Authors: Savannah Odom, Lauren Freeman, Hannah Harpe Objective: This study evaluates the effectiveness of a practice advisory alert in improving antibiotic prescribing at hospital discharge. Background: Antimicrobial resistance is a major and growing global public health threat, driven largely by antimicrobial misuse and overuse. Inappropriate antibiotic prescribing at hospital discharge is a key contributor, with studies demonstrating that durations frequently exceed guideline recommendations. Prior research has shown that antibiotic overuse occurs in up to 75% of patients, primarily due to excessive treatment duration and failure to account for inpatient therapy. This highlights a critical opportunity for antimicrobial stewardship interventions targeting transitions of care to optimize antibiotic use and improve patient outcomes. Building on a prior institutional initiative in which a fluoroquinolone-specific alert significantly reduced treatment duration, this study assesses whether expanding the alert to additional antibiotic agents results in similar improvements in prescribing practices. The alert prompts providers to account for inpatient antibiotic days when determining discharge durations, supporting appropriate therapy length and antimicrobial stewardship efforts. Self Assessment Question: What was the main finding after implementation of the practice advisory? Methods: This retrospective, multi-center, quasi-experimental study evaluates adults discharged on oral antibiotics before (January 2025-February 2025) and after (January 2026-February 2026) implementation of a practice advisory. A random sample from the pre-intervention group is matched 1:1 to the post-intervention group by antibiotic and indication. Patients receiving antibiotics for prophylaxis or suppression, those immunocompromised, or those with severe or complicated infections were excluded. Data collected include demographics, antibiotic regimen and indication, infectious diseases consultation, and prescriber credentials. The primary outcome is the proportion of patients discharged with antibiotic durations consistent with guidelines or infectious diseases recommendations, adjusted for inpatient days of therapy. Secondary outcomes include 30-day treatment for Clostridioides difficile and 30-day all-cause readmission. Results: A total of 300 patients were included, with 150 patients in both the pre- and post-intervention groups. Baseline characteristics, including age, sex, infection type, and antibiotic selection, were well balanced between groups. Implementation of the practice advisory alert was associated with a significant improvement in guideline-concordant antibiotic prescribing at discharge, increasing from 53.3% in the pre-intervention group to 81.3% in the post-intervention group (p < 0.001). Thirty-day all-cause readmission rates were 13.3% in the pre-intervention group versus 12% in the post-intervention group (p = 0.73). Additionally, no patients in either group required treatment for Clostridioides difficile infection within 30 days of discharge. Conclusion: Implementation of an electronic practice advisory alert that incorporates inpatient antibiotic days resulted in a clinically meaningful and statistically significant improvement in appropriate antibiotic duration at discharge. Expansion of this alert beyond fluoroquinolones to a broader range of antimicrobial agents successfully optimized prescribing practices. Importantly, these improvements were achieved without negatively impacting patient safety outcomes, as evidenced by unchanged readmission rates and absence of Clostridioides difficile infection events. Overall, this study demonstrates that targeted electronic clinical decision support tools are an effective and scalable antimicrobial stewardship strategy
