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The given research study critique will focus on the article by Smith et al. (2017), which investigates the impact of antibiotics on people with acute bronchitis. The study identified thoroughly what is known and unknown in the background section. For example, the authors state that “acute bronchitis is the ninth most common outpatient illness recorded by physicians in ambulatory practice in the USA” (Smith et al., 2017, p. 3). In addition, the researchers showcased the mismatch between antibiotic prescription and bacterial influence on the condition. It is stated that “pathogens implicated in acute bronchitis are Mycoplasma pneumoniae, Chlamydia pneumoniae, and Bordetella pertussis, each of which has been identified in up to 25% of cases in various populations” (Smith et al., 2017, p. 3). However, when it comes to antibiotics, it is reported that “antibiotics are prescribed for 60% to 83% of people who present to physicians with the condition” (Smith et al., 2017, p. 3). Therefore, in the case of what is not known, the authors state that “there are no clinically useful criteria that accurately help distinguish bacterial from viral bronchial infections therefore some authors have called for physicians to stop prescribing antibiotics for people with acute bronchitis” (Smith et al., 2017, p. 3). In other words, the study consults previously acquired data on bacterial involvement in bronchitis cases and presents contrasting evidence of antibiotic prescription but indicates that evidence is limited.
Purpose and Sampling
The purpose of the study was clearly presented and identified, which makes the research precise in its direction. The authors state that the purpose is “to assess the effects of antibiotics in improving outcomes and to assess adverse effects of antibiotic therapy for people with a clinical diagnosis of acute bronchitis” (Smith et al., 2017, p. 1). It is evident that the researchers want to know the effects of antibiotics on the condition, whether they are positive, negative, or neutral. It is important to note that this prospective cohort study included 18 trials and 5099 participants, where a simple random sampling method was utilized in order to include both antibiotic and placebo groups, and the latter acted as a control group. It is stated that “randomized controlled trials comparing any antibiotic therapy with placebo or no treatment in acute bronchitis or acute productive cough, in people without underlying pulmonary disease” (Smith et al., 2017, p. 1). In other words, the sampling plan was reliable in expecting to yield a representative sample due to a larger pool size as well as randomization. It should be noted that the sample size was sufficient to provide solid evidence for the study rationale and design since the core objective is to observe the effect of antibiotics on a particular condition. The control group did not differ demographically, and the key difference was the presence of the placebo effect, but bronchitis was present in both control and experimental groups.
Data Collection and Instruments
The data collection method was based on trial data obtained with a subsequent examination of the process. It is stated that “we examined funnel plots for each of the analyses conducted and none indicated a significant level of reporting bias,” and “we included a range of outcomes under the broad definition of ’clinically improved.’ These were clinically heterogeneous, so we used a random-effects” (Smith et al., 2017, p. 7). Thus, there was a step by step process in which the relevance and validity of data were verified for further inclusion. Therefore, considering the purpose of the study, such an approach is appropriate since longitudinal data is needed with large sample sizes in order to observe a statistically significant effect of antibiotics on acute bronchitis. The instruments included the Cochrane Central Register of Controlled Trials or CENTRAL, MEDLINE, and LILACS databases. In addition, it is stated that the authors “searched the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) and ClinicalTrials.gov” (Smith et al., 2017, p. 4). In other words, reputable instruments and databases were used to obtain the data for the cohort study. However, the instrument validity was not thoroughly and directly discussed since the databases are inherently valid on their own.
Results, Variables, and Conclusions
The study results were presented clearly and succinctly, where the findings indicate that there is no statistically significant difference between the use of antibiotics for acute bronchitis and avoidance of its usage when it comes to clinical outcomes. However, antibiotics had a positive effect in the case of cough occurrence, night cough, and additional beneficial outcomes or NNTB (Smith et al., 2017). In general, antibiotics were useful for treating acute bronchitis since they led to the reduction of major symptoms, such as coughing. The limitations were identified and addressed in the potential biases section, where the authors claim that “some patient subgroups are under-represented, as they may not have been recruited into the original trials” (Smith et al., 2017, p. 14). Therefore, there is a possibility of faulty interpretation due to the database data provision patterns.
The researchers did not make major attempts to control for confounding variables since there are a number of such influences. In addition, the databases diverge in their data collection methods, which is why it is impractical to control all possible confounding variables. However, the use of a specific focus on specific outcomes provides a more precise and centered analysis of the variables, which is why some databases were excluded. The conclusions were appropriate, with an emphasis on practical and research implications. In the case of the former, it is stated that “it is especially important for clinicians to share the decision about whether to use antibiotics or not with their patients, using the expected outcomes and their magnitude from this review as a basis for their discussion” (Smith et al., 2017, p. 15). For research, the authors state that “research efforts should also be directed at the identification of subsets of patients who are most likely or least likely to benefit from antibiotic treatment” (Smith et al., 2017, p. 16). In other words, conclusions are comprehensive since they address both clinical and research implications.
Quality Rating
The research study can be considered as high quality because the literature review includes thorough reference to scientific evidence, consistent recommendations are provided based on the data, and it has definitive conclusions. In addition, there is an adequate control group, a large sample size sufficient to justify the study design, the results are generalizable, and the findings are consistent. In other words, the study itself is reliable and accurate, which means it can be used as core evidence for statements in regards to antibiotics’ utility against acute bronchitis.
Reference
Smith, S. M., Fahey, T., Smucny, J., & Becker, L. A. (2017). Antibiotics for acute bronchitis. Cochrane Database of Systematic Reviews, 6(6), 1-59. Web.
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