Eleven RCTs were included in the review, with 1,234 patients (range 58 to 229). Randomisation was adequate in four trials; six trials were double-blind; and most trials had comparable groups at baseline and reported loss to follow-up.
Compared with control, antibiotic prophylaxis resulted in a statistically significantly reduction in overall infection rate (OR 0.24, 95% 0.12 to 0.49; Ι²=30%; 10 RCTs), and empyema (OR 0.32, 0.17 to 0.61; Ι²=0; 11 RCTs). There were non-significant results for wound infection (two RCTs; Ι²=0) and pneumonia (eight RCTs; Ι²=10%).
Subgroup analysis showed that antibiotic prophylaxis reduced the risk of infection after tube thoracostomy in patients with penetrating chest injuries (OR 0.28, 0.14 to 0.57; Ι²=0; six RCTs), but not for patients with blunt trauma (three RCTs; Ι²=0).