Quality, Reliability and Stewardship-Message Completeness of Arabic-Language Web Content on Antibiotic Use: A Cross-Sectional Infodemiological Study

Abstract

Arabic-language web pages on antibiotic use remain unevaluated despite widespread non-prescription use in the Eastern Mediterranean Region. This cross-sectional infodemiological study assessed reliability, stewardship-message completeness, and their association. Six patient-style Arabic searches conducted in September 2026 covered colds, treatment duration, non-prescription purchase, antibiotic selection for sore throat, resistance, and leftovers. Consumer-facing pages were assessed using four JAMA benchmarks and six stewardship messages derived from WHO and Saudi Ministry of Health guidance. Messages were coded as fully addressed, partially addressed, or absent. Site type, named antibiotics, and dosing information were recorded. Sixteen pages were assessed; three additional eligible pages were inaccessible. Authorship and dates appeared on 15/16 pages each, references on 4/16 and conflict-of-interest or sponsorship disclosure on 1/16. Mean JAMA score was 2.19/4; four pages scored ≥3. Mean stewardship coverage was 3.59/6; only one page conveyed all six messages. Warnings against leftover or shared antibiotics were absent from 12/16 pages. Coverage was highest among health portals (mean 5.50) and lowest among news media (3.07). Reliability and coverage were not significantly associated (Spearman ρ = −0.29; p = 0.28). Commercial pharmacy pages had the highest mean reliability score and exclusively provided specific doses, including weight-based pediatric tables alongside purchase prompts. These findings indicate incomplete stewardship communication, limited referencing and minimal disclosure. Formal reliability markers did not correspond to message completeness, limiting their standalone assessment value. Apparent credibility combined with prescribing-level content on commercial pharmacy websites warrants regulatory and stewardship attention.