aarati clsi2
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Haemophilus influenzae and Haemophilus parainfluenzae
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TESTING CONDITIONS
• Medium: Disk diffusion: Haemophilus Test
Medium (HTM) Broth dilution: HTM broth
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Haemophilus Test Medium
hematin stock solution is prepared by dissolving 50 mg of hematin powder in 100 mL of 0.01 mol/L NaOH with heat and stirring until the powder is thoroughly dissolved. 30 mL of the hematin stock solution and 5 g of yeast extract is added to 1 L of Mueller-Hinton agar (MHA) and autoclaved.After autoclaving and cooling, add 3 mL of a nicotinamide adenine dinucleotide (NAD) stock solution (50 mg of NAD dissolved in 10 mL of distilled water, filter sterilized) aseptically
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Testing conditions
• Inoculum: Direct colony suspension, equivalent to a 0.5 McFarland standard
• Incubation: 35 ± 2 °C; • Disk diffusion: 5% CO2; 16 to 18 hours • Broth dilution: ambient air; 20 to 24 hours
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Suggested grouping of antimicrobial agents that should be considered for routine testing and reporting for Haemophilus
spp.
• GROUP A DRUGS PRIMARILY TESTED AND REPORTED
AmpiciilinTrimethoprim-
Sulfamethoxazole
• GROUP B DRUGS PRIMARILY TESTED AND REPORTED SELECTIVELY
Ampicillin-SulbactamCefuroxime(parenteral)Cefotaxime or
ceftazidime or Ceftriaxone
ChloramphenicolMeropenem
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Suggested grouping of antimicrobial agents that should be considered for routine testing and reporting for Haemophilus spp.
• GROUP C (SUPPLEMENTAL) - REPORT SELECTIVELY Azithromycin Clarithromycin Aztreonam Amoxycillin-Clavulanic acid Cefaclor Cefprozil Cefdinir or Cefixime orCefpodoxime Cefuroxime(oral) Ciprofloxacin or Levofloxacin or Lomefloxacin or Moxifloxacin or Ofloxacin Gemifloxacin Ertapenem or Imipenem Rifampin Telithromycin Tetracycline
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MINIMAL QC Recommendations
Haemophilus influenzae ATCC® 49247
Haemophilus influenzae ATCC® 49766
Escherichia coli ATCC® 35218 (when testing
amoxicillin-clavulanic acid)
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Amoxicillin-clavulanic acid, Azithromycin, Clarithromycin, Cefpodoxime,Cefixime, Cefuroxime,Cefaclor, Cefprozil, Loracarbef, Cefdinir, Telithromycin
Empiric therapy for respiratory tract infections
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H. influenzae from CSF following drugs should be reported routinely.
Ampicillin
Third Generation Cephalosporins
Chloramphenicol
Meropenem
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• The results of ampicillin susceptibility tests should be used to predict the activity of Amoxicillin.
• The majority of isolates of H.influenzae that are resistant to Ampicillin and Amoxicillin produce a TEM-type β-lactamase.
• In most cases, a direct β-lactamase test can provide a rapid means of detecting resistance to ampicillin and amoxicillin.
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• Rare BLNAR strains of H. influenzae should be considered resistant to :-
Ampicillin-SulbactamAmoxacillin-Clavulanic acidCefuroximepiperacillin-tazobactamCefaclorCefetametCefonicid cefprozil Loracarbef
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• Chloramphenicol not routinely reported on isolates of urinary tract.
• Rifampicin should not be used alone for antimicrobial therapy
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Drug Conc. Of Drug used µm
H.Influenzae
Enterobacteriacae
Ampicillin 10 22 17
Ampillin-Sulbactam 10/10 20 15
Amoxicillin-Clavulanic acid
20/10 20 18
Piperacillin-Tazobactam
100/10 21 21
Cefotaxime or Ceftazidime or Ceftriaxone
303030
262626
262123
Cefuroxime 30 20 18
Cefpodoxime 10 21 21
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Drug Conc. Of Drug used µm
H.influenzae Enterobacteriacae
Cefepime 30 26 18
Ciprofloxacin or Levofloxacn or Ofloxacin
555
181618
211716
Trimethoprim-Sulfamethoxazole
1.25/23.75 16 16
Chloramphenicol30
29 18
Meropenem 10 20 23
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Drug Conc. Of Drug used µm
H.Influenzae
Enterobacteriacae
Tetracycline 30 29 15
Imipenem orEtrapenem
1010
1619
2323
Azithromycin orClarithromycin
1515
1213
_ _
Gatifloxacin 5 18 15
Rifampin 5 20 _
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NEISSERIA GONORRHOEAE
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TESTING CONDITIONS
• Medium: Disk Diffusion: GC agar base and 1% defined
growth supplement
Agar dilution: GC agar base and 1% defined growth
supplement
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GC agar supplement 1.1g L-cysteine 0.03g guanine HCL 3 mg thiamine HCL 13 mg para-aminobenzoic acid[PABA] 0.1 g B12 0.1 g cocarboxylase 0.25 g NAD 1 g adenine 10 g L-glutamine 100 g glucose 0.02 g ferric nitrate[in 1 L H2O]
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• Inoculum:Direct colony suspension, equivalent to a 0.5 McFarland standard
• Incubation: 36±1 0c, 5% CO 2,
20 to 24 hours
TESTING CONDITIONS
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MINIMAL QC Recommendations
Neisseria gonorrhoeae ATCC 49226
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Suggested grouping of antimicrobial agents that should be considered for routine testing and reporting for Neisseria
gonorrhoeae
• GROUP C (SUPPLEMENTAL)-REPORT SELECTIVELYCefixime or CefpodoximeCefotaxime or ceftriaxoneCefoxitinCefuroximeCiprofloxacin or OfloxacinPenicillinSpectinomycinTetracycline
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single dose treatment regimen for Neisseria gonorrhoeae
Ceftriaxone (125 mg IM)
Cefixime (400mg PO)
Ciprofloxacin (500 mg PO)
Ofloxacin (400 mg PO)
Levofloxacin (250 mg PO)
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Drug Conc. Of drug µm Zone
Penicillin 10 units 47
Cefotaxime or Ceftriaxone
3030
3135
Cefoxitin 30 28
Cefepime 30 31
Ceftazidime 30 31
Cefpodoxime 10 29
Tetracycline 30 38
Ciprofloxacin or ofloxacin
55
4131
Standard Zone diameters for AST of Neisseria gonorrhoeae
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