JAMA Netw Open

Simple mailed feedback delivers big returns for antibiotic stewardship

March 23, 2026

In an economic evaluation using data from a randomized clinical trial of 4,879 primary care physicians in Ontario, a mailed audit-and-feedback (A&F) intervention comparing individual antibiotic prescribing rates with peers led to meaningful reductions in antibiotic use among adults ≥65 years. The intervention—consisting of a single mailed letter highlighting prescribing patterns and harms of unnecessary antibiotics—cost just CAD $5.50 per physician but yielded CAD $43.03 in savings, largely from reduced antibiotic use and fewer adverse drug events. Overall, the program generated an estimated return on investment (ROI) of CAD $8.82 for every dollar spent, with a 93% probability of achieving a positive ROI.

Clinical takeaway: Consider incorporating low‑cost prescribing feedback tools into practice or stewardship initiatives; even minimal behavioral nudges can meaningfully curb unnecessary antibiotics and lower systemwide costs.

Source:

Masucci L, et al. (2026, March 13). JAMA Netw Open. Mailed Audit and Feedback for Antibiotic Prescribing in Primary Care. https://pubmed.ncbi.nlm.nih.gov/41823966/