FluoroquinoloneBClick on antibiotic name to see wild type MIC distributions |
Species-related breakpoints (S</R>) | Non-species related
breakpointsA S</R> | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Entero- bacteriaceaeC |
Pseudo-monas/ |
Acineto-bacter | Staphylo- coccus |
Entero- coccus |
Strepto- coccus A,B,C,G |
S.pneu- moniaeF |
Other strepto- cocci
|
H.influenzae M.catarrhalis | N.gonorr- hoeae |
N.menin- |
Gram- |
Gram-negative anaerobes | |||
| Ciprofloxacin | RD | 0.5/1 | 0.5/1 | 1/1D | 1/1E | -- | -- | 0.125/2 | -- | 0.5/0.5G | 0.03/0.06 | 0.03/0.06 | -- | -- | 0.5/1 |
| Levofloxacin | RD | 1/2 | 1/2 | 1/2 | 1/2 | -- | 1/2 | 2/2 | IE | 1/1G | IE | IE | -- | -- | 1/2 |
| Moxifloxacin | RD | 0.5/1 | -- | -- | 0.5/1 | -- | 0.5/1 | 0.5/0.5 | IE | 0.5/0.5G | IE | IE | IE | IE | 0.5/1 |
| Norfloxacin | RD | 0.5/1 | -- | -- | -- | -- | -- | -- | -- | -- | IE | -- | -- | -- | 0.5/1 |
| Ofloxacin | RD | 0.5/1 | -- | -- | 1/1E | -- | -- | 0.125/4 | -- | 0.5/0.5G | 0.12/0.25 | IE | -- | -- | 0.5/1 |
|
A.
Non-species related breakpoints
have been determined mainly on the basis of PK/PD data and are independent of
MIC distributions of specific species. They are for use only for species
not mentioned in the table or footnotes
B. For breakpoints for other fluoroquinolones (eg. pefloxacin and enoxacin) - refer to breakpoints determined by national breakpoint committees. C. Salmonella spp - there is clinical evidence for ciprofloxacin to indicate a poor response in systemic infections caused by Salmonella spp with low-level fluoroquinolone resistance (MIC>0.064 mg/L). The available data relate mainly to S.typhi but there are also case reports of poor response with other Salmonella species.D. The S/I breakpoint has been increased from 0.5 to1 mg/L to avoid dividing the wild type MIC distribution. Thus there is no intermediate category for Acinetobacter species E. Staphylococcus spp - breakpoints for ciprofloxacin and ofloxacin relate to high dose therapy.F. Streptococcus pneumoniae - wild type S.pneumoniae are not considered susceptible to ciprofloxacin or ofloxacin and are therefore categorized as intermediate. For ofloxacin the I/R breakpoint was increased from 1.0 to 4.0 mg/L and for levofloxacin the S/I-breakpoint from 1.0 to 2.0 to avoid dividing the wild type MIC distribution. The breakpoints for levofloxacin relate to high dose therapy. G. Strains 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. Until there is evidence regarding clinical response for confirmed isolates with MIC above the current resistant breakpoint (in italics) they should be reported resistant. Haemophilus/Moraxella - fluoroquinolone low-level resistance (ciprofloxacin MIC:s of 0.125 - 0.5 mg/L) may occur in H.influenzae. There is no evidence that low-level resistance is of clinical importance in respiratory tract infections with H.influenzae.H. Neisseria meningitidis - breakpoints apply to the use of ciprofloxacin in the prophylaxis of meningococcal disease. -- = Susceptibility testing not
recommended as the species is a poor target for therapy with the
drug. |
| Version* | Date | Action |
| 2.6 | 2009-04-07 | Clerical error in the numbering of footnotes corrected |
| 2.5 | 2008-06-19 | "Other streptococci" and "Grampositive anaerobes" added to table. No new breakpoints added. |
| 2.4 | 2008-03-12 | Error correction (wrong footnote for S.pneumoniae - changed from 5 to 6) |
| 2.3 | 2007-10-05 | Links to EUCAST Rationale Documents added. |
| 2.2 | 2006-06-20 | This table rearranged in reverse chronological order. |
| 2.1 | 2006-01-31 | Added an explanation of links from antibiotic names to wild type MIC distributions. Revised footnotes. Table version number added. |
| 2.0 | 2005-11-02 | Moxifloxacin given breakpoints for staphylococci and streptococci. |
| 1.0 | 2004-04-30 | European fluoroquinolone breakpoints harmonised by EUCAST |