Cluster RCT: A discharge-focused prospective audit and feedback intervention did not reduce overall antibiotic use at hospital discharge but improved optimal discharge prescribing for common infections; broader approaches are needed.

Question Does a discharge-focused prospective audit and feedback process decrease antibiotic overuse at hospital discharge?

Findings In this stepped-wedge cluster-randomized clinical trial across participating units at 10 hospitals with 21 842 admissions, the frequency and duration of antibiotic prescribing at hospital discharge did not decrease after implementing a prospective audit and feedback process. However, in selected patients with uncomplicated infections, optimal antibiotic-prescribing increased once the intervention went into effect.

Meaning Discharge-focused prospective audit and feedback was not effective in reducing general antibiotic overuse at hospital discharge, but it did improve antibiotic prescribing in a subset of patients, suggesting that other strategies are needed to prevent unnecessary antibiotic use at this transition of care.