V 11.0 Breakpoint Tables

European Committee on Antimicrobial Susceptibility Testing
Breakpoint tables for interpretation of MICs and zone diameters

Version 11.0, valid from 2021-01-01
This document should be cited as "The European Committee on Antimicrobial Susceptibility Testing. Breakpoint tables for interpretation of MICs and zone diameters.
Version 11.0, 2021. http://www.eucast.org."
Content Page Additional information

Changes 1
Notes 8
Guidance on reading EUCAST Breakpoint Tables 10
Dosages 11
Information on technical uncertainty 15
Enterobacterales 17
Pseudomonas spp. 23
Stenotrophomonas maltophilia 28 Link to Guidance Document on Stenotrophomonas maltophilia
Acinetobacter spp. 30
Staphylococcus spp. 35
Enterococcus spp. 40
Streptococcus groups A, B, C and G 45
Streptococcus pneumoniae 50
Viridans group streptococci 56
Haemophilus influenzae 61
Moraxella catarrhalis 67
Neisseria gonorrhoeae 71
Neisseria meningitidis 75
Gram-positive anaerobes 79
Clostridioides difficile 84
Gram-negative anaerobes 85
Helicobacter pylori 89
Listeria monocytogenes 90
Pasteurella multocida 91
Campylobacter jejuni and coli 93
Corynebacterium spp. 94
Aerococcus sanguinicola and urinae 96
Kingella kingae 98
Aeromonas spp. 100
Achromobacter xylosoxidans 102
Content Page Additional information
Bacillus spp. 103
Burkholderia pseudomallei 105
Burkholderia cepacia complex 107 Link to Guidance Document on Burkholderia cepacia complex
Legionella pneumophila 108
Mycobacterium tuberculosis 109
Topical agents 110 Link to Guidance Document on Topical Agents
PK-PD (Non-species related) breakpoints 111
Expert Rules - Link to EUCAST Expert Rules
Detection of Resistance Mechanisms - Link to EUCAST Guidelines on Detection of Resistance Mechanisms
Antimicrobial susceptibility tests on groups of organisms or agents for
- Link to Guidance Document on how to test and interpret results when there are no breakpo
which there are no EUCAST breakpoints
Changes (cells containing a change, a deletion or an addition) from v. 10.0 are marked yellow.
Version 10.0, 2020-01-01
Changed comments are underlined. Removed comments are shown in strikethrough font style.
General • MIC and zone diameter breakpoints are linked to the search page of the new EUCAST database for MIC and zone diameter distributions.
• Explanation added for "off scale breakpoints" (S≤0.001 mg/L, S≥50 mm) in relevant tables
• Links added to rationale documents for temocillin, ceftazidime-avibactam and ceftolozane-tazobactam
• "Mecillinam oral" changed to "Mecillinam oral (Pivmecillinam)"
• Cefiderocol breakpoints added
• Doripenem breakpoints added
• Lefamulin breakpoints added
Notes • Note 4 updated with information on links from MIC and zone diameter breakpoints.
• Explanation added for breakpoints in brackets.
Dosages General
• Indications added for daptomycin
New dosages
• Temocillin
• Cefiderocol
• Doripenem
• Fidaxomicin
• Lefamulin
Revised dosages
• Piperacillin
• Piperacillin-tazobactam
• Cefaclor
New comments
• Piperacillin
• Doripenem
• Daptomycin
Revised comments
• Cefaclor
• Cefixime
• Ceftriaxone
• Azithromycin
• Clarithromycin
• Chloramphenicol
1
Version 10.0, 2020-01-01
Enterobacterales General
• Link to cefiderocol guidance document added in MIC methodology
• New indications related to meningitis for cefotaxime, ceftriaxone and meropenem
• List of species streamlined for imipenem and imipenem-relebactam
• Species information added for fosfomycin oral
New breakpoints
• Temocillin (MIC and zone diameter)
• Cefazolin (zone diameter)
• Cefiderocol (MIC and zone diameter)
• Cefotaxime (meningitis) [MIC and zone diameter]
• Ceftriaxone (meningitis) [MIC and zone diameter]
• Doripenem (MIC and zone diameter)
• Imipenem-relebactam (zone diameter)
• Meropenem (meningitis) [MIC and zone diameter]
Revised breakpoints
• Piperacillin (MIC and zone diameter)
• Piperacillin-tazobactam (MIC and zone diameter)
• Imipenem (zone diameter)
• Tobramycin (zone diameter)
• Fosfomycin iv (zone diameter)
• Fosfomycin oral (MIC)
New ATUs
• Cefiderocol (zone diameter)
• Ceftolozane-tazobactam (zone diameter)
Revised ATUs
• Piperacillin-tazobactam (zone diameter)
New comments
• Cephaloporins comment 2/A
• Cephaloporins comment 3
Revised comments
• Macrolides comment 1
Removed comments
• Penicillins previous comment 5/C (temocillin)
Pseudomonas spp. General

New breakpoints
• Cefiderocol (MIC and zone diameter)
Revised breakpoints
• Cefoxitin (changed from NA to dash)
New ATUs
• Cefiderocol (zone diameter)
New comments
• Cephalosporins comment 1
2
Version 10.0, 2020-01-01
Stenotrophomonas maltophilia General
• Notes added for cefiderocol
New comments
• Cephalosporins comment A
Acinetobacter spp. General

• Notes added for cefiderocol
New breakpoints
Revised breakpoints
• Meropenem-vaborbactam (changed from IE to Note 2/A)
New comments
• Carbapenems comment 2/A
Staphylococcus spp. General

• Taxonomy information updated
• All penicillin comments and placement of comments reviewed
• Species information added for oxacillin
New breakpoints
• Oxacillin (separate lines for "Oxacillin (screen only), S. pseudintermedius and S. schleiferi" and "Oxacillin, other staphylococci")
• Doripenem (Note)
• Lefamulin (MIC and zone diameter)
Revised breakpoints
• Benzylpenicillin, Coagulase-negative staphylococci (changed from dash to Note 2/C)
Removed breakpoints
• Ofloxacin (changed to Note 2/D)
New comments
• Penicillins comment 2/C
• Penicillins comment E
• Fluoroquinolones comment 2/D
Revised comments
• Penicillins comment 1/A (staphylococci changed to S. aureus)
• Tetracyclines comment B
3
Version 10.0, 2020-01-01
Enterococcus spp. General
• Note added for lefamulin
Revised breakpoints
• Imipenem-relebactam (changed from IE to Note 1/A)
• Moxifloxacin (changed from dash to Note 1/B)
New comments
• Fluoroquinolones comment 1/B
• Miscellaneous agents comment 2/A
Revised comments
• Fluoroquinolones comment C
Streptococcus groups A, B, C and G General

• New indication related to meningitis for benzylpenicillin
New breakpoints
• Benzylpenicillin (meningitis) [MIC and zone diameter]
• Doripenem (Note)
Revised breakpoints
• Cefoxitin (changed from NA to IE)
Streptococcus pneumoniae General

• New indications related to meningitis for ampicillin, amoxicillin iv, cefotaxime and ceftriaxone
• Clarification in flow chart for meningitis and screen-positive isolates
New breakpoints
• Ampicillin (meningitis) [MIC]
• Amoxicillin iv (meningitis) [MIC]
• Cefotaxime (meningitis) [MIC]
• Ceftriaxone (meningitis) [MIC]
• Doripenem (MIC)
• Lefamulin (MIC and zone diameter)
Revised breakpoints
New comments
• Penicillins comment B
• Cephaloporins comment B
• Carbapenems comment B
• Miscellaneous agents comment 1
Removed comments
• Penicillins previous comment 2
4
Version 10.0, 2020-01-01
Viridans group streptococci New breakpoints
• Benzylpenicillin (screen only) [MIC]
• Doripenem (MIC)
Revised breakpoints
• Imipenem-relebactam (zone diameter) [changed from IP to Note 2/B]
• Meropenem-vaborbactam (changed from IE to Note 2/B)
• Moxifloxacin (changed from IE to Note 1/B)
• Linezolid (changed from dash to IE)
• Tedizolid (MIC)
• Rifampicin (changed from dash to Note 1/A)
Removed breakpoints
• Cefazolin (MIC)
New comments
• Penicillins comment 2
• Fluoroquinolones comment 1/B
• Miscellaneous agents comment 1/A
Revised comments
• Penicillins comment 1/A
• Penicillins comment 3/B
• Carbapenems comment A
Haemophilus influenzae General

• New indications related to meningitis for ampicillin and amoxicillin iv
• Clarification regarding meningitis in flow chart
New breakpoints
Revised breakpoints
• Imipenem-relebactam (changed from IE to Note 3/E)
• Meropenem-vaborbactam (changed from IE to Note 3/E)
New ATUs
New comments
• Penicillins comment F
• Carbapenems comment 3/E
• Miscellaneous agents comment 1
5
Version 10.0, 2020-01-01
Moraxella catarrhalis
New breakpoints
Revised breakpoints
• Imipenem-relebactam (changed from IE to Note 2/A))
• Meropenem-vaborbactam (changed from IE to Note 2/A)
Removed breakpoints
• Chlorampenicol (referral to tables of topical agents)
New comments
Neisseria gonorrhoeae Revised breakpoints
• Cefoxitin (changed from dash to IE)
Neisseria meningitidis
General
• New indications related to meningitis for ampicillin, amoxicillin and meropenem
• Note added for doripenem
Revised breakpoints
• Benzylpenicillin
• Ertapenem (changed from dash to IE)
• Imipenem (changed from dash to Note 2)
• Imipenem-relebactam (changed from dash to Note 3)
• Meropenem-vaborbactam (changed from IE to Note 3)
New comments
• Carbapenems comment 2
Gram-positive anaerobes New breakpoints

• Doripenem
Revised breakpoints
New comments
• Penicillins comment 1
Gram-negative anaerobes New breakpoints

