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Impact of antibiotic prophylaxis on postbronchoscopy fever: a randomised controlled study
1Division of Pulmonary and Critical Care Medicine, Bundang Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
Background:
Postbronchoscopy fever can develop in 5-16% of adult patients. The microbiological contribution to postbronchoscopy fever is unclear.
Objective:
To elucidate the effect of prophylactic antibiotics on the development of postbronchoscopy fever and pneumonia.
Design:
Study patients were randomised to receive no treatment or oral amoxicillin/clavulanate 30 min before flexible bronchoscopy. The primary outcome variable was the frequency of postbronchoscopy fever and pneumonia. White blood cell counts, C-reactive protein and the serum pyrogenic cytokines interleukin (IL) 1β, IL-6 and tumour necrosis factor-alpha were measured before and after bronchoscopy.
Results:
Of 143 subjects enrolled in the study, the final analysis was performed among 67 subjects in the prophylaxis group and 64 in the control group. The frequency of postbronchoscopy fever did not differ between the groups (25.4% for the prophylaxis group vs. 26.6% for controls, P > 0.05). Pneumonia developed in 1.5% of the prophylaxis group and 4.7% of the controls. There was no bacteraemia in either group. Serum pyrogenic cytokines did not differ between the groups.
Conclusions:
Prophylactic antibiotics before bronchoscopy did not reduce the frequency of postbronchoscopy fever and did not affect serum levels of pyrogenic cytokines. These findings suggest that microbiological factors may not be responsible for the development of postbronchoscopy fever.
Insights
Prophylactic antibiotics before flexible bronchoscopy did not prevent postbronchoscopy fever or alter inflammatory markers. These findings suggest that fever after bronchoscopy may not stem from microbiological causes.
Area of Science:
- Pulmonology
- Infectious Diseases
- Clinical Pharmacology
Background:
- Postbronchoscopy fever affects 5-16% of adult patients.
- The role of microbiology in postbronchoscopy fever is not well understood.
Purpose of the Study:
- To investigate the efficacy of prophylactic antibiotics in preventing postbronchoscopy fever and pneumonia.
- To assess the impact of antibiotics on inflammatory markers.
Main Methods:
- Randomized controlled trial comparing amoxicillin/clavulanate prophylaxis versus no treatment before flexible bronchoscopy.
- Primary outcomes included fever and pneumonia incidence.
- Secondary outcomes included white blood cell count, C-reactive protein, and serum cytokines (IL-1β, IL-6, TNF-α).
Main Results:
- No significant difference in fever frequency between prophylaxis (25.4%) and control (26.6%) groups.
- Pneumonia incidence was 1.5% in the prophylaxis group versus 4.7% in the control group.
- No significant differences in serum pyrogenic cytokines or C-reactive protein levels were observed between groups.
Conclusions:
- Prophylactic antibiotics before bronchoscopy do not reduce fever incidence.
- Antibiotics did not influence serum pyrogenic cytokine levels.
- Microbiological factors may not be the primary drivers of postbronchoscopy fever.
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