Post-prescription audit and review, a key antibiotic stewardship intervention, can be successfully implemented at community hospitals, which often have limited resources, according to a study published in JAMA Network Open.
Researchers conducted a multicenter clinical trial at four community hospitals in North Carolina from October 2014 through October 2015. They examined the feasibility of implementing two antibiotic stewardship interventions recommended by the Infectious Diseases Society of America:
• A modified preauthorization, in which the prescriber had to receive pharmacist approval for use of the antibiotic after the first dose
• Post-prescription audit and review, in which the pharmacist would discuss antibiotic appropriateness with the prescriber after 72 hours of therapy
Each hospital performed the modified preauthorization and post-prescription audit and review interventions for six months at a time. During the study, pharmacists performed 1,456 modified preauthorization interventions and 1,236 post-prescription audit and review interventions.
Antibiotic therapy was deemed inappropriate twice as often during the post-prescription audit and review phase of the study period than the preauthorization period. Pharmacists recommended dose change more often during the modified preauthorization intervention; however, de-escalation of antibiotic therapy occurred more often during the post-prescription audit and review.
Overall antibiotic use decreased during the post-prescription audit and review intervention as compared with historical controls, but not during modified preauthorization period.