• Doripenem
Revised breakpoints
New comments
Listeria monocytogenes General

• New indications related to meningitis for benzylpenicillin
Campylobacter jejuni and coli Revised breakpoints
• Ciprofloxacin (MIC and zone diameter)
Corynebacterium spp. Revised breakpoints
• Ciprofloxacin (MIC and zone diameter)
• Gentamicin (changed from dash to IE)
Achromobacter xylosoxidans • New table
Bacillus spp. • New table
6
Version 10.0, 2020-01-01
Mycobacterium tuberculosis New breakpoints
• Pretomanid
New comment
• Comment 2
Topical agents Revised screening cut-off values
• P. aeruginosa and tobramycin (zone diameter)
• P. aeruginosa and ciprofloxacin (zone diameter)
• M. catarrhalis and chloramphenicol (zone diameter)
PK-PD breakpoints New breakpoints
• Cefiderocol
• Doripenem
• Fosfomycin oral
• Lefamulin
Revised breakpoints
• Piperacillin
New comments
7
Notes
1. The EUCAST clinical breakpoint tables contain clinical MIC breakpoints (determined or revised during 2002-2019) and their inhibition zone diameter correlates. The EUCAST breakpoint table
version 10.0 includes corrected typographical errors, clarifications, breakpoints for new agents and/or organisms, revised MIC breakpoints and revised and new zone diameter breakpoints.
Changes are best seen on screen or on a colour printout since cells containing a change are yellow. New or revised comments are underlined. Removed comments are shown in strikethrough
font style.
2. PK-PD (Non-species related) breakpoints are listed separately.
3. Numbered notes relate to general comments and/or MIC breakpoints. Lettered notes relate to the disk diffusion method.
4. Antimicrobial agent names in blue are linked to EUCAST rationale documents. MIC and zone diameter breakpoints in blue are linked to the search page of the EUCAST MIC and zone
diameter distribution database.
5. The document is released as an Excel® file suitable for viewing on screen and as an Acrobat® pdf file suitable for printing. To utilize all functions in the Excel® file, use Microsoft™ original
programs only. The Excel® file enables users to alter the list of agents to suit the local range of agents tested. The content of single cells cannot be changed. Hide lines by right-clicking on the
line number and choose "hide". Hide columns by right-clicking on the column letter and choose "hide".
6. EUCAST breakpoints are used to categorise results into three susceptibility categories:
S - Susceptible, standard dosing regimen: A microorganism is categorised as Susceptible, standard dosing regimen, when there is a high likelihood of therapeutic success using a standard
dosing regimen of the agent.
I - Susceptible, increased exposure: A microorganism is categorised as Susceptible, increased exposure* when there is a high likelihood of therapeutic success because exposure to the agent
is increased by adjusting the dosing regimen or by its concentration at the site of infection.
R - Resistant: A microorganism is categorised as Resistant when there is a high likelihood of therapeutic failure even when there is increased exposure.
*Exposure is a function of how the mode of administration, dose, dosing interval, infusion time, as well as distribution and excretion of the antimicrobial agent will influence the infecting organism
at the site of infection.
7. For an agent and a species, the ECOFF (epidemiological cut-off value) is the highest MIC (or the smallest inhibition zone diameter) for organisms devoid of phenotypically detectable acquired
resistance mechanisms. Breakpoints in brackets are based on ECOFF values for relevant species. They are used to distinguish between organisms with and without acquired resistance
mechanisms. ECOFFs do not predict clinical susceptibility but in some situations and/or when the agent is combined with another active agent, therapy may be considered.
8. An MIC breakpoint of S ≤ 0.001 mg/L is an arbitrary, "off scale" breakpoint (corresponding to a zone diameter breakpoint of "S ≥ 50 mm") which categorises wild-type organisms (organisms
without phenotypically detectable resistance mechanisms to the agent) as "Susceptible, increased exposure" (I). For these organism-agent combinations, never report “Susceptible, standard
dosing regimen” (S).
9. For some organism-agent combinations, results may be in an area where the interpretation is uncertain. EUCAST has designated this an Area of Technical Uncertainty (ATU). It corresponds
to an MIC value and/or zone diameter interval where the categorisation is doubtful. See separate page for more information on ATU and how to deal with results in the ATU.
8
Notes
10. In order to simplify the EUCAST tables, the "Susceptible, increased exposure" (I category) is not listed. It is interpreted as values between the S and the R breakpoints. For example, for MIC
breakpoints listed as S ≤ 1 mg/L and R > 8 mg/L, the I category is 2-8 (technically >1-8) mg/L, and for zone diameter breakpoints listed as S ≥ 22 mm and R < 18 mm, the I category is 18-21 mm.
11. For Escherichia coli with fosfomycin, Stenotrophomonas maltophilia with trimethoprim-sulfamethoxazole, Staphylococcus aureus with benzylpenicillin, enterococci with vancomycin,
Haemophulis influenzae with beta-lactam agents, Aeromonas spp. with trimethoprim-sulfamethoxazole and Burkholderia pseudomallei with trimethoprim-sulfamethoxazole, it is crucial to follow
specific reading instructions for correct interpretation of the disk diffusion test. For these, pictures with reading examples are included at the end of the corresponding breakpoint table. For
general and other specific reading instructions, please refer to the EUCAST Reading Guide.
12. With a few exceptions, EUCAST recommends the use of the broth microdilution reference method as described by the International Standards Organisation for MIC determination of non-
fastidious organisms. For fastidious organisms, EUCAST recommends the use of the same methodology but with the use of MH-F broth (MH broth with lysed horse blood and beta-NAD), see
EUCAST media preparation file at www.eucast.org. There are a number of commercially available surrogate methods, for which it is the responsibility of the manufacturer to guarantee the
accuracy of the system and the responsibility of the user to quality control the results.
13. By international convention MIC dilution series are based on twofold dilutions up and down from 1 mg/L. At dilutions below 0.25 mg/L, this leads to concentrations with multiple decimal
places. To avoid having to use these in tables and documents, EUCAST has decided to use the following format (in bold): 0.125→0.125, 0.0625→0.06, 0.03125→0.03, 0.015625→0.016,
0.0078125→0.008, 0.00390625→0.004 and 0.001953125→0.002 mg/L.
14. Definitions of "uncomplicated UTI" and “Infections originating from the urinary tract” used with EUCAST breakpoints:
Uncomplicated UTI: acute, sporadic or recurrent lower urinary tract infections (uncomplicated cystitis) in patients with no known relevant anatomical or functional abnormalities within the urinary
tract or comorbidities.
Infections originating from the urinary tract: Infections originating from, but not confined to, the urinary tract, including acute pyelonephritis and bloodstream infections.
"-" indicates that susceptibility testing is not recommended as the species is a poor target for therapy with the agent. Isolates may be reported as R without prior testing.
"IE" indicates that there is insufficient evidence that the organism or group is a good target for therapy with the agent. An MIC with a comment but without an accompanying S, I or R
categorisation may be reported.
NA = Not Applicable
IP = In Preparation
( ) = Breakpoints in brackets are based on ECOFF values for relevant species. They are used to distinguish between organisms with and without acquired resistance mechanisms. ECOFFs do
not predict clinical susceptibility but in some situations and/or when the agent is combined with another active agent, therapy may be considered.
9
Guidance on reading EUCAST Breakpoint Tables
MIC determination (broth microdilution according to ISO standard 20776-1)

Medium:
Inoculum:
Incubation: EUCAST methodology and quality
Reading: control for MIC determination
Quality control:
The I category is not listed but is interpreted as the values between the
S and the R breakpoints. If the S and R breakpoints are the same value
An arbitrary "off scale" Breakpoints with a there is no I category.
breakpoint which species name apply
categorises wild-type only to that particular Agent A: No I category
organisms as species (in this Agent B: I category: 4 mg/L, 23-25 mm
"Susceptible, increased example S. aureus) Agent H: I category: 1-2 mg/L, 24-29 mm
exposure (I)".
Antimicrobial agent MIC breakpoint Disk Zone diameter breakpoint

(mg/L) content (mm)
S≤ R> ATU (µg) S≥ R< ATU
Antimicrobial agent A 11 11 X 20A 20A
Antimicrobial agent B 22 4 Y 26 23
Antimicrobial agent C 0.001 8 X 50 18
Antimicrobial agent D, S. aureus IE IE IE IE
Antimicrobial agent E - - - -
Antimicrobial agent F IP IP IP IP
Antimicrobial agent G (screen only) NA NA Y 25 25
Antimicrobial agent H 0.5 2 Z 30 24
Antimicrobial agent I (8)1 (8)1 30 (18)A (18)A
Screening breakpoint to
differentiate between Not Applicable
isolates without and with (disk screening
resistance mechanisms breakpoint only)
In Preparation
MIC breakpoints in blue
are linked to MIC
distributions
Breakpoints in brackets are used to

Antimicrobial agents in blue distinguish between organisms with and Insufficient evidence that the
are linked to EUCAST without acquired resistance mechanisms organism or group is a good
rationale documents (see Notes) target for therapy with the agent
10
Breakpoints in brackets are used to
Antimicrobial agents in blue distinguish between organisms with and Insufficient evidence that the
are linked to EUCAST without acquired resistance mechanisms organism or group is a good
rationale documents (see Notes) target for therapy with the agent
11
EUCAST Clinical Breakpoint Tables v. 11.0, valid from 2021-01-01
Disk diffusion (EUCAST standardised disk diffusion method)

Medium:
Inoculum:
Incubation: EUCAST methodology and
Reading: quality control for disk diffusion
Quality control:
but is interpreted as the values between the

the S and R breakpoints are the same value
Area of Technical Uncertainty

See specific information on how to
23-25 mm handle technical uncertainty in
L, 24-29 mm antimicrobial susceptibility testing.
Notes
Numbered notes relate to general comments and/or MIC breakpoints.
Lettered notes relate to the disk diffusion method.
1. Notes that are general comments and/or relating to MIC breakpoints.
2. New comment
Removed comment
A. Comment on disk diffusion
Changes from previous

version highlighted in yellow
No breakpoints.
Susceptibility testing
is not recommended
Zone diameter breakpoints

in blue are linked to zone
diameter distributions
nsufficient evidence that the

rganism or group is a good
get for therapy with the agent
12
nsufficient evidence that the
rganism or group is a good
get for therapy with the agent
13
Dosages EUCAST Clinical Breakpoint Tables v. 11.0, valid from 2021-01-01
EUCAST breakpoints are based on the following dosages (see section 8 in Rationale Documents). Alternative dosing regimens may result in equivalent exposure. The table should not be
considered a guidance for dosing in clinical practice, and does not replace specific local, national, or regional dosing guidelines. However, if national practices significantly differ from those
listed below, EUCAST breakpoints may not be valid. Situations where less antibiotic is given as standard or high dose should be discussed locally or regionally.
Uncomplicated UTI: acute, sporadic or recurrent lower urinary tract infections (uncomplicated cystitis) in patients with no known relevant anatomical or functional abnormalities within the
urinary tract or comorbidities.
Penicillins Standard dosage High dosage Uncomplicated UTI Special situations

Benzylpenicillin 0.6 g (1 MU) x 4 iv 1.2 g (2 MU) x 4-6 iv Meningitis caused by S. pneumoniae:
For a dose of 2.4 g (4 MU) x 6 iv, isolates with MIC≤0.06 mg/L are susceptible.
Pneumonia caused by S. pneumoniae: breakpoints are related to dosage:

For a dose of 1.2 g (2 MU) x 4 iv, isolates with MIC ≤0.5 mg/L are susceptible.
For a dose of 2.4 (4 MU) g x 4 iv or 1.2 g (2 MU) x 6 iv, isolates with MIC ≤1 mg/L are
susceptible.
For a dose of 2.4 g (4 MU) x 6 iv, isolates with MIC ≤2 mg/L are susceptible.
Ampicillin 2 g x 3 iv 2 g x 4 iv Meningitis: 2 g x 6 iv
Ampicillin-sulbactam (2 g ampicillin + 1 g sulbactam) x 3 iv (2 g ampicillin + 1 g sulbactam) x 4 iv

Amoxicillin iv 1 g x 3-4 iv 2 g x 6 iv Meningitis: 2 g x 6 iv
Amoxicillin oral 0.5 g x 3 oral 0.75-1 g x 3 oral 0.5 g x 3 oral

