Antibiotic Treatment for Otitis Media with Effusion

Antibiotics are not indicated for otitis media with effusion (OME) except in cases where acute otitis media (AOM) continues beyond 3 months. 1

Distinguishing Between Types of Otitis Media

Acute otitis media (AOM) involves middle ear effusion with signs of acute inflammation and symptoms, requiring consideration for antibiotic therapy 2
Otitis media with effusion (OME) is characterized by asymptomatic middle-ear effusion without the signs and symptoms of AOM (fever, otalgia, or otorrhea) 3
The CDC recommends differentiating between patients with AOM, in whom initial antibiotic therapy may be indicated, and those with OME, in whom it is not 1

Watchful waiting is recommended for children with OME who are not at risk for speech, language, or learning problems for three months from the date of effusion onset or diagnosis 1
Approximately 75-90% of residual OME after an episode of AOM resolves spontaneously within three months 1
Antibiotics are not indicated for routine management of OME 1

For children with OME who are at risk for speech, language, or learning problems, more prompt evaluation of hearing, speech, language, and need for intervention is recommended 1
In cases of prolonged course and hearing loss, referral to an ENT specialist is recommended rather than antibiotic treatment 1
After successful antibiotic treatment of AOM, 60-70% of children have middle ear effusion at 2 weeks, decreasing to 40% at 1 month and 10-25% at 3 months - this residual effusion is defined as OME and requires monitoring but not antibiotics 2

Antihistamines and decongestants are ineffective for OME and are not recommended for treatment 1
Antimicrobials and corticosteroids do not have long-term efficacy and are not recommended for routine management of OME 1
The high natural cure rate of OME coupled with concerns about antimicrobial resistance makes routine antibiotic treatment unwarranted 3
Studies show only a trend toward short-term efficacy of antimicrobial treatment for OME, but long-term efficacy is doubtful 3

Antibiotics may be considered in cases of AOM that continue beyond 3 months 1
A one-time short course of antibiotics may be useful in selected patients with chronic OME (3 months or longer of bilateral effusion or 6 months or longer of unilateral effusion) for whom surgery is being considered 3
Antimicrobial therapy may provide short-term relief for symptomatic children (hearing loss, developmental delay) for whom surgery must be postponed or is contraindicated 3

Hearing testing is recommended when OME persists for three months or longer, or at any time that language delay, learning problems, or significant hearing loss is suspected 1
At each assessment of the child with OME, clinicians should document the laterality (unilateral or bilateral), duration of effusion, and presence and severity of associated symptoms 1
For children with persistent OME, tympanostomy tube insertion may be considered, particularly for those with hearing difficulties or symptoms attributable to OME 1

The bacterial profile of OME differs from AOM, with coagulase-negative Staphylococcus, Pseudomonas, and methicillin-resistant Staphylococcus aureus being more common in chronic OME 4
Antibiotic sensitivity is generally lower in bacteria isolated from post-tympanostomy tube otorrhea compared to those from middle ear effusion fluid 4