CLINICAL ARTICLES
Antibiotic Use by Members of the American Association of Endodontists in the Year 2000: Report of a National Survey

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The purpose of this study was to determine the prescribing habits of active members of the American Association of Endodontists (AAE) with regard to antibiotics.

A one-page, double-sided questionnaire was sent to the active members of the AAE living in the United States. The 1999 mailing list of 3203 members was obtained from the AAE, and the return rate was 50.1% (1606 surveys). With a sample size over 1000, the study was able to distinguish differences to within 0.5% with power = 80% (at alpha = 5%). The data were analyzed using descriptive statistics and chi-square tests of independence. Penicillin VK, 500 mg, 4 times a day, was the first choice antibiotic prescribed by 61.48% of respondents. Clindamycin (Cleocin®), 150 mg, 4 times a day, was selected by 29.59%. For those patients with a penicillin allergy, 57.03% prescribed clindamycin and various erythromycin preparations were prescribed by 26.65%. A loading dose was used by 85.14%. The average duration of antibiotic therapy was 7.58 days. Those respondents involved in academics, either part-time or full-time, were significantly more likely to prescribe penicillin VK, 500 mg, 4 times a day at a rate of 85% versus those in part-time or full-time private practice at a rate of 67%. For cases of irreversible pulpitis, 16.76% of responding endodontists prescribed antibiotics. For the scenario of a necrotic pulp, acute apical periodontitis, and no swelling, 53.93% prescribed antibiotics. Almost 12% prescribed antibiotics for necrotic pulps with chronic apical periodontitis and a sinus tract. For the most part, the majority of the members of the AAE were selecting the appropriate antibiotic for use in orofacial infections, but there are still many who are prescribing antibiotics inappropriately. Although there were trends of improvement in some areas with regards to prescribing antibiotics, there were other areas where there had been no improvement in 25 years. Unless these trends change, our generation and those to come may not have effective antibiotics for use in the management of true orofacial infections.

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MATERIALS AND METHODS

A one-page, double-sided questionnaire was sent to the active members of the AAE living in the United States (Fig. 1). A cover letter and postage-paid return envelope were also included. The 1999 mailing list of 3274 members was obtained from the AAE. Some questions were based on those asked in the previous surveys (4, 5, 6, 7), and the questionnaire was reviewed by dental researchers and endodontic faculty for appropriateness and clarity. The sample size was arrived at by a power calculation.

RESULTS

Of the 3274 surveys mailed, 1677 surveys were returned. A total of 71 were returned as undeliverable, and the others (n = 1606) were found to be usable. The overall response rate was 50.1%. The results of the survey are presented in Table 1, Table 2, Table 3, Table 4, Table 5, Table 6, Table 7, Table 8. Note that in some instances the percentages may not add up to 100%, because some questions allowed multiple responses and the sample size (n) for each question may be different due to improperly

DISCUSSION

The survey instrument has historically been successful in obtaining pertinent information on the practice of endodontics. The population sampled in this study was very large, 3274 members of the AAE. A large percentage of this target population was practicing endodontists, and it should be noted that no attempt was made to survey practicing endodontists who were not members of the AAE. The overall response rate of 50.1% is considered to be an acceptable rate of return for surveys. Questions

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This research was supported in part by the Alexander Fellowship Fund.

The authors thank Dr. Al Best and Ms. Stacey S. Cofield from the Department of Biostatistics at Virginia Commonwealth University for their invaluable assistance in statistical analysis and Ms. Vivian Hyo Lee of the Virginia Commonwealth University School of Dentistry for her dedicated research support.

The opinions and conclusions in this study are those of the authors and are not intended to represent the official position of the Department of Defense, United States Air Force, or any other Government Agency.

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