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Guideline Concordance and Antimicrobial Stewardship in Community Pharmacy Management of Suspected Pediatric Acute Otitis Media: A Simulated Patient Study in Saudi Arabia

Year: 2026

Type: article

Abstract: Introduction: Acute otitis media (AOM) is a common pediatric condition requiring careful assessment to distinguish children needing medical referral from those suitable for watchful waiting. Community pharmacists are often the first healthcare professionals consulted; however, evidence regarding the quality and guideline concordance of their AOM management remains limited. This study evaluated community pharmacists’ management of pediatric AOM across scenarios of varying clinical severity. Methods: A cross-sectional simulated patient study was conducted using three standardized pediatric AOM scenarios: a 5-month-old infant requiring referral, an 18-month-old child suitable for watchful waiting, and a 5-year-old child with multiple red flags requiring urgent referral. Trained simulated caregivers completed 203 community pharmacy visits. The primary outcome was scenario-specific guideline-concordant management. Secondary outcomes included referral, watchful waiting, antimicrobial recommendations, information gathering, counseling, and communication quality. Generalized estimating equation (GEE) logistic regression models accounted for clustering by simulated patient. Results: Guideline-concordant management was provided in 58.8% of Case 1 visits, 8.8% of Case 2 visits, and 58.2% of Case 3 visits. Referral was recommended in 60.3%, 47.1%, and 58.2% of visits, respectively, whereas watchful waiting was recommended in only 13.2% of the low-severity Case 2 visits. Antimicrobials were recommended in 7.4%, 22.1%, and 22.4% of visits, predominantly as topical antibiotics. Although pharmacists commonly assessed patient age and generally communicated professionally, assessment of symptoms, fever, ear discharge, medication use, allergies, and recurrent infections was inconsistent. Compared with Case 2, Cases 1 and 3 had substantially greater odds of guideline-concordant management. Conclusions: Community pharmacists’ management of suspected pediatric AOM varied considerably by clinical presentation. Major gaps were observed in watchful waiting, systematic clinical assessment, and antimicrobial stewardship. Standardized triage protocols and targeted professional training are needed to improve safe, guideline-concordant management.

Source: Healthcare

DOI: 10.3390/healthcare14193255