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Should Otitis Media with Effusion Get Antibiotics?

May 5, 2021

Written by Clay Smith

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The authors determined that the harms from antibiotics outweighed the benefit of speedier resolution of otitis media with effusion (OME) in children.

Why does this matter?
OME is common. I find it’s easiest for me to see when there are small air bubbles behind the TM. You can also use pneumatic otoscopy. With OME, there is no redness or bulging with pus. It’s just clear fluid. This may cause hearing loss which could adversely impact language and cognitive development. The AAP recommends against steroids, antihistamines and antibiotics but notes that PE tubes may help if OME persists > 3 months. Despite the AAP recommendations, some studies seem to indicate speedier resolution with antibiotics. Is that true?

Antibiotics fix everything!
This is a concise summary of a Cochrane review on this topic. Several studies showed a greater probability of resolution in 2-3 months with receipt of antibiotics, 24.6% absolute risk difference, NNT = 5. However, adverse effects from antibiotics – such as diarrhea, vomiting, or rash – were also common, absolute risk difference 20%, NNH = 5. The authors rated this article as RED, meaning the harms outweighed potential benefits. They noted that while short-term hearing loss may have been improved, the point was to prevent long term educational or cognitive declines due to hearing loss, which none of these studies addressed. So, we see fluid go away faster but adverse effects from antibiotics just as much, not to mention the potential for promoting antimicrobial resistance, which was not measured. This affirms my practice. I don’t treat OME with antibiotics. In fact, the TM has to look red and bulging with loss of landmarks for me to prescribe an antibiotic.

Antibiotics for Otitis Media With Effusion In Children. Acad Emerg Med. 2021 Mar 8. doi: 10.1111/acem.14246. Epub ahead of print.

What are your thoughts?