Övriga antibiotika - Klinisk MIC-brytpunkter och artrelaterade MIC-gränser
Non-betalactam antibiotics -
Clinical MIC-values and species-related MIC-breakpoints

All breakpoints in this table now harmonised through EUCAST.
Zone diameter breakpoint correlates available in disk diffusion breakpoint table.

Grey background: recently abandoned original SRGA breakpoints (Feb, 2008).

Table 2

F-MIC
S</R>
Enterobac-
teriaceae,

SSYC
Pseudo-
monas
Acineto-
bacter
Staphylo-
coccus
Entero-
coccus
Strepto-
coccus
Pneumo-
coccus
H.influ-
enzae
M.ca-
tarrhal
C.ureal
C.jeikei
N.gonor-
rhoeae
N.menin-
gitidis
Method (see below)   A A A A A B B B B B B (nalidixic
 acid
screen)
B
Amikacin 8/16 8/16 8/16 8/16 8/16 ent strep -- IE IE -- -- --
Gentamicin 2/4 2/4 4/4 4/4 1/1 ent strep -- IE IE -- -- --
Netilmicin 2/4 2/4 4/4 4/4 1/1 ent strep -- IE IE -- -- --
Tobramycin 2/4 2/4 4/4 4/4 1/1 ent strep -- IE IE -- -- --
Erythromycin IE -- -- -- 1/2 -- 0.25/0.5 0.25/0.5 0.5/16

0.25/0.5

IE -- --
Roxithromycin IE -- -- -- 1/2 -- 0.5/1 0.5/1 1/16 0.5/1 IE -- --
Klarithromycin IE -- -- -- 1/2 -- 0.25/0.5 0.25/0.5 1/32 0.25/0.5 IE -- --

Azithromycin

IE -- -- -- 1/2 -- 0.25/0.5 0.25/0.5 0.12/4

0.5/0.5

IE 0.25/0.5 --

Telithromycin

IE -- -- -- IE -- 0.25/0.5 0.25/0.5 0.12/8 0.25/0.5 -- -- --

Clindamycin

IE -- -- -- 0.25/0.5 -- 0.5/0.5 0.5/0.5 -- -- IE -- --
Fusidic acid 0.5/0.5 -- -- -- 0.5/0.5 -- IE IE -- -- 0.5/0.5 -- --
Fusidic acid IE -- -- -- 1/1 -- IE -- -- -- -- -- --
Kloramfenikol 8/8 8/8 -- -- 8/8 -- -- (8/8) 2/2 -- IE -- 2/8
Chloramphenicol IE 8/8 -- -- 8/8 -- 8/8 8/8 1/2 1/2 -- -- 2/4
Doxycyklin* (2/2)* -- -- -- -- -- -- -- -- -- -- -- --
Doxycyklin IE -- -- -- 1/2 -- 1/2 1/2 1/2 1/2 -- IE --
Tetracyklin* 2/2 -- -- -- 2/2 IE 2/2 2/2 2/2 2/2 -- 0.12/1 --
Tetracyklin* IE -- -- -- 1/2 -- 1/2 1/2 1/2 1/2 -- (0.5/1)# 1/2
(Prophylaxis)
Tigecyklin 0.25/0.5 1/2** -- IE 0.5/0.5 0.25/0.5 0.25/0.5 IE IE IE IE IE IE
  F-MIC Enterobac-
teriaceae
Pseudo-
monas
Acineto-
bacter
Staphylo-
coccus
Entero-
coccus
Strepto-
coccus
Pneumo-
coccus
H.influ-
enzae
M.ca-
tarrhal
C.ureal
C.jeikei
N.gonor-
rhoeae
N.menin-
gitidis
Rifampicin 1/1 -- -- -- 1/1 -- 1/1 1/1 -- -- IE -- 1/1
(Prophylaxis)
Rifampicin IE -- -- -- 0.06/0.5 -- 0.06/0.5 0.06/0.5 0.5/0.5 IE IE -- 0.25/0.25(Prophylaxis)

Vancomycin

4/8 -- -- -- 4/8 4/8 4/4 4/4 -- -- IE -- --

Teicoplanin

4/8 -- -- -- 4/8 4/8 4/4 4/4 -- -- IE -- --
Linezolid 2/4 -- -- -- 4/4 4/4 2/4 2/4 -- -- IE -- --
Daptomycin* IE -- -- -- 1/1 IE 1/1 IE -- -- -- -- --

Quinupristin/-
dalfopristin

IE -- -- -- 1/2 E.faecalis: R
E.faecium: 1/4
-- -- -- -- -- -- --
Metronidazole 4/4 -- -- -- -- -- -- -- -- -- -- -- --
Metronidazole IE -- -- -- -- -- -- -- -- -- -- -- --
Norfloxacin (U) 0.5/1 0.5/1 -- -- -- -- -- -- -- -- -- IE --
Ciprofloxacin 0.5/1 0.5/1 0.5/1 1/1 1/1**** -- -- 0.12/2 0.5/0.5 0.5/0.5 IE 0.03/0.06 0.03/0.06
(Prophylaxis)
Ofloxacin 0.5/1 0.5/1 -- -- 1/1**** -- -- 0.12/4 0.5/0.5 0.5/0.5 -- 0.12/0.25 IE
Levofloxacin 1/2 1/2 1/2 1/2 1/2**** -- 1/2 2/2 1/1 1/1 IE IE IE
Moxifloxacin 0.5/1 0.5/1 -- -- 0.5/1 -- 0.5/1 0.5/0.5 0.5/0.5 0.5/0.5 IE IE IE
Nitrofurantoin 32/32 32/32 -- 32/32 32/32 E.faecalis: 32/32
E.faecium: R
32/32 -- -- -- -- -- --
Nitrofurantoin (U) IE 64/64 -- -- 64/64 64/64 64/64 -- -- -- -- -- --
Trimetoprim 2/4 2/4 -- -- 2/4 2/4 2/4 -- -- -- IE -- --
Trimethoprim (U) IE 2/4 -- -- 2/4 0.032/1 -- -- -- -- -- -- --
TrimSulfa 16/32 16/32 -- 16/32 16/32 -- 16/32 16/32 16/32 16/32 IE -- --
TrimSulfa (ratio 1:19) IE 2/4 Pseudo-monas: --
S.maltophilia:
4/4
2/4 2/4 0.032/1 1/2 1/2 0.5/1 0.5/1 IE -- --
Colistin 2/2 2/2 2/2 2/2 -- -- -- -- -- -- -- -- --
Colistin IE 2/2 2/2 2/2 -- -- -- -- -- -- -- -- --
Fosfomycin-trometamol(U) IE 32/32
(endast på licens)
-- -- -- -- -- -- -- -- -- -- --
Spectinomycin 32/32 -- -- -- -- -- -- -- -- -- -- 32/32 --
Spectinomycin IE -- -- -- -- -- -- -- -- -- -- 64/64 --

