If outcome = "no. of antibiotic prescriptions" and more people in one arm get LT antibiotics (which presumably precludes further prescriptions?), this does seem like a challenge.

Could of course be good reasons for it - does highlight importance of estimands (along with justifications for choice)!

Think they've used a treatment policy strategy (ie were interested in the effect of Hiprex vs placebo whether or not people started on suppressive antibiotics later).

I don't know enough about the area to say if this is sensible, but if suppressive antibiotics are part of usual care, it may be?