Reducing Antibiotic Dispensing in Primary Care for Children with Respiratory Tract Infections: A Randomized Controlled Trial Clustering by General Practice.

The CHICO (CHIldren’s COugh) trial was a two-arm randomized controlled trial clustered by general practice that aimed to assess the effectiveness of a multifaceted intervention for reducing antibiotic dispensing in English primary care practices for children presenting with respiratory tract infections. The study used routine outcome data and included qualitative and economic evaluations. The intervention involved eliciting parental concerns during consultation, using a clinician-focused prognostic algorithm to identify children at very low, normal, or elevated risk of hospital admission accompanied by antibiotic prescribing guidance, and providing a leaflet for carers including safety netting advice. The primary outcome measures were the rates of dispensed amoxicillin and macrolide antibiotics and hospital admissions for respiratory tract infection. A total of 294 practices were randomized (144 intervention and 150 controls), representing 5% of all registered 0-9 year olds in England. Results showed no evidence that antibiotic dispensing differed between intervention and control practices, but pre-specified subgroup analyses suggested reduced dispensing in intervention practices with fewer prescribing nurses, in single-site practices, and in practices located in areas of lower socioeconomic deprivation. The study concluded that the multifaceted antibiotic stewardship intervention did not reduce overall antibiotic dispensing, but evidence suggested that it slightly reduced prescribing rates in some subgroups and situations.