Are Management Practices for Pediatric Uncomplicated Acute Otitis Media Different on Weekends Versus Weekdays?

BACKGROUND: Acute otitis media (AOM) is a leading cause of antibiotic prescriptions in children. The "weekend effect"-reduced care quality outside standard hours due to lower senior supervision-has been reported for various pediatric conditions, but its impact on AOM management remains unexplored. METHODS: We conducted a retrospective cross-sectional study of children aged 6 months to 10 years diagnosed with uncomplicated AOM in a secondary academic pediatric emergency department (PED) between 2017 and 2024. Treatment appropriateness was assessed against the 2023 Israeli AOM guidelines. Care optimality was stratified by visit timing and physician seniority into 3 levels: level 0 (weekday, attending present), level 1 (after-hours, attending present) and level 2 (after-hours, no attending). RESULTS: Of 288 children included, weekend and weekday visitors were clinically and demographically comparable. The presence of attending physicians was significantly higher on weekdays (82.8% vs. 55.6%, P < 0.001). Guideline-appropriate treatment was achieved in 72.9% of cases overall, with amoxicillin as the first-line chosen antibiotic therapy. No significant differences in treatment appropriateness were found between weekend and weekday visits, nor across care optimality levels (P = 0.363), indicating that physician supervision level did not influence guideline adherence. CONCLUSIONS: AOM management was guideline-adherent regardless of visit timing or physician supervision level, with no weekend effect identified. These findings suggest effective standardization of clinical practice in our pediatric emergency department and support maintaining current protocols as a model for consistent AOM care in emergency settings.