Discussion
respiratory tract infections
RESPIRATORY TRACT INFECTION, RESPIRATORY TRACT INFECTIONS, SENSITIVITY
This complex intervention, designed for use in pre-pandemic conditions, did not reduce overall dispensing of amoxicillin and macrolide antibiotics for children with respiratory tract infections presenting before and during the covid-19 pandemic. Neither did it increase the rate of hospital admissions for respiratory tract infection. Sensitivity and subgroup analyses showed decreased dispensing rates in the intervention arm for older children, practices restricted to one site, and practices with proportionally fewer nurse practitioners and in less deprived areas, although, given the number of sensitivity analyses carried out, these may have been chance findings. After the introduction of covid-19 restrictions in March 2020, average antibiotic dispensing halved in both study arms until the end of the trial. A post hoc sensitivity analysis suggested possible effectiveness of the intervention before the pandemic, although the magnitude of any effect was difficult to measure.