THE ANTIMICROBIC NEWSLETI'ER, VOLUME 7, NUMBER 4, APRIL 1990 27

M7-A2

TABLE 1 Suggested ~ of Anlkn/uob/al Agents That Shou/d Be Cons/der~ for Routine Test/rig and Repotl~ by Cl~cal Mictobio~y Laboratories

I Streptococci

Entmobactedaceae Pseuck)monas. St~nylococd Enlerococci* Enterococci HaemopN~ Ampicillin c Penicillin G Penicillin G ~ or Penicillin G

Ampicillin

= =£=.

Cephak3~in c,h Cefazolin c,h Gentamicin c

Carb~icillin or Ticarcillin

Mezlocillin or Piperacillin

A m4~icillin / Sulbactam Amoxicillin / Clavulanic

ack~ Ticarcillir~/Clavulanic

acid

Cefotetan Cefoxitin Cefoperazone

Cefuroxime or Cefamandole or Cefonicid

Cefotaxime d or Ceftazidime~ or Ceftizoxime d or Ceftriaxone~

Aztreonam d

Amikacin

Trimethoprim/ Sulfamethoxazole c

Imipenem

Tetracycline c

Tobramycin

Netilmicin

Kar~mycin

Chloramphenicol

Ciprofloxacin c

Cinoxacin Norfloxacin

Nitrofurantoin

T r i ~ i m

Sulfisoxazole

Carbenicillin or Mezlocillin or Ticmcillin

~ i c i n

Azlocillin or Pip~acillin

Cefoperazone or Ceftazidime

Aztreor~m

Tic~cillinl Clavulanic Acid

Imipensm

Ciprofloxacin

Amikacin

Tobramycin

Cefotaxime or Ceftriaxone or Moxalactam

C h l o r a ~ i c o Y T r i ~ m /

S~arne~oxazole ~

Netilmicin

Oxacillin or Me(~cillin h

Cephalothin h or Cefazolin h

Erylhromycin I

Clindamycin

Ampicillin/ SuIbactam h

An~xicillin/ Clavulanic Acid h

Tetracycline~

T r i ~ i m / Sulfame~oxazole

C-~tamicin Vancomycnn

Imipe~em

Chloramphenico~J

Ciprofloxacin

Rifampin ~

Ceflizoxime Nitrofurantoin

Norfloxacin Norfloxacin

Tetracycline ~,~ Trimethoprim

Sulfisoxazole Sulfisoxazole

Vancomycin ~

Ciprofloxacin Norftoxacin

Tetracycline

Nilrofurantoin

Cept~othin

Ewthrornycin

Clindarnycin

Te~acycline

Chl~,~f ~.~,~,;~u;J

Va~comycin m

Norfloxacin

Nitrofura~toin

Ampicillin ~ Trime@~ptim/

Sulfamethoxazole n

Amoxicillin / clavulanic acid"

Ampicillin/ sutbactam

Cefuroxime sodium (p=~.,;¢. ¢,;)

Cefaclor n Cefixime n Cefuroxime axetil n

Cefotaxime ° or Ceftazidime or Ceftizoxime or Ceflfiaxone

Chloramph~icol °

Cefamandole Cefonicid

Rifampin

NOllE 1: Seiecti~1~fthem~stap~xmteantimic~bia1agentst~testisa~ecis~nbestrr~adebyea~c~ini~ IM~yat o~ in cons~dtatio,1 with the kllectious disease ~actit ioq~s, the pt~macy, and the i#~ar macy and/or infection co~trot cornf l l l t tm of ~le medical staff ~ lists comprise agents of Woven clinical efficacy for mat ocgamsm group arKI which show acc~ptsbk~ /,1 vitro test pef/ommnce. Tests on selected ~;e~ts may be useful for infection comrol purposes

NOTE 2: or designates a related ~oup of agents wh~-h ShOw nearly i~entiC~l spectrum and k~ecpcetive r t~ults, a#td oomplrablo clinical efficacy. In addition to these groups of reklted agents, 1tie boxes in

Table also designate clustecs of other Ct~l~ 'able agents that need nor be dupliCated in testing because interpretive results will uSUally be sknilar ~ clinical efficacy cocw~arable. Usual~y only one of the agents wilhin ea¢~ selection box (related ~oup or cluster} ~ou ld be included in panels selected for t~ti~g. Agents r w~o~tex~ must be testod ar~l sho¢lkl ulsu, olly match 1hose included in 1~e hOSpitat formulary Or else the report should klciude footnotes indicating the a ~ t s which uSUally show comparable mlerpretive reSUltS.

NOTE 3: Fnfornlatio~ in bok~face typ~ is CO4~Sidor od ~ for one year Afthou~ no information appears in botdface ~po in this table, all infmmatio~ is considered t ~ e for one year

a. Grouo B~Represents ~ J l t S which may warrant inclusk~l in a primary test panel but which should be reported O~tly selectively, such as when the orge~snl is resistant to ag~tts of the same fBrni~y in the prirnuy report CaleQOry ~ indiCatlO~ for repot'ring the result ~ klclude ~ol~;ted $1p~¢k"n~l SOUrces (e.g., third g ~ r a t k ~ t C~ohalosporin for an ontek-ic Irom corob¢ospinal flt~l I 06' t~imothoprim/ sullarrmlhoxazole for urina~ tract isolates) or on re~ l~ t in cases of alkl~y or intolorllnc~, or f ililur~ to r e s e l l to agents in the p¢imary test category, Or reporting to in f~ction cordrol ~1 ~ epid~miologlc aid (e,g,, tetracycline for staphylococci)

b G/o~o C-~l~or~l~Nlflt $ air ~¢~ltive or supp~lf~mlt~l antin~robial ~ t s that rrmy r Oq¢l/ee temtlng L'I i~ t i t~ iO~ harboring end~rdc O¢ e~d~lllC s~ain~ r~i~tant to one Or more of ~ prima~ drugs (o~eci~lty in the same fl~'lily, e.g., ~- Iact l r~ o~ ~lm~noglyco=id~), o¢ for treatnle~ of ~ 1 1 1 or~nl.~lls (e.g., chloramphemlcol for some PseudomOtlaS sp~,), or reportk~g to Infe~-tion co~tro~ as an epidemiolo~c aid (eg.. chloral~ohe~Icol arid ka~mlycin for enteric.s).

