Pre-Referral Antibiotic Use and Bacteriology in Children with Persistent Otitis Media with Effusion Undergoing Ventilation Tube Insertion in Korea

Background: Current clinical guidelines for pediatric otitis media with effusion (OME) advise watchful waiting and strongly discourage systemic antibiotic use. This study evaluated the rate of pre-referral antibiotic use among children with persistent OME requiring ventilation tube (VT) insertion and analyzed the bacterial culture positivity of middle ear effusion. Methods: We retrospectively reviewed 38 children (56 ears) aged 3 months to 12 years with persistent OME (≥3 months) who underwent first-time VT insertion between March 2025 and August 2026 at a secondary referral center. Prior antibiotic history from primary care clinics was investigated, and antibiotics were discontinued upon referral. Middle ear effusion samples were aseptically aspirated during VT insertion for bacterial direct culture and susceptibility testing. Results: Among the 38 children, 78.9% had received antibiotics prescribed by primary care clinics for OME before referral. Following a mean antibiotic-free interval of 27.34 days, direct bacterial cultures of middle ear effusion yielded positive growth in only 10 of 56 ears (17.9%). The most commonly isolated organisms were coagulase-negative staphylococci (CoNS; 80%, 8/10), of which 75% (6/8) showed methicillin resistance. Prior antibiotic exposure was not significantly associated with bacterial culture positivity (18.2% vs. 16.7%, Fisher’s exact test, p = 1.000). Conclusions: Despite guideline recommendations, pre-referral antibiotic use remains common among children with OME requiring VT insertion in South Korea. Given the observational design, small sample size, and culture sensitivity limits, these findings support adherence to existing clinical guidelines. Educational initiatives and guidance are needed to promote evidence-based prescribing in primary care.