Some Antibiotic Stewardship Interventions Have Negative Effects

Conan MacDougall, PharmD, professor of clinical pharmacy, University of California, San Francisco, discusses some interventions that have been shown to produce negative behavioral changes for antibiotic stewardship.

Interview Transcript (slightly modified for readability)

“It’s always important to think about — when you’re implementing a behavioral change strategy – potential unintended consequences. A great example is the use of prior authorization, one of the restricted approaches we use for antimicrobial stewardship. Although it’s highly effective in reducing overall antibiotic use, some studies have documented ways in which prescribers can gain the system.

One great study found that the time of day that was highest for prescribing restrictive antibiotics was, actually, immediately after the antibiotic restriction period ended. So, you have prescribers who are basically waiting hours to prescribe a patient a restrictive antibiotic, just to avoid having a conversation with the stewardship team. In those circumstances, at least some of those patients probably needed earlier treatment, and so, you can actually end up with suboptimal patient care.

So, it’s important to think about what are all the potential consequences, both positive and negative, when you’re implementing an intervention.”