U.S. swimmer Tom Dolan blistered the entire field, and broke a six-year-old world record to successfully defend his Olympic title in the event. Acknowledging a massive roar from an Australian crowd, Dolan pulled away from the field on the backstroke leg, and then opened up his lead to a powerful finish in a sterling time of 4:11.76. Dolan's teammate Erik Vendt came from last place on the first turn with a spectacular swim to take home the silver in 4:14.23, pulling off another top-two finish of the night for the Americans. Meanwhile, Canada's Curtis Myden managed to repeat his bronze from Atlanta four years earlier in 4:15.33, handing a second straight medal haul for North America in the event's history.
Leading earlier in the prelims, Italy's Alessio Boggiatto finished outside the podium by six-tenths of a second (0.60) in 4:15.93. South Africa's Terence Parkin, a deaf mute since birth, swam on the outside in lane eight, but pulled off a fifth-place effort in an African record of 4:16.92. He was followed in sixth spot by Australia's newcomer Justin Norris (4:17.87), and in seventh by Romania's Cezar Bădiță (4:20.91), who had been overshadowed in his presence by a doping ban before the start of the Games. In May 2000, Badita failed a doping test for a steroid nandralone when he competed at the Mare Nostrum meet in Barcelona, Spain. Japan's Shinya Taniguchi closed out the field to eighth place with a time of 4:20.93.