Antibiotic stewardship in pediatric emergency and primary care: a narrative review from Oman’s perspective

Abstract Antimicrobial resistance (AMR) poses a significant global health challenge, with children being particularly vulnerable to its consequences (World Health Organization, 2015; Science 353(6302):874–875, 2016). This narrative review examines antibiotic stewardship practices within pediatric emergency and primary care settings, emphasizing gaps and opportunities within the healthcare framework of Oman. Relevant publications from 2013 to 2023, including clinical guidelines such as those from the American Academy of Pediatrics (2021) and the WHO AWaRe classification (2023), along with national Omani data (Oman Med J 36:e287, 2021, J Infect Public Health 15:322–329, 2022), were reviewed to evaluate patterns of antibiotic utilization and stewardship interventions. A thematic synthesis—guided by the identification of recurring themes across sources rather than formal qualitative coding—was used to combine findings from different types of evidence (BMC Med Res Methodol 8:45, 2008). Despite comprehensive guidance, both international and local studies consistently report that 30–40% of pediatric antibiotic use is unnecessary (Pediatrics 132(6):1146–1154, 2013, JAMA 315(17):1864–1873, 2016), with Omani audits indicating that 37% of prescriptions were inappropriate, often involving broad-spectrum agents (Oman Med J 36(4):e287, 2021). Practical strategies to reduce this inappropriate use include delayed prescriptions, shorter treatment durations, and electronic decision-support tools (Cochrane Database System Rev (9):CD004417, 2017, JAMA 309(22):2345–2352, 2013). In Oman, stewardship initiatives have demonstrated measurable benefits, including a reduction in multidrug-resistant organisms (from 2.8 to 0.6 per 1000 patient-days) and annual cost savings ranging from USD 70,000 to 80,000 (J Infect Public Health 15(3):322–329, 2022). Embedding evidence-based strategies and integrating stewardship into health systems are essential for sustaining progress and regional impact.