Effect of Antimicrobial Resistance on Development of Obesity in Children - Critical Appraisal Essay

Name-Soniya Mehan
Student Id:00160721T
Assessment 3,
Critical Appraisal Essay
PUBH 6005
EPIDEMIOLOGY
ASSIGNMENT 3
CRITICAL APPRAISAL ESSAY
1

Name-Soniya Mehan
Student Id:00160721T
Assessment 3,
Critical Appraisal Essay
Introduction
According to Australian Government (2018), Antimicrobial resistance (AMR) is one of the biggest
concern for global public health due to threat that it can cause in human and animal health today. AMR
occurs when microorganisms like bacteria, parasites and viruses become resistance to antibiotics and stop
them from working against antimicrobial medicines (World Health Organisation, 2018). Although
antibiotics are lifesaving drugs and are used in human medicines, 50 % of the time due to antibiotics not
optimally prescribed, incorrect duration and dosage can lead to emergence of AMR (Centers for Disease
Control and Prevention, 2018). The use of antimicrobial resistance in Australia is high (Australian
Commission on Safety & Quality in Health Care, 2015). The author also states that in 2014, Australians
were prescribed more than 30 million antibacterial through Pharmaceutical Benefits Scheme (PBS).
Moreover, in 2015, 45% of the Australian population were given at least 1 antibiotic (Australian
Government, 2018). Regulation on the over the counter antibiotics availability, using the antibiotics
rationally and improving hand hygiene are some important approaches to reduce and combat the rising
number of AMR (Uchil, Kohli, Katekhaye, & Swami, 2014). The purpose of this paper is to critically
appraise research articles with an aim of understanding the effect/impact of antibiotics/antimicrobial
resistance including the development of obesity in children. The focus is to
Research Question
What is the effect/impact of antimicrobial resistance in the development of obesity in Children
Methods
The keywords used to run the search were Antimicrobial resistance; antibiotics; and administration of
antibiotics which was merged with more specific words which were Children; Obesity; Childhood
Obesity. The databases used to search the relevant articles was Google Scholar, PudMed, Laureate
Australia Library and Research Gate. The articles which were used are peer-reviewed journal articles and
were critically appraised using the Critical Appraisal Skills Programme (CASP) checklist (2017). There
were total number of 5 articles used for critical appraisal using CASP checklist. Additionally the studies
were rank according to the FORM (Hillier et al., 2011) or GRADE levels of evidence (The GRADE
working Group, 2008) and the level of evidence were accessed using National Health and Medical
Research Council (NHMRC, 2009) body for evidence matrix.
Results
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Name-Soniya Mehan
Student Id:00160721T
Assessment 3,
Critical Appraisal Essay
5 Research articles (peer-reviewed journal articles) which are used for antimicrobial resistance were all of
cohort study design. Critical Appraisal Skills Program (CASP) checklist were used to answer 12
questions in order to critical appraise the 5 articles which were Infant antibiotic exposures and early-life
body mass; Association of antibiotics in infancy with early childhood obesity; Administration of
antibiotics to children before age 2 years increases risk for childhood obesity; Infant antibiotic exposure
and the development of childhood overweight and central adiposity; and Childhood overweight after
establishment of the gut microbiota: the role of delivery mode, pre-pregnancy weight and early
administration of antibiotics. Moreover, NHMRC Body of evidence matrix has been used for the group
level of evidence including various components such as Evidence base, Consistency, Clinical Impact,
Generalizability and Applicability of 5 articles.
Table 1. Critical appraisal using CASP checklist for Cohort Studies Questions
Questions Trasande et
al., 2013
Bailey et al.,
2014
Scott et al.,
2016
Azad et al., 2014 Ajslev et al.,
2011
1. Did the study
address a clearly
focused issue?
Yes Yes Yes Yes Yes
2. Was the cohort
recruited in an
acceptable way?
Yes Yes Yes Yes Yes
3. Was the exposure
accurately measured
to minimise bias?
Yes Yes Yes No No
4. Was the outcome
accurately measured
to minimise bias?
No Yes Yes No No
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Name-Soniya Mehan
Student Id:00160721T
Assessment 3,
Critical Appraisal Essay
5. (a) Have the
authors identified all
important
confounding factors?
Yes Yes Yes Yes Yes
5. (b) Have they
taken account of the
confounding factors
in the design and/or
analysis?
Yes Yes Yes Yes Yes
6. (a) Was the follow
up of subjects
complete enough?
Yes Yes Yes Yes Yes
6. (b) Was the follow
up of subjects long
enough?
Yes Yes Yes Yes Yes
7. What are the
results of this study?
Exposure to
antibiotic in
early life is
related to
increase body
mass and
exposure to
non-
antibiotic
medication is
not
69% children
were used
antibiotics in
early life and
among them
95% have been
found to be
associated
with obesity in
later life.
1306 children
were obese at
the age of 4
years due to
exposure to
antibiotics and
antifungal
agents are not
associated
with obesity.
32.4% children
found to be
associated with
childhood obesity
at the age 12 due
to exposure to
antibiotics during
infancy.
Administering
antibiotics
during infancy
leads to the high
risk of obesity in
childhood and
association of
delivery mode
with childhood
obesity is not
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