In the case of ear effusion with perforation, what is indicated?

In the case of ear effusion with perforation, the administration of antibiotics is indicated primarily to address the risk of bacterial infection that may arise from the perforation. A perforated tympanic membrane can allow pathogens to enter the middle ear, increasing the likelihood of complications such as acute otitis media or other infections. Antibiotics are an essential treatment in such scenarios to prevent the onset or worsening of these infections.

In cases of ear effusion, particularly with a perforation, the application of topical analgesics might provide temporary relief from discomfort, but it doesn't tackle the underlying risk of infection. Likewise, while observation might be sufficient in some scenarios without perforation, it is crucial to monitor and potentially treat with antibiotics in the presence of a perforation to mitigate any complications.

Immediate surgical intervention is rarely the first-line approach unless there’s a significant complication or if the condition does not resolve with medical management. Hence, the most appropriate answer here is to administer antibiotics to protect against potential infection associated with the perforation.