From the Guidelines
Oral prednisone is not recommended for routine treatment of acute otitis media (AOM). The standard treatment for AOM typically includes pain management with acetaminophen or ibuprofen, and in many cases, antibiotics such as amoxicillin, as recommended by the American Academy of Pediatrics (AAP) and the American Academy of Family Physicians (AAFP) 1. Corticosteroids like prednisone have not been shown to provide significant benefit in uncomplicated AOM and may expose patients to unnecessary side effects including immune suppression, mood changes, increased blood sugar, and fluid retention.
The inflammation in AOM is typically best addressed by treating the underlying infection and managing pain while the body's immune system resolves the condition. The use of antibiotics, such as amoxicillin, is recommended as first-line therapy for AOM because it is generally effective against susceptible and intermediate resistant pneumococci, and it is safe, inexpensive, and has an acceptable taste and narrow microbiologic spectrum 1.
In certain special circumstances, such as when AOM is accompanied by severe inflammation causing significant hearing loss or when standard treatments have failed, a specialist might consider short-term steroids, but this would be an exception rather than standard practice. It's worth noting that the use of oral corticosteroids as an adjunct in treating patients with acute sinusitis is reasonable when the patient fails to respond to initial treatment, demonstrates nasal polyposis, or has demonstrated marked mucosal edema 1. However, this does not apply to the treatment of AOM. If symptoms of AOM persist beyond 48-72 hours of appropriate treatment or worsen at any point, patients should be reevaluated by a healthcare provider.
From the Research
Oral Prednisone for Acute Otitis Media
- The use of oral prednisone for acute otitis media (AOM) has been explored in several studies, with varying results 2, 3, 4.
- A 2018 systematic review found that the evidence for the effect of systemic corticosteroids on AOM is of low to very low quality, making it uncertain whether they are effective in reducing symptoms or improving outcomes 2.
- However, a 1999 study found that oral prednisolone was an effective adjuvant therapy for AOM with discharge through tympanostomy tubes, reducing the duration of otorrhea 3.
- A 2020 pilot study found that oral corticosteroids may reduce pain intensity at day 3, but did not have a discernible effect on middle ear effusion resolution and duration 4.
Adverse Effects of Oral Prednisone
- Adverse effects of oral prednisone have been reported, including fluid retention, bloating, and insomnia, but these can often be minimized by reducing the dosage 5.
- A 2020 study found that prednisolone may cause drowsiness, but this was not severe enough to require cessation of treatment 4.
Clinical Decision-Making
- The decision to use oral prednisone for AOM should be made on a case-by-case basis, taking into account the individual patient's symptoms, medical history, and potential risks and benefits 2, 3, 4.
- Further research is needed to fully understand the effectiveness and safety of oral prednisone for AOM, particularly in children 2, 4.