Table 1.

Survey questions

How many times in the last year have you been on an antibiotic for treatment of a respiratory infection?
_____ times
When you get a respiratory infection, how many days do you usually wait before you seek treatment from a healthcare provider?
_____ days
Do you think that an antibiotic is necessary when you have a respiratory infection for a period of over 5 days?
Yes _____ No _____
When prescribed an antibiotic for a respiratory infection, do you take it for the number of days that your doctor prescribes for you?
Yes _____ No _____
If not, what is the main reason you do not? (ie, side effects? forget?)
When given an antibiotic for a respiratory infection, to take for 5 days, I finish taking all of the medication.
Yes _____ No _____
When given an antibiotic for a respiratory infection, to take for 10 days, I finish taking all of the medication.
Yes _____ No _____
I stop taking antibiotics when I start feeling better.
Yes _____ No _____
Do you think that some antibiotics for a respiratory infection, work better for you?
Yes _____ No _____
Have you ever requested a specific antibiotic by name for a respiratory infection?
Yes _____ No _____
If so, which one?
Patients with symptoms of the common cold require treatment with antibiotics
Do not agree	Slightly agree	Moderately agree	Strongly agree	Completely agree
Patients who cough up yellow or greenish mucous require antibiotics
Do not agree	Slightly agree	Moderately agree	Strongly agree	Completely agree
Patients who have yellow or greenish nasal discharge from the nose require antibiotics
Do not agree	Slightly agree	Moderately agree	Strongly agree	Completely agree
Respiratory infections caused by viruses require treatment with antibiotics
Do not agree	Slightly agree	Moderately agree	Strongly agree	Completely agree
Many antibiotics today do not work as well as they used to in the past
Do not agree	Slightly agree	Moderately agree	Strongly agree	Completely agree