Amoxicillin-clavulanic acid iv (1 g amoxicillin + 0.2 g clavulanic acid) x (2 g amoxicillin + 0.2 g clavulanic acid) x
3-4 iv 3 iv
Amoxicillin-clavulanic acid oral (0.5 g amoxicillin + 0.125 g (0.875 g amoxicillin + 0.125 g clavulanic (0.5 g amoxicillin + 0.125 g Amoxicillin-clavulanic acid has separate breakpoints for systemic infections and
clavulanic acid) x 3 oral acid) x 3 oral clavulanic acid) x 3 oral uncomplicated UTI. When amoxicillin-clavulanic acid is reported for uncomplicated UTI,
the report must make clear that the susceptibility category is only valid for uncomplicated
UTI.
Piperacillin 4 g x 4 iv 4 g x 4 iv High dosage for more serious infections.

by extended 3-hour infusion
Piperacillin-tazobactam (4 g piperacillin + 0.5 g tazobactam) (4 g piperacillin + 0.5 g tazobactam) A lower dosage of (4 g piperacillin + 0.5 g tazobactam) x 3 iv is adequate for some
x 4 iv x 4 iv by extended 3-hour infusion infections such as complicated UTI, intraabdominal infections and diabetic foot infections,
or x 3 by extended 4-hour infusion but not for infections caused by isolates resistant to third-generation cephalosporins.
Ticarcillin 3 g x 4 iv 3 g x 6 iv
Ticarcillin-clavulanic acid (3 g ticarcillin + 0.1-0.2 g clavulanic acid) (3 g ticarcillin + 0.1 g clavulanic acid) x 6
x 4 iv iv
Temocillin 2 g x 2 iv 2 g x 3 iv The 2 g x 2 iv dose has been used in the treatment of uncomplicated UTI caused by
bacteria with beta-lactam resistance mechanisms.
Phenoxymethylpenicillin 0.5-2 g x 3-4 oral None
depending on species and/or infection
type
Oxacillin 1 g x 4 iv 1 g x 6 iv
Cloxacillin 0.5 g x 4 oral or 1 g x 4 iv 1 g x 4 oral or 2 g x 6 iv
Dicloxacillin 0.5-1 g x 4 oral or 1 g x 4 iv 2 g x 4 oral or 2 g x 6 iv
Flucloxacillin 1 g x 3 oral or 2 g x 4 iv 1 g x 4 oral or 2 g x 6 iv
(or 1 g x 6 iv)
Mecillinam oral (pivmecillinam) None None 0.2-0.4 g x 3 oral
14
Cephalosporins Standard dosage High dosage Uncomplicated UTI Special situations

Cefaclor 0.25-0.5 g x 3 oral 1 g x 3 oral Staphylococcus spp.: Minimum dose 0.5 g x 3 oral
depending on species and/or infection
type
Cefadroxil 0.5-1 g x 2 oral None 0.5-1 g x 2 oral

Cefalexin 0.25-1 g x 2-3 oral None 0.25-1 g x 2-3 oral
Cefazolin 1 g x 3 iv 2 g x 3 iv
Cefepime 1 g x 3 iv or 2 g x 2 iv 2 g x 3 iv
Cefiderocol 2 g x 3 iv over 3 hours None
Cefixime 0.2-0.4 g x 2 oral None 0.2-0.4 g x 2 oral Uncomplicated gonorrhoea: 0.4 g oral as a single dose
Cefotaxime 1 g x 3 iv 2 g x 3 iv Meningitis: 2 g x 4 iv
S. aureus: High dose only
Cefpodoxime 0.1-0.2 g x 2 oral None 0.1-0.2 g x 2 oral
Ceftaroline 0.6 g x 2 iv over 1 hour 0.6 g x 3 iv over 2 hours S. aureus in complicated skin and skin structure infections: There is some PK-PD
evidence to suggest that isolates with MICs of 4 mg/L could be treated with high dose.
Ceftazidime 1 g x 3 iv 2 g x 3 iv or 1 g x 6 iv
Ceftazidime-avibactam (2 g ceftazidime + 0.5 g avibactam) x 3 iv over 2 hours
Ceftibuten 0.4 g x 1 oral None
Ceftobiprole 0.5 g x 3 iv over 2 hours None
Ceftolozane-tazobactam (intra-abdominal infections
(1 g ceftolozane
and UTI)
+ 0.5 g tazobactam) x 3 None
iv over 1 hour
Ceftolozane-tazobactam (hospital acquired pneumonia,
(2 g ceftolozane
including
+ 1 g tazobactam)
ventilator associated pneumonia)
None
x 3 iv over 1 hour
Ceftriaxone 2 g x 1 iv 2 g x 2 iv or 4 g x 1 iv Meningitis: 2 g x 2 iv or 4 g x 1 iv
S. aureus: High dose only
Uncomplicated gonorrhoea: 0.5-1 g im as a single dose
Cefuroxime iv 0.75 g x 3 iv 1.5 g x 3 iv
Cefuroxime oral 0.25 g x 2 oral 0.5 g x 2 oral 0.25 g x 2 oral
Carbapenems Standard dosage High dosage Uncomplicated UTI Special situations

Doripenem 0.5 g x 3 iv over 1 hour 1 g x 3 iv over 1 hour HAP/VAP* due to non-fermenting Gram-negative pathogens (such as Pseudomonas
spp. and Acinetobacter spp.) should be treated with 1 g x 3 iv over 4 hours.
Ertapenem 1 g x 1 iv over 30 minutes None

Imipenem 0.5 g x 4 iv over 30 minutes 1 g x 4 iv over 30 minutes
Imipenem-relebactam (0.5 g imipenem + 0.25 g relebactam) None
x 4 iv over 30 minutes
Meropenem 1 g x 3 iv over 30 minutes 2 g x 3 iv over 3 hours Meningitis: 2 g x 3 iv over 30 minutes (or 3 hours)
Meropenem-vaborbactam (2 g meropenem + 2 g vaborbactam) x 3 iv over 3 hours
15
* HAP/VAP = hospital-acquired pneumonia/ventilator-associated pneumonia
16
Monobactams Standard dosage High dosage Uncomplicated UTI Special situations

Aztreonam 1 g x 3 iv 2 g x 4 iv
Fluoroquinolones Standard dosage High dosage Uncomplicated UTI Special situations

Ciprofloxacin 0.5 g x 2 oral or 0.4 g x 2 iv 0.75 g x 2 oral or 0.4 g x 3 iv
Delafloxacin 0.45 g x 2 oral or 0.3 g x 2 iv None
Levofloxacin 0.5 g x 1 oral or 0.5 g x 1 iv 0.5 g x 2 oral or 0.5 g x 2 iv
Moxifloxacin 0.4 g x 1 oral or 0.4 g x 1 iv None
Norfloxacin None None 0.4 g x 2 oral
Ofloxacin 0.2 g x 2 oral or 0.2 g x 2 iv 0.4 g x 2 oral or 0.4 g x 2 iv
Aminoglycosides Standard dosage High dosage Uncomplicated UTI Special situations

Amikacin 25-30 mg/kg x 1 iv None
Gentamicin 6-7 mg/kg x 1 iv None
Netilmicin Under review Under review
Tobramycin 6-7 mg/kg x 1 iv None
Glycopeptides and Standard dosage High dosage Uncomplicated UTI Special situations
lipoglycopeptides
Dalbavancin 1 g x 1 iv over 30 minutes on day 1 None
If needed, 0.5 g x 1 iv over 30 minutes on
day 8
Oritavancin 1.2 g x 1 (single dose) iv None
over 3 hours
Teicoplanin 0.4 g x 1 iv 0.8 g x 1 iv
Telavancin 10 mg/kg x 1 iv over 1 hour None
Vancomycin 0.5 g x 4 iv or 1 g x 2 iv None Based on body weight. Therapeutic drug monitoring should guide dosing.
or 2 g x 1 by continuous infusion
Macrolides, lincosamides and Standard dosage High dosage Uncomplicated UTI Special situations
streptogramins
Azithromycin 0.5 g x 1 oral or 0.5 g x 1 iv None Uncomplicated gonorrhoea: 2 g oral as a single dose
Clarithromycin 0.25 g x 2 oral 0.5 g x 2 oral In some countries clarithromycin is available for intravenous administration at a dose of
0.5 g x 2, principally for treating pneumonia.
Erythromycin 0.5 g x 2-4 oral or 0.5 g x 2-4 iv 1 g x 4 oral or 1 g x 4 iv
Roxithromycin 0.15 g x 2 oral None
Telithromycin 0.8 g x 1 oral None
Clindamycin 0.3 g x 2 oral or 0.6 g x 3 iv 0.3 g x 4 oral or 0.9 g x 3 iv
Quinupristin-dalfopristin 7.5 mg/kg x 2 iv 7.5 mg/kg x 3 iv
17
Tetracyclines Standard dosage High dosage Uncomplicated UTI Special situations

Doxycycline 0.1 g x 1 oral 0.2 g x 1 oral
Eravacycline 1 mg/kg x 2 iv None
Minocycline 0.1 g x 2 oral None
Tetracycline 0.25 g x 4 oral 0.5 g x 4 oral
Tigecycline 0.1 g loading dose None
followed by 50 mg x 2 iv
Oxazolidinones Standard dosage High dosage Uncomplicated UTI Special situations

Linezolid 0.6 g x 2 oral or 0.6 g x 2 iv None
Tedizolid 0.2 g x 1 oral or 0.2 g x 1 iv None
Miscellaneous agents Standard dosage High dosage Uncomplicated UTI Special situations
Chloramphenicol 1 g x 4 oral or 1 g x 4 iv 2 g x 4 oral or 2 g x 4 iv For chloramphenicol treatment of meningitis always use intravenous high dose.
Colistin 4.5 MU x 2 iv None
with a loading dose of 9 MU
Daptomycin (cSSTI** without concurrent S. aureus bacteraemia)
4 mg/kg x 1 iv None . .
Daptomycin (cSSTI** with concurrent S. aureus bacteraemia;

6 mg/kgright-sided
x 1 iv infective endocarditis due to S. aureus)
None Enterococcal bloodstream infection and endocarditis, see
http://www.eucast.org/guidance_documents/.
Fidaxomicin 0.2 g x 2 oral None

