Comparison of Prior Authorization and Prospective Audit with Feedback for Antimicrobial Stewardship

Antimicrobial stewardship programs (ASPs) are multifaceted, interdisciplinary approaches to optimize anti-infective therapy and address emerging resistant pathogens.1,2 Guidelines for stewardship identify several potential strategies, including 2 core “active” methods: formulary restriction with prior authorization and prospective audit with feedback to prescribers. Prior authorization permits use of select agents after approval from an ASP team member, whereas prospective audit with feedback utilizes postprescriptive reviews conducted by the ASP to recommend changes in agent selection, dosing, or duration of therapy.2,3 Published literature supports both methods as being effective strategies to decrease antimicrobial exposure, decrease costs, and improve clinical outcomes.4–9 However, because these 2 ASP methods have not been compared, the most effective approach remains unclear.2,10 Implementation of ASPs is increasingly common, and widespread adoption of stewardship interventions has been promoted by professional and governmental organizations.2,11,12 This study aims to compare an ASP based on prior authorization alone to one combining prior authorization and prospective audit with feedback.