*Daptomycin susceptibility testing - MIC-determination on MH only.
(U) = Urinary tract infections only.
#Neisseria gonorrhoeae – tetracycline is not recommended for treatment of gonorrhoea, and resistance to tetracycline mainly constitutes an epidemiological marker.

Listeria
Medium B
Penicillin G (2/2), Ampicillin (2/2), Meropenem (0.5/0.5), TrimSulfa (2/4). Vid allergi hos gravida Erythromycin (0.5/0.5) som har sämre klinisk effekt. See EUCAST MIC-distributions for Listeria monocytogenes.
P.multocida
Medium B
Penicillin V (0.5/0.5), Ampicillin (0.5/0.5), Cefotaxime (0.12/1), Ciprofloxacin (0.12/0.25), Tetracycline (2/4) och TrimSulfa (2/4). See EUCAST MIC-distributions for P.multocida.
H.pylori
Medium B
Ampicillin (0.5/1), Clarithromycin (0.25/0.25), Tetracycline (2/2), Metronidazole (4/4). See EUCAST MIC-distributions for H. pylori.
Legionella pneumophila See MIC-distributions for relevant antimicrobials (EUCAST MIC-distributions for L. pneumophila)
Bacteroides,
Clostridium

Medium B + Anaerobe incubation
Penicillin G for Clostridium (0.25/1), Piperacillin/tazobactam (16/16), Imipenem (1/1), Meropenem (1/1), Clindamycin for Bacteroides 4/4, Clindamycin for Clostridium 4/4, Chloramphenicole (8/8), Tetracycline (2/2; proposed change: IE), Doxycycline (1/2; proposed change: IE), Metronidazole (4/4)
Stenotrophomonas maltophilia Trimsulfa 4/4 mg/L (MIC-tests should be performed on Mueller-Hinton agar). Breakpoints for other antimicrobials are not given by SRGA or EUCAST. Clinical correlation between MIC-values and clinical outcome is lacking and testing is uncertain. When testing, always use Mueller Hinton medium.

 

*Använd tetracyklin (lappar, Etest och substans för MIC-bestämning) i all resistensbestämning av tetracykliner.
**Tigecyklin har låg aktivitet mot Proteus, Morganella och Providencia. Resistensbestämning mot dessa bör ej utföras.
***För dalfopristin-quinupristin rekommenderas MIC-bestämning om behov för resistensbestämning föreligger.
****Aktiviteten mot Grampositiva bakterier är sämre än moxifloxacins aktivitet.

*Always use tetracyline (discs, Etest and susbstance for MIC-determination) in all susceptibility testing of tetracyclines. 
**
Tigecycline has decreased activity against Morganella, Proteus and Providencia; susceptibility testing should be avoided.
***For dalfopristine-quinupristine it is recommended that the MIC is determined when there is need for susceptibility testing.

Kursiv text anger en länk till en fotnot. För den som skriver ut tabellen på papper är det viktigt att även alla fotnoter skrivs ut och följer med tabellen.

Text = a link to a footnote. If you print the table on paper, remember to print the footnotes - they contain important information on methodology.
4/8 - sättet att beskriva MIC-gränser (exempelvis 4/8) skall tolkas S< 4 och R>8 mg/l (obs! ändrades 2003 från R> till R>).

IE - Klinisk effekt utesluts ej men in vitro och/eller in vivo dokumentation saknas.

--  RAF avråder från resistensbestämning. Ej relevant behandlingsalternativ: 

  1. godkänd indikation saknas
  2. otillräcklig aktivitet även mot bakterier som ej utvecklat resistens
  3. resistens så vanlig (>50%) att medlet får anses oanvändbart

Proph - endast för profylax

4/8 - the way breakpoints are described - interpretate S< 4 mg/l and R>8 mg/l (changed in 2003 from R> to R>).

IE - Clinical effect is not ruled out but EUCAST has not been able to find enough evidence to make a breakpoint decision.

--  SRGA advices against susceptibility testing. Not a relevant alternative:

  1. no approved indication
  2. insufficient activity
  3. extensive resistance development - the drug may be considered obsolete.

Proph - prophylaxis only

Metod:
A
= grundmedium utan tillsatser. Inkubation i luft, 35 - 37o C.
B = grundmedium + 5% skakhästblod + NAD. Inkubation 35 - 37o C i 5 % CO2. 
Method:
A
= medium without additives. Incubation in air, 35 - 37o C.
B = medium + 5% defibrinated horse blood + NAD. Incubation at 35 - 37o C in 5 % CO2.

RAF & RAF-M
Uppdaterat 2008-05-07, G Kahlmeter