Miscellaneous antibiotics -  MIC-breakpoints (Version 2009-04-27)

All breakpoints in this table harmonised through EUCAST.
Words and breakpoints in hypertext (link): always consult footnote prior to use. 

Previous version of MIC-breakpoints

Link from antibiotic to EUCAST MIC-distributions

Breakpoints not related to species

 Enterobac-teriaceae Pseudo-monas Acineto-bacter Staphylo-
coccus		 Entero-
coccus		 Strepto-
coccus A,B,C,G		 S.pneu-moniae Other
strepto-cocci		 H.influ-enzae M.catarr-halis P.multo-
cida
Method:   A A A A A B B B B B B
Amikacin 8/16 8/16 8/16 8/16 8/16 Note - - Note IE IE -
Gentamicin 2/4 2/4 4/4 4/4 1/1 Note - - Note IE IE -
Netilmicin 2/4 2/4 4/4 4/4 1/1 Note - - Note IE IE -
Tobramycin 2/4 2/4 4/4 4/4 1/1 Note - - Note IE IE -
Erythromycin IE - - - 1/2 - 0.25/0.5 0.25/0.5 IE 0.5/16

0.25/0.5

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

Azithromycin

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

0.5/0.5

 -

Telithromycin

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

Clindamycin

 IE - - - 0.25/0.5 - 0.5/0.5 0.5/0.5 Pending - - -
Fusidic acid IE - - - 1/1 - IE - - - - -
Chloramphenicol (T) IE 8/8 - - 8/8 - 8/8 8/8 - 1/2 1/2 -
Doxycycline IE - - - 1/2 - 1/2 1/2 - 1/2 1/2 2/4
Tetracycline IE - - - 1/2 - 1/2 1/2 - 1/2 1/2 2/4
Tigecycline 0.25/0.5 1/2 - IE 0.5/0.5 0.25/0.5 0.25/0.5 IE IE IE IE IE
Link from antibiotic to EUCAST MIC-distributions

Breakpoints not related to species

 Enterobac-
teriaceae		 Pseudo-
monas		 Acineto-
bacter		 Staphylo-
coccus		 Entero-
coccus		 Strepto-
coccus A,B,C,G		 S.pneu-moniae Other strepto-cocci H.influ-enzae M.catarr-halis P.multo-
cida
Rifampicin IE - - - 0.06/0.5 - 0.06/0.5 0.06/0.5 Pending 0.5/0.5 IE -

Vancomycin**

 4/8 - - - 4/8* 4/8 4/4* 4/4* 4/4* - - -

Teicoplanin**

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

Quinupristin/-
 dalfopristin**

 IE - - - 1/2 E.faecalis:-
E.faecium:1/4		 - - - - - -
Norfloxacin (U) 0.5/1 0.5/1 - - - - - - - - - -
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 0.12/0.25
Ofloxacin 0.5/1 0.5/1 - - 1/1 - - 0.12/4 - 0.5/0.5 0.5/0.5 IE
Levofloxacin 1/2 1/2 1/2 1/2 1/2 - 1/2 2/2 IE 1/1 1/1 IE
Moxifloxacin 0.5/1 0.5/1 - - 0.5/1 - 0.5/1 0.5/0.5 IE 0.5/0.5 0.5/0.5 IE
Nitrofurantoin (U) IE 64/64 - - 64/64 E.faecalis:64/64
 E.faecium:-		 64/64 - - - - -
Trimethoprim (U) IE 2/4 - - 2/4 0.032/1 - - - - - -
TrimSulfa
(ratio 1:19)		 IE 2/4 Pseudomonas:-
 S.maltophilia:4/4		 2/4 2/4 Note 1/2 1/2 - 0.5/1 0.5/1 2/4
Kolistin** IE 2/2 2/2 2/2 - - - - - - - -
Fosfomycin-trometamol (U) IE 32/32 - - - - - - - - - -

 

*Isolat med MIC-värden över S/I-brytpunkten är ovanliga eller har ännu inte beskrivits. Identifiering och resistensbestämning skall upprepas och om resultatet konfirmeras skickas isolatet till referenslaboratorium.

**MIC-bestämning på MH-medium. För daptomycin krävs tillsats av calcium.

(U) Brytpunkterna gäller endast vid nedre okomplicerad urinvägsinfektion.
(T) Brytpunkterna gäller endast vid topikal användning av medlet.

*Isolates with MIC values above the S/I-breakpoint are very rare or not yet reported. The identification and antimicrobial susceptibility tests on any such isolate must be repeated and if the result is confirmed the isolate sent to a reference laboratory.

**MIC-determination on MH only. For daptomycin the addition of calcium is required. 

(U) = Breakpoints valid for uncomplicated urinary tract infections only.
(T) = Breakpoints valid for topical treatment only.

Note/brytpunkt i hypertext - länk till särskild information om brytpunkten. Informationen finns i samma dokument som den länk som ges från artnamnen. För den som skriver ut tabellen på papper är det viktigt att även alla fotnoter skrivs ut och följer med tabellen.

 Note/breakpoint in hypertext = 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.

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
4/8 - breakpoints for SIR-categorisation: S< 4 mg/l and  R>8 mg/L.

IE - Clinical effect is not ruled out but EUCAST/SRGA have not been able to find enough clinical evidence to determine a breakpoint.

-  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.
Metod:
A = grundmedium utan tillsatser. Inkubation 35o C i luft.
B = grundmedium + 5% skakhästblod.+ NAD. Inkubation i 5 % CO2 vid 35o C .

Method:
A = medium without additives. Incubation in air, 35o C.
B = medium + 5% defibrinated horse blood + NAD. Incubation in 5 % CO2 at 35o C.
RAF & RAF-M
Uppdaterat 2009-05-03