Interventions
Table 1. Comparison of Preauthorization and Prospective Audit
and Feedback Strategies for Antibiotic Stewardship
Preauthorization Prospective Audit and Feedback
Advantages
• Reduces initiation of unnecessary/
inappropriate antibiotics
• Optimizes empiric choices and
influences downstream use
• Prompts review of clinical data/
prior cultures at the time of initiation
of therapy
• Decreases antibiotic costs, including
those due to high-cost agents
• Provides mechanism for rapid response
to antibiotic shortages
• Direct control over antibiotic use
• Can increase visibility of ASP and
build collegial relationships
• More clinical data available for
recommendations, enhancing uptake
by prescribers
• Greater flexibility in timing of
recommendations
• Can be done on less than daily basis if
resources are limited
• Provides educational benefit to
clinicians
• Prescriber autonomy maintained
• Can address de-escalation of antibiotics
and duration of therapy
Disadvantages
• Impacts use of restricted agents only
• Addresses empiric use to a much
greater degree than downstream use
• Loss of prescriber autonomy
• May delay therapy
• Effectiveness depends on skill of
approver
• Real-time resource intensive
• Potential for manipulation of system
(e.g., presenting request in a biased
manner to gain approval)
• May simply shift to other antibiotic
agents and select for different
antibiotic-resistance patterns
• Compliance voluntary
• Typically labor-intensive
• Success depends on delivery method of
feedback to prescribers
• Prescribers may be reluctant to change
therapy if patient is doing well
• Identification of interventions may
require information technolog y
support and/or purchase of
computerized surveillance systems
• May take longer to achieve reductions
in targeted antibiotic use