Fosfomycin iv 4 g x 3 iv 8 g x 3 iv
Fosfomycin oral None None 3 g x 1 oral as a single dose
Fusidic acid 0.5 g x 2 oral or 0.5 g x 2 iv 0.5 g x 3 oral or 0.5 g x 3 iv
Lefamulin 0.15 g x 2 iv or 0.6 g x 2 oral None
Metronidazole 0.4 g x 3 oral or 0.4 g x 3 iv 0.5 g x 3 oral or 0.5 g x 3 iv
Nitrofurantoin None None 50-100 mg x 3-4 oral Dosing is dependent on drug formulation.
Nitroxoline None None 0.25 g x 3 oral
Rifampicin 0.6 g x 1 oral or 0.6 g x 1 iv 0.6 g x 2 oral or 0.6 g x 2 iv
Spectinomycin 2 g x 1 im None
Trimethoprim None None 0.16 g x 2 oral
Trimethoprim-sulfamethoxazole (0.16 g trimethoprim + 0.8 g (0.24 g trimethoprim + 1.2 g (0.16 g trimethoprim + 0.8 g
sulfamethoxazole) x 2 oral sulfamethoxazole) x 2 oral sulfamethoxazole) x 2 oral
or (0.16 g trimethoprim + 0.8 g or (0.24 g trimethoprim + 1.2 g
sulfamethoxazole) x 2 iv sulfamethoxazole) x 2 iv
** cSSTI = complicated skin and skin structure infection
18
How to handle technical uncertainty in antimicrobial susceptibility testing
All measurements are affected by random variation and some by systematic variation. Systematic variation can normally be avoided and random variation should be reduced as muc
possible. Antimicrobial susceptibility testing (AST), irrespective of method, is no exception.
EUCAST strives to minimise variation by providing standardised methods for MIC determination and disk diffusion and by avoiding setting breakpoints which seriously affect the repr
AST. Variation in AST can be further reduced by setting more stringent standards for manufacturers of AST material (broth, agar, antimicrobial disks) and criteria for quality control of
manufacturing processes and laboratory practices.
It is tempting to think that generating an MIC value will solve all problems. However, MIC measurements also have variation and a single value is not automatically accurate. Even wh
reference method, MICs might vary between days and technicians. Under the best of circumstances, an MIC of 1.0 mg/L should be considered as a value between 0.5 and 2.0 mg/L
the probability of getting any one of these three values is not equal and will vary among strains and antimicrobial agents. Not infrequently, EUCAST discovers problems with commer
systems including quality of disks and media for disk diffusion, commercial panels for broth microdilution tests, gradient tests and semi-automated AST devices. Some of these affect
(poorly calibrated concentration series) and others precision (poor general quality, batch-to-batch variation).
Although AST is straightforward for most agents and species, there are problematic situations even when testing is performed to a high standard. It is important to warn laboratories a
and the uncertainty of susceptibility categorisation. Analysis of EUCAST data (readily available at http://www.eucast.org/ast_of_bacteria/calibration_and_validation/) that have been g
over the years has identified such situations, named by EUCAST “Area of Technical Uncertainty (ATU)”. The ATUs are warnings to laboratory staff that there is an uncertainty th
be addressed before reporting AST results to clinical colleagues. The ATU is not a susceptibility category and does not prevent the laboratory from interpreting the susceptibility test
Below are alternatives for how the ATUs can be dealt with by the laboratory. Which of these actions are chosen will depend on the situation. The type of sample (blood culture vs. uri
the number of alternative agents available, the severity of the disease, whether or not a consultation with clinical colleagues is feasible, will influence the action taken.
• Repeat the test
To ONLY repeat the test is relevant if there is reason to suspect a technical problem in the primary AST. To repeat the test while confirming the result with another test is good labo
practice. If an MIC test is performed, the chances are that this result may also end up in the ATU. If so, a primary test and an alternative test may both point to a result and an interp
the ATU. In this case, interpret the result according to the breakpoints and report.
• Use an alternative test (perform an MIC or a genotypic test)
This may be relevant if the susceptibility report otherwise leaves only few therapeutic alternatives. If the organism is multi-resistant, perform an MIC determination for several antibio
possibly extending the AST to include new beta-lactam inhibitor combinations and colistin for Gram-negative bacteria. Sometimes it may be necessary to perform genotypic or phen
characterisation of the resistance mechanism to obtain more information, some of which may be of importance for epidemiological decisions. When performing an MIC, this result m
the ATU. In this case, interpret the result according to the breakpoints and report.
• Downgrade the susceptibility category
19
If there are other therapeutic alternatives in the AST report, it is permissible to downgrade the result (from S to I, or from I to R or from S to R). However, a comment should be inclu
isolate saved for further testing.
20
• Include the uncertainty as part of the report

It is common practice in many other laboratory settings to include information on the uncertainty of the reported result. This can be dealt with in several alternative ways:
• Report results in the ATU as "uncertain". This can be achieved by leaving the interpretation "blank + a comment".
• Develop the LIS system to deliver an asterix or Note (instead of an S, I or R) which refers to a comment explaining the uncertainty.
• Categorise the result according to the breakpoints but include information about the technical difficulties and/or the uncertainty of the interpretation. In many instances, an “R” is le
ambiguous than other alternatives, especially when there are alternative agents. Do not report "S" unless you have confirmed the result.
For serious situations, take the opportunity to contact the clinical colleague to explain and discuss the results.
• Omit an uncertain result
When there are several therapeutic options, or when an ambiguous interpretation cannot be readily resolved in a timely manner, an ATU result is best left either unreported or down
above).
The Area of Technical Uncertainty is typically listed as a defined MIC value or in disk diffusion as a range of 2-4 mm. ATUs are only listed when obviously needed. The ab
21
Enterobacterales*
Expert Rules and Intrinsic Resistance Tables
An MIC breakpoint of S ≤ 0.001 mg/L is an arbitrary, "off scale" breakpoint (corresponding to a zone diameter breakpoint of "S ≥ 50 mm") which categorises wild-type organisms (organisms without phenotypically detectable resistance
mechanisms to the agent) as "Susceptible, increased exposure" (I). For these organism-agent combinations, never report “Susceptible, standard dosing regimen” (S).
MIC determination (broth microdilution according to ISO standard 20776-1 except for mecillinam and
fosfomycin where agar dilution is used)
Medium: Mueller-Hinton broth (for cefiderocol, see http://www.eucast.org/guidance_documents/)
Inoculum: 5x105 CFU/mL
Incubation: Sealed panels, air, 35±1ºC, 18±2h
Reading: Unless otherwise stated, read MICs at the lowest concentration of the agent that completely inhibits
visible growth.
Quality control: Escherichia coli ATCC 25922. For agents not covered by this strain and for control of the
inhibitor component of beta-lactam inhibitor combinations, see EUCAST QC Tables.
* Recent taxonomic studies have narrowed the definition of the family Enterobacteriaceae. Some previous members of this family are now included in other families within the Order Enterobacterales. Breakpoints in this table apply to all
members of the Enterobacterales.
Penicillins1 MIC breakpoints Disk Zone diameter

(mg/L) content breakpoints (mm)
Benzylpenicillin - - - -
Ampicillin1 8 8 10 14A 14A
Ampicillin-sulbactam1 82 82 10-10 14A 14A
Amoxicillin1 8 8 - NoteB NoteB
Amoxicillin-clavulanic acid1 83 83 20-10 19A 19A 19-20
Amoxicillin-clavulanic acid (uncomplicated 323 323 20-10 16A 16A
UTI only)
Piperacillin 8 8 30 20 20
Piperacillin-tazobactam 84 84 16 30-6 20 20 19
Ticarcillin 8 16 75 23 20
Ticarcillin-clavulanic acid 83 163 75-10 23 20
Temocillin (infections originating from the urinary tract),
0.001
E. coli, Klebsiella
16 spp. (except K. aerogenes)
30 and
50C
P. mirabilis
17C
Phenoxymethylpenicillin - - - -
Oxacillin - - - -
Cloxacillin - - - -
Dicloxacillin - - - -
Flucloxacillin - - - -
Mecillinam oral (pivmecillinam) (uncomplicated UTI8only),
5
E. coli,
85 Citrobacter spp., Klebsiella
10 spp., Raoultella
15C 15Cspp., Enterobacter spp. and P. mirabilis
22
Enterobacterales*
Cephalosporins1 MIC breakpoints Disk Zone diameter

Cefaclor - - - -
Cefadroxil (uncomplicated UTI only) 16 16 30 12 12
Cefalexin (uncomplicated UTI only) 16 16 30 14 14
Cefazolin (infections originating from the 0.0012 42 30 50A 20A
urinary tract), E. coli, and Klebsiella spp.
(except K. aerogenes)
Cefepime 1 4 30 27 24
Cefiderocol 23 23 30 22 22 18-22
Cefixime (uncomplicated UTI only) 1 1 5 17 17
Cefotaxime (indications other than meningitis) 1 2 5 20 17
Cefotaxime (meningitis) 1 1 5 20 20
Cefoxitin (screen only)4 Note4 Note4 30 19 19
Cefpodoxime 1 1 10 21 21
(uncomplicated UTI only)
Ceftaroline 0.5 0.5 5 23 23 22-23

Ceftazidime 1 4 10 22 19
Ceftazidime-avibactam 85 85 10-4 13 13
Ceftibuten (infections originating from the 1 1 30 23 23
urinary tract)
Ceftobiprole 0.25 0.25 5 23 23
Ceftolozane-tazobactam6 27 27 30-10 22 22 19-21
Ceftriaxone (indications other than 1 2 30 25 22
meningitis)
Ceftriaxone (meningitis) 1 1 30 25 25
Cefuroxime iv, E. coli, Klebsiella spp. (except K. aerogenes),
0.001 Raoultella
8 spp. and P. mirabilis
30 50 19
Cefuroxime oral (uncomplicated UTI only), E. 8 8 30 19 19

coli, Klebsiella spp. (except K. aerogenes),
Raoultella spp. and
P. mirabilis
23
Enterobacterales*
Carbapenems1 MIC breakpoints Disk Zone diameter

Doripenem 1 2 10 24 21
Ertapenem 0.5 0.5 10 25 25
Imipenem, Enterobacterales except Morganellaceae2 4 10 22 19
Imipenem2, Morganellaceae 0.001 4 10 50 19

Imipenem-relebactam, Enterobacterales except 23 23 10-25 22 22
Morganellaceae
Meropenem (indications other than meningitis) 2 8 10 22 16
Meropenem (meningitis) 2 2 10 22 22
Meropenem-vaborbactam 84 84 IP IP IP
Monobactams MIC breakpoints Disk Zone diameter

Aztreonam1 1 4 30 26 21
Fluoroquinolones MIC breakpoints Disk Zone diameter

Ciprofloxacin 0.25 0.5 0.5 5 25 22 22-24
Ciprofloxacin1, Salmonella spp. 0.06 0.06 NoteA NoteA
Pefloxacin (screen only)1,2 NA NA 5 24B,C 24B,C
Salmonella spp.
Delafloxacin, E. coli 0.125 0.125 NoteD NoteD
Levofloxacin 0.5 1 5 23 19
Moxifloxacin 0.25 0.25 5 22 22
Nalidixic acid (screen only) NA NA NA NA
Norfloxacin (uncomplicated UTI only) 0.5 0.5 10 22 22
Ofloxacin 0.25 0.5 5 24 22
24
Enterobacterales*
Aminoglycosides1,2 MIC breakpoints Disk Zone diameter

Amikacin (systemic infections) (8)1 (8)1 30 (18)A (18)A
Amikacin (infections originating from the urinary tract)
8 8 30 18 18
Gentamicin (systemic infections) (2)1 (2)1 10 (17)A (17)A

