| 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 antimicrobial stewardship program 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 well
- Effectiveness depends on skill of approver
- Real-time resource intensive
- Potential for manipulation of system (eg, 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 technology support and/or purchase of computerized surveillance systems
- May take longer to achieve reductions in targeted antibiotic use
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