c. M~ly be ~opropriat~ for inclusion in a patrol for testing of urinary u~ct isolates a l ~ w ~ ~ ~ in ~

o~ For CSF ~oe¢i~l~s one r~p~esordative agent ~d~ould be reporled with Gro~o A.

e. Also ~opl~s to Ackl~o~f~h~s~p

May be indicated ~r testing s~me Pseu~Gm~tms spp~ ~u1er than ~ ae~ugm~sa~ ~r f~r Acinet~bacfer ~

NCCLS VOL, 10 NO. 8

V

g. Doxycyclirm 0( rrwlOCycllne r~ly be t~stecJ in place of 0r i¢1 ~ to teltlbcyct~e ~ ~ ~ t ~ of S. aur~N/s and nonf~rmenfative, ~¢lml~N~lat(ve bacilli (e.g.. Acinek~oach~r spp.) but ~ not be wsuJ to p r ~ tetrlcycllne s u s c e ~ l , y .

h. The cephaIo~dn susceptibility t est results c~noL be relbld u~on to dlotect ce~ok)~lpor kl.r ii~stance among r net hiciIXn-,r esiltant S l ~ spp. (see FOOtnOte d, Table 2, in M7 lerldlOr Footnote h, Table 2, kl M2). Amoxict~l/clavulantc eckl. a~lDlcillin/suibactam, kn~oetlem, and UcarcIHkVcLIiVUlan~ acid have • sirnl lu and Coflxoa fllble ~ as the p ~ l i C i l ~ o s J s t a n t ~ ic i lX f t s ~ thQ ¢ e l ~ l k ~ k l s 10glhlst intHnsJc~ly oxacmm-res~su~ (hetero~sistant) sta;~yk)cocci, and heter~e~stlc, t staphylococcal st, sins re~Istwlt to oxacglM Or melhiciHIn should curre~ly also be ~ ref1"actocy to amoxicill~nlclavulmllc acid, mtl~ll l in/sulbactent, i m p , and tica,-cillhl / clavulani¢ acid,

Celazolin test results may not accurately Wedict susceptibility to other first ge~wation cephJosporkls. Cept~othi . should be tested instead to re~resent cephatoth~, cef~ckx (except for H~m~c~#us), cephapi~m, ce~rad/41e, Cephalexkl. ~ cefa~roxil.

L The re,suits of ~ i c t l l l r l s u s c ~ l i t y tests rely be used to ;x~d~'t the activity of a~lOxtclilkl. The vast r r l ~ i t y of clklP.~ isolates of Pil~11olO~l~ ~ f f f .~z i~ that ace re~sk;tl~lt to ampicillkl ~ Iin~xk:illin produce a "i~EM-ty~e ~-Iaclamase, AS a result, in most ca..-e~, ~ ~-Iectamese mtay alone ~ ~ ~ ~ pr~M~ct the activity of these two agents,

j. NOt routinely t~ted llg~in~t or~ni6rrts iso~llted h'om ~ urktary tract.

k. Ant blli~Oblal agents r tot listl~d kl thls colunln ~ h ~s the col~n~k)~)~ins, cllndwnycin, a~l the ~ - cosides shoed not be tested andlor r~0orted a~ainst the enterococct because th~ re,porting of ~ w ~ can be d a n g e ~ l y misstating.

I. Pellk;Ulln G ~ l l l ~ l b t l l t y nlay be ueed to pt*~d~t the lul~egfl~lity to llmp~illirl, ampi4;illln i , UlllO~l, amoxtclll~l, iin(I ~'ylll l~p~iliin~ to which olltorococci are IIIio " ~ a t l l l y ~cel ) t ib l~. " 1.10w41~, corl'lb4tlltion ~llll'llpy Of penicil lb G o¢ amplCilltn, N an aminogly¢o~id~, is U~ll l ly i~diQi1od for ent~oc~Cal Infect~r~ such as olldocarditts,

m. Va~comyG)n is of~m used for 84Rk0~m ~ 1 inf~--tions it1 p ~ with s i~ l l can t pen~clllifl 81k~gy. ft shoed ~ re~orted sok~cUve0y (or footnote) as ~eing indicated only in suc~ ~t lems.

n. The result& of tosts wil~ agents that are edm~niste~d only by the oral ro~4e shouk:l be re~rtod only w ~ ~ late~ o# ~ t u s spp. ~ IOC~ized, r~z-llfe-lhreatenlng infections (e.g.. uncomplicated cases of miffs med~ and sinusitis, and sek~cted Ixonchop~molwy infections).

o. The result of testing with o~e of the extmld~d spect~la~ c e p h ~ l n s and C:hk~lvnphml~ol shotdd be reported routinely wWn i n ilolales o f / ' l ~ k ~ / n f/uenza~ recovered from patients with se¢iot~, llle- Ihreate~ing tnfectkms (e,9. m~nl~git Is, bacte~erma, eiMg~ottttis, lac~al celkdltts, etc)

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