Gentamicin (infections originating from the urinary 2tract) 2 10 17 17
Netilmicin IE IE IE IE
Tobramycin (systemic infections) (2)1 (2)1 10 (16)A (16)A
Tobramycin (infections originating from the urinary2tract) 2 10 16 16
Glycopeptides and MIC breakpoints Disk Zone diameter

lipoglycopeptides (mg/L) content breakpoints (mm)
Dalbavancin - - - -
Oritavancin - - - -
Teicoplanin - - - -
Telavancin - - - -
Vancomycin - - - -
Macrolides, lincosamides and MIC breakpoints Disk Zone diameter

streptogramins (mg/L) content breakpoints (mm)
Azithromycin1 - - - -
Clarithromycin - - - -
Erythromycin - - - -
Roxithromycin - - - -
Telithromycin - - - -
Clindamycin - - - -
Quinupristin-dalfopristin - - - -
25
Enterobacterales*
Tetracyclines MIC breakpoints Disk Zone diameter

Doxycycline - - - -
Eravacycline, E. coli 0.5 0.5 20 17 17
Minocycline - - - -
Tetracycline1 - - - -
Tigecycline, E. coli and C. koseri 0.52,3 0.52,3 15 18A,B 18A,B
Oxazolidinones MIC breakpoints Disk Zone diameter

Linezolid - - - -
Tedizolid - - - -
Miscellaneous agents MIC breakpoints Disk Zone diameter

Chloramphenicol 8 8 30 17 17
Colistin1 2 2 NoteA NoteA
Daptomycin - - - -
Fosfomycin iv 322 322 200B 21C,D 21C,D
Fosfomycin oral (uncomplicated UTI only), E. coli 82 82 200B 24D 24D
Fusidic acid - - - -
Lefamulin - - - -
Metronidazole - - - -
Nitrofurantoin (uncomplicated UTI only), E. coli 64 64 100 11 11
Nitroxoline (uncomplicated UTI only), E. coli 16 16 30 15 15
Rifampicin - - - -
Spectinomycin - - - -
Trimethoprim (uncomplicated UTI only) 4 4 5 15 15
Trimethoprim-sulfamethoxazole3 2 4 1.25-23.75 14 11
26
Enterobacterales*
a) b) c)
Examples of inhibition zones for Escherichia coli with fosfomycin.

a-c) Ignore all colonies and read the outer zone edge.
d) Record as no inhibition zone.
27
int of "S ≥ 50 mm") which categorises wild-type organisms (organisms without phenotypically detectable resistance
port “Susceptible, standard dosing regimen” (S).

Medium: Mueller-Hinton agar
Inoculum: McFarland 0.5
Incubation: Air, 35±1ºC, 18±2h
Reading: Unless otherwise stated, read zone edges as the point showing no growth viewed from the back of the plate
against a dark background illuminated with reflected light.
Quality control: Escherichia coli ATCC 25922. For agents not covered by this strain and for control of the inhibitor
component of beta-lactam inhibitor-combination disks, see EUCAST QC Tables.
f this family are now included in other families within the Order Enterobacterales. Breakpoints in this table apply to all
Notes
1. Aminopenicillin breakpoints in Enterobacterales are based on intravenous administration. For oral administration the
breakpoints are relevant for urinary tract infections only. Breakpoints for other infections are under review.
2. For susceptibility testing purposes, the concentration of sulbactam is fixed at 4 mg/L.
3. For susceptibility testing purposes, the concentration of clavulanic acid is fixed at 2 mg/L.
4. For susceptibility testing purposes, the concentration of tazobactam is fixed at 4 mg/L.
5/C. Breakpoints still under consideration.
5. Agar dilution is the reference method for mecillinam MIC determination.
A. Ignore growth that may appear as a thin inner zone on some batches of Mueller-Hinton agars.
B. Susceptibility inferred from ampicillin.
C. Ignore isolated colonies within the inhibition zone.
28
Notes
1. The cephalosporin breakpoints for Enterobacterales will detect all clinically important resistance mechanisms (including
ESBL and plasmid mediated AmpC). Some isolates that produce beta-lactamases are susceptible to 3rd or 4th generation
cephalosporins with these breakpoints and should be reported as tested, i.e. the presence or absence of an ESBL does not
in itself influence the categorisation of susceptibility. ESBL detection and characterisation are recommended for public health
and infection control purposes.
2/A. Isolates susceptible to cefadroxil and/or cefalexin can be reported "susceptible, increased exposure” (I) to cefazolin.
3. Broth microdilution MIC determination must be performed in iron-depleted Mueller-Hinton broth and specific reading
instructions must be followed. For testing conditions and reading instructions, see
4. The cefoxitin ECOFF (8 mg/L) has a high sensitivity but poor specificity for identification of AmpC-producing
Enterobacterales as this agent is also affected by permeability alterations and some carbapenemases. Classical non-AmpC
producers are wild type, whereas plasmid AmpC producers or chromosomal AmpC hyperproducers are non-wild type.
5. For susceptibility testing purposes, the concentration of avibactam is fixed at 4 mg/L.
6. See table of dosages for dosing for different indications.
29
Notes
1. Some isolates that produce carbapenemase are categorised as susceptible with the current breakpoints and should be
reported as tested, i.e. the presence or absence of a carbapenemase does not in itself influence the categorisation of
susceptibility. Carbapenemase detection and characterisation are recommended for public health and infection control
purposes. For carbapenemase screening a meropenem screening cut-off of >0.125 mg/L (zone diameter <28 mm) is
recommended.
2. The intrinsically low activity of imipenem against Morganella morganii, Proteus spp. and Providencia spp. requires the high
exposure of imipenem.
3. For susceptibility testing purposes, the concentration of relebactam is fixed at 4 mg/L.
4. For susceptibility testing purposes, the concentration of vaborbactam is fixed at 8 mg/L.
Notes
1. The aztreonam breakpoints for Enterobacterales will detect clinically important resistance mechanisms (including ESBL).
Some isolates that produce beta-lactamases are susceptible to aztreonam with these breakpoints and should be reported as
tested, i.e. the presence or absence of an ESBL does not in itself influence the categorisation of susceptibility. ESBL
detection and characterisation are recommended for public health and infection control purposes.
Notes
1. There is clinical evidence for ciprofloxacin to indicate a poor response in systemic infections caused by Salmonella spp.
with low-level ciprofloxacin resistance (MIC >0.06 mg/L). The available data relate mainly to Salmonella Typhi but there are
also case reports of poor response with other Salmonella species.
2/C. The pefloxacin 5 µg breakpoint used to screen for clinical fluoroquinolone resistance in Salmonella spp., can also be
used to detect fluoroquinolone resistance mechanisms in other Enterobacterales such as E. coli, K. pneumoniae and Shigella
spp.
A. Tests with a ciprofloxacin 5 µg disk will not reliably detect low-level resistance in Salmonella spp. To screen for
ciprofloxacin resistance in Salmonella spp., use the pefloxacin 5 µg disk. See Note B.
B. Susceptibility of Salmonella spp. to ciprofloxacin can be inferred from pefloxacin disk diffusion susceptibility.
D. A disk diffusion test is not yet developed. Perform an MIC test.
30
Notes
1/A. For systemic infections, aminoglycosides must be used in combination with other active therapy. In this circumstance,
the breakpoint/ECOFF in brackets can be used to distinguish between organisms with and without acquired resistance
mechanisms. For isolates without resistance mechanisms, include a comment in the report: “Aminoglycosides are often given
in combination with other agents, either to support the activity of the aminoglycoside or to broaden the spectrum of therapy. In
systemic infections, the aminoglycoside must be supported by other active therapy." For more information, see
2. Breakpoints do not apply to Plesiomonas shigelloides since aminoglycosides have low intrinsic activity against this
species.
Notes
Notes
1. Azithromycin has been used in the treatment of enteric infections, primarily with Salmonella Typhi and Shigella spp. For
wild-type isolates of both species, the MICs are ≤16 mg/L and the inhibition zone diameters for the azithromycin 15 µg disk
≥12 mm.
31
Notes
1. Tetracycline can be used to predict doxycycline susceptibility for the treatment of Yersinia enterocolitica infections
(tetracycline MIC ≤4 mg/L for wild-type isolates). The corresponding zone diameter for the tetracycline 30 µg disk is ≥19 mm.
2. For tigecycline broth microdilution MIC determination, the medium must be prepared fresh on the day of use.
3/A. For other Enterobacterales, the activity of tigecycline varies from insufficient in Proteus spp., Morganella morganii and
Providencia spp. to variable in other species. For more information, see http://www.eucast.org/guidance_documents/.
B. Zone diameter breakpoints validated for E. coli only. For C. koseri, use an MIC method.
Notes
Notes
1. Colistin MIC determination should be performed with broth microdilution. Quality control must be performed with both a
susceptible QC strain (E. coli ATCC 25922 or P. aeruginosa ATCC 27853) and the colistin resistant E. coli NCTC 13846
(mcr-1 positive).
2. Agar dilution is the reference method for fosfomycin. MICs must be determined in the presence of glucose-6-phosphate
(25 mg/L in the medium). Follow the manufacturers' instructions for commercial systems.
3. Trimethoprim:sulfamethoxazole in the ratio 1:19. Breakpoints are expressed as the trimethoprim concentration.
A. Use an MIC method (broth microdilution only).

B. Fosfomycin 200 µg disks must contain 50 µg glucose-6-phosphate.
C. Zone diameter breakpoints apply to E. coli only. For other Enterobacterales, use an MIC method.
D. Ignore isolated colonies within the inhibition zone (see pictures below).
32
d)
No zone
33
Pseudomonas spp.
MIC determination (broth microdilution according to ISO standard 20776-1 except for fosfomycin where
agar dilution is used)
visible growth.
Quality control: Pseudomonas aeruginosaATCC 27853. For agents not covered by this strain and for control
of the inhibitor component of beta-lactam inhibitor combinations, see EUCAST QC Tables.
Pseudomonas aeruginosa is the most frequent species of this genus. Other less frequent Pseudomonas species recovered in clinical samples are: P. fluorescens group, P. putida group and P. stutzeri group.
Penicillins MIC breakpoints Disk Zone diameter

Ampicillin - - - -
Ampicillin-sulbactam - - - -
Amoxicillin - - - -
Amoxicillin-clavulanic acid - - - -
Piperacillin 0.001 16 30 50 18 18-19
Piperacillin-tazobactam 0.0011 161 30-6 50 18 18-19
Ticarcillin 0.001 16 75 50 18
Ticarcillin-clavulanic acid 0.0012 162 75-10 50 18
Temocillin - - - -
Oxacillin - - - -
Cloxacillin - - - -
Mecillinam oral (pivmecillinam) (uncomplicated UTI-only) - - -
34
Pseudomonas spp.
Cephalosporins MIC breakpoints Disk Zone diameter

Cefaclor - - - -
Cefadroxil - - - -
Cefalexin - - - -
Cefazolin - - - -
Cefepime 0.001 8 30 50 21
Cefiderocol, P. aeruginosa 21 21 30 22 22 14-22
Cefixime - - - -
Cefotaxime - - - -
Cefoxitin - - - -
Cefpodoxime - - - -
Ceftaroline - - - -
Ceftazidime 0.001 8 10 50 17
Ceftazidime-avibactam, P. aeruginosa 82 82 10-4 17 17 16-17
Ceftibuten - - - -
Ceftobiprole IE IE IE IE
Ceftolozane-tazobactam3, P. aeruginosa 44 44 30-10 23 23
Ceftriaxone - - - -
Cefuroxime iv - - - -
Cefuroxime oral - - - -
Carbapenems MIC breakpoints Disk Zone diameter

Doripenem 0.001 2 10 50 22
Ertapenem - - - -
Imipenem 0.001 4 10 50 20
Imipenem-relebactam, P. aeruginosa 21 21 10-25 22 22
Meropenem-vaborbactam, 82 82 IP IP IP
P. aeruginosa

Aztreonam 0.001 16 30 50 18
35
Pseudomonas spp.

