Guideline Concordance and Antimicrobial Stewardship in Community Pharmacy Management of Suspected Pediatric Acute Otitis Media: A Simulated Patient Study in Saudi Arabia.
- 1Department of Pharmacy Practice, College of Pharmacy, Taibah University, Madinah 41477, Saudi Arabia.
- 2Department of Pharmacy Practice, College of Pharmacy, Qassim University, Qassim 51452, Saudi Arabia.
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.
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BibTeX
@article{alnezary2026guideline,
title = {{Guideline Concordance and Antimicrobial Stewardship in Community Pharmacy Management of Suspected Pediatric Acute Otitis Media: A Simulated Patient Study in Saudi Arabia.}},
author = {Faris S Alnezary and Nadia M Aljuhani and Shuruq S Almurashi and Reham A Albuthayli and Adel Altarjami and Fahad Alzahrani and Haifa A Fadil and Waad Alrohily and Masaad S Almutairi},
journal = {Healthcare (Basel, Switzerland)},
year = {2026},
month = oct,
doi = {10.3390/healthcare14193255},
url = {https://europepmc.org/article/MED/42881693},
note = {CC BY},
}
RIS
TY - JOUR
TI - Guideline Concordance and Antimicrobial Stewardship in Community Pharmacy Management of Suspected Pediatric Acute Otitis Media: A Simulated Patient Study in Saudi Arabia.
AU - Faris S Alnezary
AU - Nadia M Aljuhani
AU - Shuruq S Almurashi
AU - Reham A Albuthayli
AU - Adel Altarjami
AU - Fahad Alzahrani
AU - Haifa A Fadil
AU - Waad Alrohily
AU - Masaad S Almutairi
PY - 2026
DA - 2026/10/01
JO - Healthcare (Basel, Switzerland)
DO - 10.3390/healthcare14193255
UR - https://europepmc.org/article/MED/42881693
AB - 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.
SN - 2227-9032
ER -