Prophylactic antibiotics for the prevention of fever and infectious complications after bronchoscopy: a systematic review and meta-analysis of comparative studies

Abstract Bronchoscopy is a widely used diagnostic and therapeutic procedure that is generally considered safe, although it may be followed by fever and infectious complications such as pneumonia. The use of prophylactic antibiotics to prevent these events remains controversial, with inconsistent recommendations across clinical settings. This study aimed to evaluate the effectiveness of prophylactic antibiotics in reducing post-bronchoscopy fever and infectious complications through a systematic review and meta-analysis of available evidence. A comprehensive search identified six studies, including randomized controlled trials and observational designs, encompassing a broad range of patient populations and procedural indications. The pooled analysis showed that prophylactic antibiotics were not associated with a statistically significant reduction in the combined outcome of post-procedural fever and pneumonia. The results were characterized by substantial variability between studies and wide uncertainty in the estimated effect, limiting the confidence in a consistent benefit. Sensitivity analyses confirmed the robustness of the overall findings, although certain individual studies contributed to heterogeneity. Overall, current evidence does not support the routine use of prophylactic antibiotics in patients undergoing bronchoscopy. These findings highlight the need for more rigorous and adequately powered studies to better identify patient subgroups that may benefit from targeted preventive strategies and to inform clinical decision-making.