Ciprofloxacin 0.001 0.5 5 50 26
Delafloxacin IE IE IE IE
Moxifloxacin - - - -
Norfloxacin (uncomplicated UTI only) - - - -
Ofloxacin - - - -
Aminoglycosides1 MIC breakpoints Disk Zone diameter

16 16 30 15 15
Gentamicin (systemic infections) IE IE IE IE

Gentamicin (infections originating from the urinaryIE
tract) IE IE IE

Dalbavancin - - - -
Oritavancin - - - -
Teicoplanin - - - -
Telavancin - - - -
Vancomycin - - - -
36
Pseudomonas spp.

Azithromycin - - - -
Clindamycin - - - -

Doxycycline - - - -
Eravacycline - - - -
Minocycline - - - -
Tetracycline - - - -
Tigecycline - - - -

Linezolid - - - -
Tedizolid - - - -
37
Pseudomonas spp.

Chloramphenicol - - - -
Colistin1 2 2 4 NoteA NoteA
Daptomycin - - - -
Fosfomycin iv2 - - - -
Fosfomycin oral2 - - - -
Lefamulin - - - -
Nitrofurantoin (uncomplicated UTI only) - - - -
Nitroxoline (uncomplicated UTI only) - - - -
Rifampicin - - - -
Trimethoprim (uncomplicated UTI only) - - - -
Trimethoprim-sulfamethoxazole - - - -
38

Quality control: Pseudomonas aeruginosa ATCC 27853. For agents not covered by this strain and for control of the inhibitor
vered in clinical samples are: P. fluorescens group, P. putida group and P. stutzeri group.
Notes
39
Notes
2. For susceptibility testing purposes, the concentration of avibactam is fixed at 4 mg/L.
Notes
2. For susceptibility testing purposes, the concentration of vaborbactam is fixed at 8 mg/L.
Notes
40
Notes
Notes
Notes
41
Notes
Notes
Notes
42
Notes
(mcr-1 positive).
(25 mg/L in the medium). Follow the manufacturers' instructions for commercial systems. Infections caused by wild-type
isolates (ECOFF: MIC 128 mg/L; corresponding zone diameter 12 mm using the disk potency and reading instructions for E.
coli) have been treated with fosfomycin in combination with other agents.
43
Stenotrophomonas maltophilia
Trimethoprim-sulfamethoxazole is the only agent for which EUCAST breakpoints are currently available. For further information, see guidance document on www.eucast.org.

Reading: For trimethoprim-sulfamethoxazole, the MIC should be read at the lowest concentration that inhibits
approximately 80% of growth as compared with the growth control well.
Quality control: Escherichia coli ATCC 25922

Cefiderocol IE1 IE1 NoteA NoteA

Trimethoprim-sulfamethoxazole1 0.001 4 1.25-23.75 50A 16A,B
44
Stenotrophomonas maltophilia
a) b) c)
Examples of inhibition zones for Stenotrophomonas maltophilia with trimethoprim-sulfamethoxazole.

a-c) An outer zone can be seen. Read the outer zone edge and interpret according to the breakpoints.
d) Growth up to the disk and no sign of inhibition zone. Report resistant.
45
nformation, see guidance document on www.eucast.org.

Reading: Read zone edges from the back of the plate against a dark background illuminated with reflected light (see below
for specific instructions).
Quality control: Escherichia coli ATCC 25922
Notes
A. Zone diameters of ≥20 mm for the cefiderocol 30 µg disk correspond to MIC values below the PK-PD breakpoint of S ≤ 2
mg/L.
Notes
A. There may be growth within the inhibition zone. The density of growth may vary from a fine haze to substantial growth
(see pictures below). If any zone edge can be seen, ignore growth within the inhibition zone and read the zone diameter.
B. Trimetoprim-sulfamethoxazole resistance in S. maltophilia is rare and should be confirmed with an MIC test.
46
d)
oxazole.
47
Acinetobacter spp.

visible growth.
Quality control: Pseudomonas aeruginosaATCC 27853. For agents not covered by this strain, see EUCAST
QC Tables.
This genus includes several species. The most frequent Acinetobacter species recovered in clinical samples are those included in the A. baumannii group, which includes A. baumannii, A. nosocomialis, A. pittii, A. dijkshoorniae and A. seifertii.
Other species are A. haemolyticus, A. junii, A. lwoffii, A. ursingii and A. variabilis.

Ampicillin - - - -
Ampicillin-sulbactam IE IE IE IE
Amoxicillin - - - -
Amoxicillin-clavulanic acid - - - -
Piperacillin IE IE IE IE
Piperacillin-tazobactam IE IE IE IE
Ticarcillin IE IE IE IE
Ticarcillin-clavulanic acid IE IE IE IE
Temocillin - - - -
Oxacillin - - - -
Cloxacillin - - - -
48
Acinetobacter spp.

Cefaclor - - - -
Cefadroxil - - - -
Cefalexin - - - -
Cefazolin - - - -
Cefepime - - - -
Cefiderocol IE1 IE1 NoteA NoteA
Cefixime - - - -
Cefotaxime - - - -
Cefoxitin - - - -
Cefpodoxime - - - -
Ceftaroline - - - -
Ceftazidime - - - -
Ceftazidime-avibactam - - - -
Ceftibuten - - - -
Ceftobiprole - - - -
Ceftolozane-tazobactam - - - -
Ceftriaxone - - - -

Doripenem 0.001 2 10 50 22
Ertapenem - - - -
Imipenem 2 4 10 24 21
Imipenem-relebactam2 21 21 10-25 24 24
Meropenem-vaborbactam2 Note2 Note2 NoteA NoteA

Aztreonam - - - -
49
Acinetobacter spp.

Ciprofloxacin 0.001 1 5 50 21
Moxifloxacin - - - -
Ofloxacin - - - -

8 8 30 19 19
Gentamicin (systemic infections) (4)1 (4)1 10 (17)A (17)A

Gentamicin (infections originating from the urinary 4tract) 4 10 17 17

Dalbavancin - - - -
Oritavancin - - - -
Teicoplanin - - - -
Telavancin - - - -
Vancomycin - - - -
50
Acinetobacter spp.

Clindamycin - - - -

Doxycycline - - - -
Eravacycline IE IE IE IE
Minocycline IE IE IE IE
Tigecycline IE IE IE IE

Linezolid - - - -
Tedizolid - - - -
51
Acinetobacter spp.

Colistin1 2 2 NoteA NoteA
Daptomycin - - - -
Fosfomycin iv - - - -
Fosfomycin oral - - - -
Lefamulin - - - -
Rifampicin - - - -
52

Quality control: Pseudomonas aeruginosa ATCC 27853. For agents not covered by this strain, see EUCAST QC Tables.
e included in the A. baumannii group, which includes A. baumannii, A. nosocomialis, A. pittii, A. dijkshoorniae and A. seifertii.
Notes
1. Susceptibility testing of Acinetobacter spp. to penicillins is unreliable. In most instances, Acinetobacter spp. are resistant to
penicillins.
53
Notes
A. Zone diameters of ≥17 mm for the cefiderocol 30 µg disk correspond to MIC values below the PK-PD breakpoint of S ≤ 2
mg/L.
Notes
2/A. The beta-lactamases produced by the organisms either do not modify the parent carbapenem or are not affected by the
inhibitor. Therefore the addition of the beta-lactamase inhibitor does not add clinical benefit.
Notes
54
Notes
Notes
Notes
55
Notes
Notes
Notes
56
Notes
(mcr-1 positive).
57
Staphylococcus spp.
MIC determination (broth microdilution according to ISO standard 20776-1 except for fosfomycin where
agar dilution is used)
Medium: Mueller-Hinton broth
visible growth.
Quality control: Staphylococcus aureus ATCC 29213. For agents not covered by this strain, see EUCAST QC
Tables.
Unless otherwise indicated, breakpoints apply to all members of the Staphylococcus genus.
• Breakpoints for S. aureus also apply to other coagulase positive staphylococci, unless otherwise indicated: S. argenteus, S. schweitzeri, S. intermedius, S. pseudintermedius and S. coagulans (previously S. schleiferi subsp. coagulans).
• Coagulase-negative staphylococci include S. capitis, S. cohnii, S. epidermidis, S. haemolyticus, S. hominis, S. hyicus, S. lugdunensis, S. pettenkoferi, S. saprophyticus, S. schleiferi, S. sciuri, S. simulans, S. warneri and S. xylosus. For these,
unless otherwise indicated, use breakpoints for “coagulase-negative staphylococci”.
• For S. saccharolyticus, use methodology and breakpoints for Gram-positive anaerobic bacteria.

Benzylpenicillin, S. aureus 0.1251 0.1251 1 unit 26A,B 26A,B
Benzylpenicillin, S. lugdunensis 0.125 0.125 1 unit 26 26
Benzylpenicillin, Coagulase-negative staphylococci
Note2 Note2 NoteC NoteC
Ampicillin, S. saprophyticus Note2,3 Note2,3 2 18C,D 18C,D

Ampicillin-sulbactam Note 1,2,3
Note1,2,3 NoteA,C,D NoteA,C,D
Amoxicillin Note1,2,3 Note1,2,3 NoteA,C,D NoteA,C,D
Amoxicillin-clavulanic acid Note1,2,3 Note1,2,3 NoteA,C,D NoteA,C,D
Piperacillin Note1,2,3 Note1,2,3 NoteA,C,D NoteA,C,D
Piperacillin-tazobactam Note 1,2,3
Note 1,2,3
Note A,C,D
NoteA,C,D
Ticarcillin Note1,2 Note1,2 NoteA,C NoteA,C
Ticarcillin-clavulanic acid Note1,2 Note1,2 NoteA,C NoteA,C
Temocillin - - - -
Phenoxymethylpenicillin, S. aureus Note1 Note1 NoteA NoteA
Phenoxymethylpenicillin, Coagulase-negative staphylococci
-2 -2 NoteC NoteC
Oxacillin (screen only), NA NA 1 20E 20E

S. pseudintermedius and S. schleiferi
Oxacillin4, other staphylococci Note1,4 Note1,4 NoteA NoteA
Cloxacillin Note 1,2
Note 1,2
Note A,C
NoteA,C
Dicloxacillin Note1,2 Note1,2 NoteA,C NoteA,C
Flucloxacillin Note1,2 Note1,2 NoteA,C NoteA,C
58
Staphylococcus spp.

