6834
  • URL: /core/journals/infection-control-and-hospital-epidemiology
Please enter your name
Please enter a valid email address
Who would you like to send this to? *