Preprescription Authorization vs. Postprescription Review with Feedback for Antimicrobial Stewardship

There are two general approaches to implementing antimicrobial stewardship. With preprescription approval (PPA), antibiotics can only be prescribed if there is prior approval from the stewardship program. Although PPA assures that the most appropriate antibiotics are chosen and cultures are obtained, it generally only pertains to specific agents. Postprescription review with feedback (PPRF) is more flexible, allows more evidence-based discussion with prescribers, and applies to all antibiotic use. However, PPRF occurs after antibiotics have been prescribed, can be time consuming, and does not address empiric use. Little evidence exists on which approach is better.

To compare the effect of each approach, researchers at Johns Hopkins Hospital …