antibiotic prescribing trends before and after implementation of an audit and feedback program in internal ward of a tertiary hospital in tehran

We implemented a post prescribing review and feedback program to investigate its effect on appropriateness of antimicrobial use and antimicrobial consumption rate. a pre-post interventional study conducted in internal ward of imam hossein teaching hospital. for nine months of intervention phase, medical file of all patients who received intravenous antibiotic were reviewed by a clinical pharmacy specialist. discrepancies from international and local guidelines were discussed with physicians. outcome measures included appropriateness of antimicrobial usage, length of stay, and broad- spectrum antimicrobial usage rate. a total of 198 antibiotic courses (154 in intervention phase and 44 in pre-intervention phase) were reviewed. one-hundred sixty-seven recommendations in treatment course of 75.3% of patients were made. the most common recommendations were discontinuing antibiotics and changing from intravenous to oral therapy (35% and 22%). the acceptance rate was 80.2%. rate of discrepancies from guidelines was compared between pre-intervention and two last months of intervention period which showed a significant reduction in antibiotic choosing (47%, p-value < 0.001), de-escalation (48%, p-value < 0.001), on time changing intravenous to oral therapy (60%, p-value < 0.001) and dosing schedule (30%, p-value = 0.003). hospital length of stay showed a significant reduction from 16.1 days to 11.6 days (p-value < 0.05) between pre-intervention and post-intervention group. mortality rate was not different in the patients that intervention in their treatment was accepted vs. rejected (p-value = 1.00). there was a reduction trend in consumption rate of carbapenems, vancomycin, and ciprofloxacin. therefore, prospective audit and feedback program effectively decreased inappropriate treatment and hospital length of stay with no effect on mortality.