Cefaclor2 Note1 Note1 NoteA NoteA
Cefadroxil Note1 Note1 NoteA NoteA
Cefalexin Note 1
Note 1
Note A
NoteA
Cefazolin Note1 Note1 NoteA NoteA
Cefepime Note1 Note1 NoteA NoteA
Cefiderocol - - - -
Cefixime - - - -
Cefotaxime2 Note1 Note1 NoteA NoteA
Cefoxitin (screen only), S. aureus and Note3,4 Note3,4 30 22A,B 22A,B
coagulase-negative staphylococci other than S.
epidermidis
Cefoxitin (screen only), S. epidermidis Note4 Note4 30 25A,B 25A,B 25-27
Cefoxitin (screen only), Note5 Note5 NoteC NoteC
S. pseudintermedius and S. schleiferi
Cefpodoxime Note1 Note1 NoteA NoteA
Ceftaroline (indications other than pneumonia), S. 16
aureus 26,7 1 5 20D 17D,E 19-20
Ceftaroline (pneumonia), S. aureus 16 16 1 5 20D 20D 19-20

Ceftazidime - - - -
Ceftibuten - - - -
Ceftobiprole, S. aureus 28 28 2 5 17F 17F 16-17
Ceftriaxone2 Note1 Note1 NoteA NoteA
Cefuroxime iv Note1 Note1 NoteA NoteA
Cefuroxime oral Note 1
Note 1
Note A
NoteA

Doripenem Note1 Note1 NoteA NoteA
Ertapenem Note1 Note1 NoteA NoteA
Imipenem Note 1
Note 1
Note A
NoteA
Imipenem-relebactam Note1 Note1 NoteA NoteA
59
Staphylococcus spp.
Meropenem Note1 Note1 NoteA NoteA

Meropenem-vaborbactam Note 1
Note 1
Note A
NoteA

Aztreonam - - - -
Fluoroquinolones1 MIC breakpoints Disk Zone diameter

Ciprofloxacin, S. aureus 0.001 1 5 50A 21A
Ciprofloxacin, Coagulase-negative staphylococci0.001 1 5 50A 24A
Delafloxacin, S. aureus 0.25 0.25 NoteB NoteB

Levofloxacin, S. aureus 0.001 1 5 50A 22A
Levofloxacin, Coagulase-negative staphylococci 0.001 1 5 50A 24A
Moxifloxacin, S. aureus 0.25 0.25 5 25A 25A

Moxifloxacin, Coagulase-negative staphylococci 0.25 0.25 5 28A 28A

Norfloxacin (screen only) NA NA 10 17C NoteC
Ofloxacin Note2 Note2 NoteD NoteD

Amikacin2, S. aureus (8)1 (8)1 30 (18)A (18)A 16-19
Amikacin2, Coagulase-negative staphylococci (8)1 (8)1 30 (22)A (22)A
Gentamicin, S. aureus (1)1 (1)1 10 (18)A (18)A

Gentamicin,Coagulase-negative staphylococci (1)1 (1)1 10 (22)A (22)A
Tobramycin, S. aureus (1)1 (1)1 10 (18)A (18)A
Tobramycin, Coagulase-negative staphylococci (1)1 (1)1 10 (22)A (22)A
60
Staphylococcus spp.

lipoglycopeptides1 (mg/L) content breakpoints (mm)
Dalbavancin2 0.1253,4 0.1253 NoteA NoteA
Oritavancin2, S. aureus 0.1253,4 0.1253 NoteA NoteA
Teicoplanin2, S. aureus 2 2 NoteA NoteA
Teicoplanin, Coagulase-negative staphylococci 4 4 Note A
NoteA
Telavancin2, MRSA 0.1253,5 0.1253 NoteA NoteA

Vancomycin2, S. aureus 2 2 NoteA NoteA
Vancomycin2, Coagulase-negative staphylococci 4 4 NoteA NoteA

Azithromycin 11 21 NoteA NoteA
Clarithromycin 11 21 NoteA NoteA
Erythromycin 11 21 15 21A 18A
Roxithromycin 11 21 NoteA NoteA
Telithromycin IE IE IE IE
Clindamycin2 0.25 0.5 2 22B 19B
Quinupristin-dalfopristin 1 2 15 21 18C

Doxycycline 11 21 NoteA NoteA
Eravacycline, S. aureus 0.25 0.25 20 20B 20B
Minocycline 0.51 0.51 30 23A 23A
Tetracycline 11 21 30 22A 19A
Tigecycline2 0.53 0.53 15 19 19
61
Staphylococcus spp.

Linezolid 4 4 10 21 21
Tedizolid 0.51 0.5 2 21A 21

Colistin - - - -
Daptomycin1 12 12 NoteA NoteA
Fosfomycin iv 323 323 NoteA NoteA
Fusidic acid 1 1 10 24 24
Lefamulin, S. aureus 0.25 0.25 5 23 23
Nitrofurantoin (uncomplicated UTI only), S. saprophyticus
64 64 100 13 13
Nitroxoline (uncomplicated UTI only), S. saprophyticusIE IE IE IE
Rifampicin 0.06 0.5 5 26 23

Trimethoprim (uncomplicated UTI only) 4 4 5 14 14
a) b)
Examples of inhibition zones for Staphylococcus aureus with benzylpenicillin.

a) Fuzzy zone edge and zone diameter ≥ 26 mm. Report susceptible.
62
Staphylococcus spp.
b) Sharp zone edge and zone diameter ≥ 26 mm. Report resistant.
63

against a dark background illuminated with reflected light (except for benzylpenicillin, see below).
Quality control: Staphylococcus aureus ATCC 29213. For agents not covered by this strain, see EUCAST QC Tables.
teus, S. schweitzeri, S. intermedius, S. pseudintermedius and S. coagulans (previously S. schleiferi subsp. coagulans).
s, S. lugdunensis, S. pettenkoferi, S. saprophyticus, S. schleiferi, S. sciuri, S. simulans, S. warneri and S. xylosus. For these,
Notes
1/A. Most S. aureus are penicillinase producers and some are methicillin resistant. Either mechanism renders them resistant
to benzylpenicillin, phenoxymethylpenicillin, ampicillin, amoxicillin, piperacillin and ticarcillin. Isolates that test susceptible to
benzylpenicillin and cefoxitin can be reported susceptible to all penicillins. Isolates that test resistant to benzylpenicillin but
susceptible to cefoxitin are susceptible to β-lactam β-lactamase inhibitor combinations, the isoxazolylpenicillins (oxacillin,
cloxacillin, dicloxacillin and flucloxacillin) and nafcillin. For agents given orally, care to achieve sufficient exposure at the site
of the infection should be exercised. Isolates that test resistant to cefoxitin are resistant to all penicillins.
2/C. Most coagulase-negative staphylococci are penicillinase producers and some are methicillin resistant. Either mechanism
renders them resistant to benzylpenicillin, phenoxymethylpenicillin, ampicillin, amoxicillin, piperacillin and ticarcillin. No
currently available method can reliably detect penicillinase production in coagulase-negative staphylococci but methicillin
resistance can be detected with cefoxitin as described.
3/D. Ampicillin susceptible S. saprophyticus are mecA-negative and susceptible to ampicillin, amoxicillin and piperacillin
(without or with a beta-lactamase inhibitor).
4. S. aureus, S. lugdunensis and S. saprophyticus with oxacillin MIC values >2 mg/L are mostly methicillin resistant due to
the presence of the mecA or mecC gene. Occasionally oxacillin MIC values are high in S. aureus in absence of mec-gene
mediated resistance. These isolates have been called BORSA (borderline oxacillin resistant S. aureus). EUCAST does not
recommend systematic screening for BORSA. For coagulase-negative staphylococci other than S. saprophyticus and S.
lugdunensis, the oxacillin MIC in methicillin resistant isolates is >0.25 mg/L.
B. For S. aureus, disk diffusion is more reliable than MIC determination for detection of penicillinase producers, provided the
zone diameter is measured AND the zone edge closely inspected (see pictures below). Examine the zone edge with
transmitted light (plate held up to light). If the zone diameter is <26 mm, then report resistant. If the zone diameter is ≥26 mm
AND the zone edge is sharp, then report resistant. If not sharp, then report susceptible and if uncertain, then report resistant.
Chromogenic cephalosporin-based beta-lactamase tests do not reliably detect staphylococcal penicillinase.
E. For screening for methicillin resistance in S. pseudintermedius and S. schleiferi.
64
mediated resistance. These isolates have been called BORSA (borderline oxacillin resistant S. aureus). EUCAST does not
recommend systematic screening for BORSA. For coagulase-negative staphylococci other than S. saprophyticus and S.
lugdunensis, the oxacillin MIC in methicillin resistant isolates is >0.25 mg/L.
B. For S. aureus, disk diffusion is more reliable than MIC determination for detection of penicillinase producers, provided the
zone diameter is measured AND the zone edge closely inspected (see pictures below). Examine the zone edge with
transmitted light (plate held up to light). If the zone diameter is <26 mm, then report resistant. If the zone diameter is ≥26 mm
AND the zone edge is sharp, then report resistant. If not sharp, then report susceptible and if uncertain, then report resistant.
EUCAST Clinical
Chromogenic cephalosporin-based beta-lactamaseBreakpoint Tables
tests do not reliably detect v. 11.0, valid
staphylococcal from 2021-01-01
penicillinase.
E. For screening for methicillin resistance in S. pseudintermedius and S. schleiferi.
Notes
1/A. Susceptibility of staphylococci to cephalosporins is inferred from the cefoxitin susceptibility except for cefixime,
ceftazidime, ceftazidime-avibactam, ceftibuten and ceftolozane-tazobactam, which do not have breakpoints and should not
be used for staphylococcal infections. For agents given orally, care to achieve sufficient exposure at the site of the infection
should be exercised. If cefotaxime and ceftriaxone are reported for methicillin-susceptible staphylococci, these should be
reported “Susceptible, increased exposure” (I). Some methicillin-resistant S. aureus are susceptible to ceftaroline and
ceftobiprole, see Notes 5/D and 7/F.
2. See table of dosages.
3. S. aureus and S. lugdunensis with cefoxitin MIC values >4 mg/L and S. saprophyticus with cefoxitin MIC values >8 mg/L
are methicillin resistant, mostly due to the presence of the mecA or mecC gene. Disk diffusion reliably predicts methicillin
resistance.
4. For staphylococci other than S. aureus, S. lugdunensis and S. saprophyticus, the cefoxitin MIC is a poorer predictor of
methicillin resistance than the disk diffusion test.
5/C. In S. pseudintermedius and S. schleiferi the cefoxitin disk is less predictive for the detection of methicillin resistance than
in other staphylococci. Use the oxacillin 1 µg disk with zone diameter breakpoints S≥20, R<20 mm.
6/D. Methicillin-susceptible isolates can be reported susceptible to ceftaroline without further testing.
7/E. Resistant isolates are rare.
8/F. Methicillin-susceptible isolates can be reported susceptible to ceftobiprole without further testing.
B. If coagulase-negative staphylococci are not identified to species level, use zone diameter breakpoints S≥25, R<25 mm.
Notes
1/A. Susceptibility of staphylococci to carbapenems is inferred from the cefoxitin susceptibility.
65
1/A. Susceptibility of staphylococci to carbapenems is inferred from the cefoxitin susceptibility.
Notes
Notes
1. For breakpoints for other fluoroquinolones (e.g. pefloxacin and enoxacin), refer to breakpoints set by national breakpoint
committees.
2/D. Ofloxacin breakpoints for Staphylococcus spp. have been removed since in systemic infections with staphylococci the
agent is inferior to other fluoroquinolones. For topical use of ofloxacin, see tables of topical agents.
A. The norfloxacin disk diffusion test can be used to screen for fluoroquinolone resistance. See Note C.
B. A disk diffusion test is not yet developed. Perform an MIC test.
C. Isolates categorised as susceptible to norfloxacin can be reported susceptible to moxifloxacin and "susceptible increased
exposure" (I) to ciprofloxacin, levofloxacin and ofloxacin. Isolates categorised as non-susceptible should be tested for
susceptibility to individual agents.
Notes
2. Resistance to amikacin is most reliably determined by testing with kanamycin (MIC >8 mg/L). The corresponding zone
diameter for the kanamycin 30 µg disk is R<18 mm for S. aureus and R<22 mm for coagulase-negative staphylococci.
66
Notes
1. Glycopeptide MICs are method dependent and should be determined by broth microdilution (ISO standard 20776-1). S.
aureus with vancomycin MIC values of 2 mg/L are on the border of the wild-type distribution and there may be an impaired
clinical response.
2. Non-susceptible isolates are rare or not yet reported. The identification and antimicrobial susceptibility test result on any
such isolate must be confirmed and the isolate sent to a reference laboratory.
3. MICs must be determined in the presence of polysorbate-80 (0.002% in the medium for broth dilution methods; agar
dilution methods have not been validated). Follow the manufacturer's instructions for commercial systems.
4. S. aureus isolates susceptible to vancomycin can be reported susceptible to dalbavancin and oritavancin.
5. MRSA isolates susceptible to vancomycin can be reported susceptible to telavancin.
A. Disk diffusion is unreliable and cannot distinguish between wild type isolates and those with non-vanA-mediated
glycopeptide resistance.
Notes
1/A. Erythromycin can be used to determine susceptibility to azithromycin, clarithromycin and roxithromycin.
2. Inducible clindamycin resistance can be detected by antagonism of clindamycin activity by a macrolide agent. If not
detected, then report as tested according to the clinical breakpoints. If detected, then report as resistant and consider adding
this comment to the report: "Clindamycin may still be used for short-term therapy of less serious skin and soft tissue
infections as constitutive resistance is unlikely to develop during such therapy".
B. Place the erythromycin and clindamycin disks 12-20 mm apart (edge to edge) and look for antagonism (the D
phenomenon) to detect inducible clindamycin resistance.
C. Isolates non-susceptible by disk diffusion should be confirmed by MIC testing.
Notes
1/A. Isolates susceptible to tetracycline are also susceptible to doxycycline and minocycline, but some resistant to
tetracycline may be susceptible to minocycline and/or doxycycline. An MIC method should be used to test doxycycline
susceptibility of tetracycline resistant isolates if required.
B. For MRSA that test susceptible with disk diffusion, the results should be confirmed with an MIC test.
67
Notes
1/A. Isolates susceptible to linezolid can be reported susceptible to tedizolid.
Notes
2. Daptomycin MICs must be determined in the presence of Ca 2+ (50 mg/L in the medium for broth dilution methods; agar
dilution methods have not been validated). Follow the manufacturers' instructions for commercial systems.
(25 mg/L in the medium). Follow the manufacturers' instructions for commercial systems.
A. Use an MIC method.
68
Enterococcus spp.
In endocarditis, refer to national or international endocarditis guidelines for breakpoints for Enterococcus spp.

