Strengths and Limitations
AOM
SECONDARY
The strengths of this trial include the randomized study design in a real-life setting to investigate the primary prevention of AOM as diagnosed by primary care physicians. To include AOM episodes not treated with antibiotics, we report all AOM episodes as a secondary outcome, because the national guideline allowed watchful waiting as a treatment strategy during the study.This study also has some limitations. A major limitation is that it was conducted during the COVID-19 pandemic, when there was a very low circulation of several respiratory viruses.