CRITICAL APPRAISAL: VIA

1. Is the study valid?

 Is the focus of this research in accordance with the objectives of the
study?
Yes, this study aims to estimate the effect of antibiotic treatment for a first
AOM episode occurring during infancy on AOM recurrences and AOM-
related health care utilization later in life and the focus of this study is to
analyze it.
 Are the research subjects taken in the right way?
Yes, the research subjects were taken correctly
- Children with at least one family physician diagnosed AOM episode
before the age of two
- The prescription of oral antibiotics for a child’s first AOM episode
before the age of two years.
 Is the data collected in accordance with the objectives of the study?
Yes, data collected is in accordance with the purpose of the study, which
is to estimate the effect of antibiotic treatment for the first episode of
AOM that occurs during infancy on recurrence of AOM and the
utilization of health services related to AOM in the future, the researchers
collected data in the form of antibiotics prescription and total number of
AOM recurrences during children’s first four years of life (≥ 3 episodes in
6 months or ≥ 4 in one year) with confounders of gender, season of birth,
parental education level, duration of exclusive breastfeeding, number of
older siblings, household smoking, daycare attendance, age of the first
AOM episode and the number of oral antibiotics before the first AOM
episode (regardless of indication).
 Does this research have enough subjects to minimize bias?
Yes, this study is a prospective birth cohort study in which all healthy
newborns in Leidsche Rijn (between 2001 and 2012), The Netherlands,
were enrolled. Every children with at least one family physician-
diagnosed AOM episode before the age of two were included in analyses.
  Is the data analysis done well enough?
Yes, characteristics of children who did and did not receive oral
antibiotics for their first AOM episode using Chi-squared tests, Mann-
Whitney U tests and independent samples T-tests.
Associations between antibiotic treatment and count outcomes (total
number of AOM recurrences, number of AOM-related consultations and
antibiotic prescriptions) were calculated using negative binomial
regression analyses.
Associations between antibiotic treatment and dichotomous outcomes
(incidence of recurrent AOM, incidence of AOM-related specialist
referrals) were estimated using Poisson regression analyses.
The study is valid.
2. Is it important?
Acute otitis media (AOM) is one of the most common reasons for primary
care consultations during early childhood. Antibiotics have been shown to
reduce AOM symptoms more quickly than placebo, but it has been
hypothesized that antibiotics put children at risk for future infections as it
affect the nasopharyngeal microbial flora, which in turn has been suggested to
enhance overgrowth and spread of potential pathogens. Moreover, recent
studies showed that biofilm formation occurred 2–5 times faster in patients
treated with antibiotics compared with those that did not receive antibiotic
treatment, biofilm formation also has been associated with an increased risk of
recurrent infections.
Only one study assessed the long-term (>12 months) impact of antibiotic
treatment on future AOM episodes. Therefore, this study is important to
estimate the effect of antibiotic treatment for a first AOM episode occurring
during infancy on AOM recurrences and AOM-related health care utilization
later in life.
3. Is it applicable?
The results of this study can be used as a reference when weighing the pros
and cons of various OMA treatment options, one of which is antibiotics. The
results of this study can be used as a reference in hospitals in Indonesia.