Background: Adenotonsillectomy is among the most common pediatric surgical procedures globally. Despite
advances in perioperative care, prophylactic antibiotic use remains widespread, often without strong supporting
evidence. This systematic review evaluates the efficacy of prophylactic antibiotic regimens in improving postoperative
outcomes among pediatric patients undergoing adenotonsillectomy.
Methods: This review followed PRISMA 2020 guidelines and was registered on PROSPERO (ID:
CRD420251079815). A comprehensive literature search was conducted across PubMed, Scopus, Web of Science, and
Cochrane CENTRAL, targeting randomized controlled trials (RCTs) and quasi-experimental studies published
between 2000 and 2025. Inclusion criteria focused on studies assessing the impact of prophylactic antibiotics versus
placebo or no antibiotic on outcomes such as pain, hemorrhage, fever, infection, and return to normal diet in children
undergoing adenotonsillectomy. Risk of bias was evaluated using the Cochrane ROB2 tool, and results were
synthesized narratively due to heterogeneity in study protocols and outcome definitions.
Results: Fourteen studies involving over 2,500 pediatric patients were included. The majority of trials reported no
significant differences in postoperative pain, fever, or hemorrhage rates between antibiotic and control groups. A few
studies demonstrated marginal benefits in infection control, particularly in low-resource settings, but these were offset by concerns regarding adverse effects and antimicrobial resistance. Overall, the findings support current
recommendations against routine prophylactic antibiotic use in pediatric adenotonsillectomy.
Conclusion: Prophylactic antibiotic administration does not provide consistent or clinically meaningful benefits in
reducing complications following pediatric adenotonsillectomy. These findings underscore the need for judicious
antibiotic prescribing and support global antimicrobial stewardship initiatives in surgical settings.
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