After implementation of antibiotic stewardships programs (ASPs) in 15 small hospitals, researchers found that only the most intensive ASP intervention was associated with reduction in total and broad spectrum antibiotic use when compared to baseline. The cluster randomized intervention assessed the effectiveness of implementing ASPs in 15 small hospitals. Each was randomized to 1 of 3 ASPs of escalating intensity. Program 1 hospitals were provided with basic antibiotic stewardship education and tools, access to an infectious disease (ID) hotline, and antibiotic utilization data. Program 2 hospitals received those interventions plus advanced education, audit, and feedback for select antibiotics, and locally-controlled antibiotic restrictions. Program 3 hospitals received Program 2 interventions plus audit and feedback on the majority of antibiotics and an ID trained clinician approved restricted antibiotics and reviewed microbiology results. Among the findings:

• Program 3 hospitals showed reductions in total and broad spectrum antibiotic use when compared to the baseline period.
• Program 1 and 2 hospitals did not experience a reduction in antibiotic use.