Antimicrobial treatment decreases the signs and symptoms of acute otitis media (AOM). The effect of antimicrobial treatment on the duration of middle ear effusion (MEE) and concomitant hearing impairment is still not known. The study was conducted to determine whether the antimicrobial treatment of AOM reduces the duration of MEE. This randomized controlled trial included a total number of 84 children with AOM with age between 6 months and 15 years. Participants were recruited from the start of September , 2021 to January 2022 from among children attending an AOM prevention trial and children visiting ENT outpatient department at Santosh university. The Middle ear effusion disappeared 2 weeks (13.7 days) earlier (P = .02) in antimicrobial group than in placebo group . Normal otoscopy findings were observed 1.4 weeks earlier in the antimicrobial group than in placebo group (P = .02). On day 14, 69% of the children in antimicrobial group and 38% in placebo group had normal tympanometry findings . On day 60, 2 children (5%) in antimicrobial group and 10 children (24%) in placebo group had persistent MEE (P = .01). Antimicrobial treatment has effectively reduced the duration of MEE and possible concomitant hearing impairment in children with AOM. Antimicrobial treatment also reduced the risk for persistent MEE.