For drug selection and dosing questions. Table 1 ...

Below are the CLSI breakpoints for selected bacteria. Please use your clinical judgement when assessing breakpoints. The lowest number does NOT equal most potent antimicrobial. Contact Antimicrobial Stewardship for drug selection and dosing questions.

Table 1: 2014 MIC Interpretive Standards for Enterobacteriaceae (includes E.coli, Klebsiella, Enterobacter, Citrobacter,

Serratia and Proteus spp)

Antimicrobial Agent

MIC Interpretive Criteria (g/mL) Enterobacteriaceae

Ampicillin Ampicillin-sulbactam Aztreonam

S 8 8/4 4

I

R

16

32

16/8

32/16

8

16

Cefazolin (blood) Cefazolin** (uncomplicated UTI only) Cefepime* Cefotetan Ceftaroline Ceftazidime Ceftriaxone Cefpodoxime Ciprofloxacin Ertapenem Fosfomycin Gentamicin Imipenem Levofloxacin Meropenem Piperacillin-tazobactam Trimethoprim-sulfamethoxazole

2 16 2 16 0.5 4 1 2 1 0.5 64 4 1 2 1 16/4 2/38

4

4-8* 32 1 8 2 4 2 1 128 8 2 4 2 32/4 ? 64/4 ---

8 32 16 64 2 16 4 8 4 2 256 16 4 8 4 128/4 4/76

*Susceptibile dose-dependent ? see chart below **Cefazolin can predict results for cefaclor, cefdinir, cefpodoxime, cefprozil, cefuroxime axetil, cephalexin and loracarbef for uncomplicated UTIs due to E.coli, K.pneumoniae, and P.mirabilis. Cefpodoxime, cefinidir, and cefuroxime axetil may be tested individually because some isolated may be susceptible to these agents while testing resistant to cefazolin.

Cefepime dosing for Enterobacteriaceae ( E.coli, Klebsiella, Enterobacter, Citrobacter, Serratia & Proteus spp)

MIC Based on dose of:

Susceptible /= 16

Do not give

Total dose

2g

3-4g

6g

NA

Table 2: 2014 MIC Interpretive Standards for Pseudomonas aeruginosa and Acinetobacter spp.

Antimicrobial Agent

Amikacin Aztreonam Cefepime Ceftazdime Ciprofloxacin Colistin/Polymixin B(Pseudomonas) Colistin/ Polymixin B (Acinetobacter) Gentamicin

MIC Interpretive Criteria (g/mL)

Pseudomonas aeruginosa

S

I

R

16

32

64

8

16

32

8

16

32

8

16

32

1

2

4

2

4

8

2

4

4

8

16

Imipenem Levofloxacin Meropenem Minocycline (Acinetobacter only) Piperacillin-tazobactam Ticarcillin-clavulanic acid Tobramycin

2 2 2 4 16/4 16/2 4

4 4 4 8 32/4 ? 64/4 32/2 ? 64/2 8

8 8 8 16 128/4 128/2 16

GRAM POSITIVES

Table 3: 2014 MIC Interpretive Standards for S.aureus.

Antimicrobial Agent

MIC Interpretive Criteria (g/mL) S.aureus

Ceftaroline Clindamycin Erythromycin

S

I

R

1

2

4

0.5

1-2

4

0.5

1-4

8

Gentamicin

4

8

16

Levofloxacin

1

2

4

Moxifloxacin Oxacillin*

0.5

1

2

2

4

Penicillin

0.12

0.25

Rifampin

1

2

4

Tetracycline

4

8

16

Trimethoprim/Sulfamethoxazole

2/38

4/76

Vancomycin

2

4-8

16

Daptomycin

1

Linezolid

4

8

*Rifampin should not be used for monotherapy ** If oxacillin susceptible, then results can applied to other beta-lactams including

cephalosporins.

Table 4: 2014 MIC Interpretive Standards for Enterococcus species.

Antimicrobial Agent

MIC Interpretive Criteria (g/mL)

Enterococcus spp

S

I

R

Ampicillin***

8

16

Daptomycin

4

Doxycycline

4

8

16

Erythromycin

0.5

1-4

8

Gentamicin

Synergy or no synergy

Linezolid

2

4

8

Penicillin**

8

16

Quinapristin-dalfopristin

1

2

4

(Synercid)

Rifampin

1

2

4

Streptomycin

Synergy or no synergy

Vancomycin

4

8-16

32

*For enterococcus, cephalosporins, aminoglycosides (except for high-level resistance screening), clindamycin, and trimethoprim-

sulfamethoxazole are not effective clinically.

**Call microbiology lab for penicillin MIC.

***Ampicillin susceptibility testing predicts activity of amoxicillin, amoxicillin-clavulanate, ampicillin-sulbactam, piperacillin, and piperacillin-tazobactam. Ampicillin susceptibility can be used to predict imipenem susceptibility provided the species is E.faecalis.

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