Interpretive breakpoints for Streptococcus pneumoniae for selected antibiotics

Interpretive breakpoints for Streptococcus pneumoniae for selected antibiotics

Antibiotic	Susceptible	Intermediate	Resistant
Penicillin G (parenteral)
Meningitis	≤0.06 mcg/mL	–	≥0.12 mcg/mL
Nonmeningitis*	≤2 mcg/mL	4 mcg/mL	≥8 mcg/mL
Penicillin V (oral)*	≤0.06 mcg/mL	0.12 to 1 mcg/mL	≥2 mcg/mL
Amoxicillin (non-meningitis)	≤2 mcg/mL	4 mcg/mL	≥8 mcg/mL
Cefuroxime
Parenteral	≤0.5 mcg/mL	1 mcg/mL	≥2 mcg/mL
Oral	≤1 mcg/mL	2 mcg/mL	≥4 mcg/mL
Cefotaxime, Ceftriaxone
Meningitis	≤0.5 mcg/mL	1 mcg/mL	≥2 mcg/mL
Nonmeningitis	≤1 mcg/mL	2 mcg/mL	≥4 mcg/mL
Cefpodoxime	≤0.5 mcg/mL	1 mcg/mL	≥2 mcg/mL
Cefdinir	≤0.5 mcg/mL	1 mcg/mL	≥2 mcg/mL
Cefprozil	≤2 mcg/mL	4 mcg/mL	≥8 mcg/mL
Ceftaroline (nonmeningitis)	≤0.5 mcg/mL	–	–
Clindamycin	≤0.25 mcg/mL	0.5 mcg/mL	≥1 mcg/mL
Rifampin^¶	≤1 mcg/mL	2 mcg/mL	≥4 mcg/mL
Azithromycin	≤0.5 mcg/mL	1 mcg/mL	≥2 mcg/mL
Clarithromycin	≤0.25 mcg/mL	0.5 mcg/mL	≥1 mcg/mL
Gemifloxacin	≤0.12 mcg/mL	0.25 mcg/mL	≥0.5 mcg/mL
Levofloxacin	≤2 mcg/mL	4 mcg/mL	≥8 mcg/mL
Moxifloxacin	≤1 mcg/mL	2 mcg/mL	≥4 mcg/mL

This table is intended for use with UpToDate content on S. pneumoniae infections. Not all of the antibiotics in the table are appropriate for all types of pneumococcal disease. Refer to UpToDate content for details of treatment of specific infections. When the E-test is used to determine minimum inhibitory concentrations (MICs), exact results are reported rather than the twofold dilutions that were used when the cut-offs were defined. An MIC value that falls between standard twofold dilutions must therefore be rounded up to the next dilution in order to be categorized. As an example, an S. pneumoniae isolate from a patient with meningitis with a cefotaxime/ceftriaxone MIC of 1.5 mcg/mL would be rounded up to 2 mcg/mL and would be considered resistant.

* For nonmeningitis isolates, a penicillin MIC ≤0.6 mcg/mL can predict susceptibility to other beta-lactams as follows: ampicillin (oral or parenteral), ampicillin-sulbactam, amoxicillin, amoxicillin-clavulanate, cefaclor, cefdinir, cefditoren, cefepime, cefotaxime, cefpodoxime, cefprozil, ceftaroline, ceftizoxime, ceftriaxone, cefuroxime, doripenem, ertapenem, imipenem, loracarbef, and meropenem.

¶ Rifampin should not be used as monotherapy.

Data from:

Clinical and Laboratory Standards Institute (CLSI). Performance Standards for Antimicrobial Susceptibility Testing, 32^nd ed. CLSI Supplement M100. Clinical and Laboratory Standards Institute 2022, p.94.

Graphic 63881 Version 8.0

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Interpretive breakpoints for Streptococcus pneumoniae for selected antibiotics