• Antibiotic Use Survey

    Please take a few moments to complete this form
  • 1. Antibiotic consumption

    Antibiotics are medications which are sometimes used to treat infections. There are several different types of antibiotics; penicillin is the most common.
  • 1.1 Which of the following medications are antibiotics?*
  • 1.2 Have you ever taken antibiotics?*
  • 1.3 How many times have you consumed antibiotics during the past 12 months?*
  • 1.4 How many times has another adult in your household (over 18 years old) received antibiotics during the past 12 months?*
  • 1.5 How many children under the age of 18 live in your household on a regular basis?*
  • 1.6 How many times have children in your household received antibiotics during the past 12 months (in total)?*
  • 1.7 Is anyone in your household taking antibiotics at the moment?*
  • 2. Antibiotic accessibility

    The following questions should be answered using the scale below. Use this scale to indicate to what extent you agree with the question/statement.
  • Please answer the following questions.*
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  • 3. Antibiotic use and its effects

  • Please answer the following questions.*
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  • 4. Side effects and resistance

  • Please answer the following questions.*
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  • 5. Patient experiences, patient-doctor relationships and infection prevention

  • Please answer the following questions.*
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