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 MALE QUESTIONNAIRE - PAGE 7(c) 

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This section deals with prescription antibiotic use. Please note specifics in the box below.
801.  Have you taken tetracyclines (Sumycin, Panmycin Vibramycin, Minocin) in the last 5 years?
No / don't know
For 1 month
1 to 2 months
2 to 3 months
4 months or longer
802.  Have you taken other broad-spectrum antibiotics for urinary, respiratory or other infections within the last 5 years? Examples include Ciprofloxacin and levofloxacin.
No / don't know
One course under 2 months
One course 2 months or longer
Two courses in a single year
Three or more courses in a single year
803.  Are you currently using prescription antibiotics, antifungals, antivirals or other drugs to kill/control organisms? If so, please answer this question and then list them in the box below. "Short term" is considered roughly 2 weeks or less.
No
Short term current use for a known infection
Short term current use for a suspected infection
Current use of 2 weeks to 3 months
Current use for longer than 3 months

Add any additional information here for the questions above:

Please mention the question number(s) if possible.

 


 


GLOSSARY

Antifungal (Antifungals)
An agent that kills or inhibits fungi, or a compound that inhibits either a dermatomycosis like ringworm or athlete's foot, or
one that inhibits Candida albicans either externally as a douche or internally as a systemic antifungal. Examples: Nystatin, griseofulvin, Tabebuia.





























 

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