visible growth.
Quality control: Enterococcus faecalis ATCC 29212. For agents not covered by this strain and for control of
the inhibitor component of beta-lactam inhibitor combinations, see EUCAST QC Tables.
This genus includes several species. The most frequent enterococci recovered in clinical samples are E. faecalis, E. faecium, E. avium, E. casseliflavus, E. durans, E. gallinarum, E. hirae, E. mundtii and E. raffinosus. Unless otherwise indicated,
breakpoints apply to all members of the Enterococcus genus.

Ampicillin1 42 82 2 10A 8A
Ampicillin-sulbactam1 42,3 82,3 NoteA NoteA
Amoxicillin1 42 82 NoteA NoteA
Amoxicillin-clavulanic acid1 42,4 82,4 NoteA NoteA
Piperacillin Note 2
Note 2
Note A
NoteA
Piperacillin-tazobactam Note2 Note2 NoteA NoteA
Ticarcillin - - - -
Ticarcillin-clavulanic acid - - - -
Temocillin - - - -
Oxacillin - - - -
Cloxacillin - - - -
69
Enterococcus spp.

Cefaclor - - - -
Cefadroxil - - - -
Cefalexin - - - -
Cefazolin - - - -
Cefepime - - - -
Cefiderocol - - - -
Cefixime - - - -
Cefotaxime - - - -
Cefoxitin - - - -
Cefpodoxime - - - -
Ceftaroline - - - -
Ceftazidime - - - -
Ceftibuten - - - -
Ceftriaxone - - - -

Doripenem - - - -
Ertapenem - - - -
Imipenem 0.001 4 10 50 21
Imipenem-relebactam1 Note1 Note1 NoteA NoteA
Meropenem - - - -
Meropenem-vaborbactam - - - -

Aztreonam - - - -
70
Enterococcus spp.

Ciprofloxacin (uncomplicated UTI only) 4 4 5 15A 15A
Levofloxacin (uncomplicated UTI only) 4 4 5 15A 15A
Moxifloxacin Note1 Note1 NoteB NoteB
Norfloxacin (screen only) NA NA 10 12C 12C
Ofloxacin - - - -

Amikacin Note2 Note2 NoteA NoteA
Gentamicin (test for high-level aminoglycoside resistance)
Note2 Note2 30 NoteA NoteA
Netilmicin Note2 Note2 NoteA NoteA

Streptomycin (test for high-level Note3 Note3 300 NoteB NoteB
streptomycin resistance)
Tobramycin Note2 Note2 NoteA NoteA

Dalbavancin IE IE IE IE
Oritavancin IE IE IE IE
Teicoplanin 2 2 30 16 16
Telavancin IE IE IE IE
Vancomycin 4 4 5 12A 12A
71
Enterococcus spp.

Clindamycin - - - -
Quinupristin-dalfopristin, E. faecium 1 4 15 22 20

Doxycycline - - - -
Eravacycline, E. faecalis 0.125 0.125 20 22 22
Eravacycline, E. faecium 0.125 0.125 20 24 24
Minocycline - - - -
Tigecycline1, E. faecalis 0.252 0.252 15 20 20
Tigecycline1, E. faecium 0.252 0.252 15 22 22

Tedizolid IE IE IE IE
72
Enterococcus spp.

Colistin - - - -
Daptomycin1 IE IE IE IE
Lefamulin Note2 Note2 NoteA NoteA
Nitrofurantoin (uncomplicated UTI only), E. faecalis64 64 100 15 15
Nitroxoline (uncomplicated UTI only) IE IE IE IE

Rifampicin - - - -
Trimethoprim (uncomplicated UTI only) Note3 Note3 5 NoteB NoteB
Trimethoprim-sulfamethoxazole4 Note3 Note3 1.25-23.75 NoteB NoteB
a) b) c)
Examples of inhibition zones for Enterococcus spp. with vancomycin.

a) Sharp zone edge and zone diameter ≥ 12 mm. Report susceptible.
b-d) Fuzzy zone edge or colonies within zone. Perform confirmatory testing with PCR or report resistant even if the zone diameter ≥ 12 mm.
73

Incubation: Air, 35±1ºC, 18±2h (for glycopeptides 24h)
against a dark background illuminated with reflected light (except for vancomycin, see below).
Quality control: Enterococcus faecalis ATCC 29212. For agents not covered by this strain and for control of the inhibitor
ecium, E. avium, E. casseliflavus, E. durans, E. gallinarum, E. hirae, E. mundtii and E. raffinosus. Unless otherwise indicated,
Notes
1. Aminopenicillin breakpoints in enterococci are based on intravenous administration. For oral administration the breakpoints
are relevant for urinary tract infections only.
2/A. Susceptibility to ampicillin, amoxicillin and piperacillin (with and without beta-lactamase inhibitor) can be inferred from
ampicillin. Ampicillin resistance is uncommon in E. faecalis (confirm with MIC) but common in E. faecium.
74
Notes
Notes
1/A. The addition of a beta-lactamase inhibitor does not add clinical benefit.
Notes
75
Notes
1/B. There are no clinical breakpoints for Enterococcus spp. and moxifloxacin, but moxifloxacin has been used for oral step-
down treatment of endocarditis caused by Enterococcus spp. The norfloxacin disk diffusion test or the moxifloxacin MIC
ECOFF (1 mg/L) can be used to screen for resistance mechanisms. When screen negative, the isolate should be reported
“wild type” or “devoid of fluoroquinolone resistance mechanisms”, but not as susceptible to moxifloxacin.
A. The norfloxacin disk diffusion test can be used to screen for fluoroquinolone resistance. See Note C.
C. Susceptibility of ciprofloxacin and levofloxacin can be inferred from the norfloxacin susceptibility. For moxifloxacin, see
comment 1/B.
Notes
1. Enterococci are intrinsically resistant to aminoglycosides and aminoglycoside monotherapy is ineffective. There is likely to
be synergy between aminoglycosides and penicillins or glycopeptides against enterococci without acquired high-level
aminoglycoside resistance. All testing is therefore to distinguish between intrinsic and high-level acquired resistance.
2/A. Gentamicin can be used to screen for high-level aminoglycoside resistance (HLAR).
Negative test: Isolates with gentamicin MIC ≤128 mg/L or a zone diameter ≥8 mm. The isolate is wild type for gentamicin
and low-level intrinsic resistant. For other aminoglycosides, this may not be the case. Synergy with penicillins or
glycopeptides can be expected if the isolate is susceptible to the penicillin or glycopeptide.
Positive test: Isolates with gentamicin MIC >128 mg/L or a zone diameter <8 mm. The isolate is high-level resistant to
gentamicin and other aminoglycosides, except streptomycin which must be tested separately if required (see note 3/B).
There will be no synergy with penicillins or glycopeptides.
3/B. Isolates with high-level gentamicin resistance may not be high-level resistant to streptomycin.
Negative test: Isolates with streptomycin MIC ≤512 mg/L or a zone diameter ≥14 mm. The isolate is wild type for
streptomycin and low-level intrinsic resistant. Synergy with penicillins or glycopeptides can be expected if the isolate is
susceptible to the penicillin or glycopeptide.
Positive test: Isolates with streptomycin MIC >512 mg/L or a zone diameter <14 mm. The isolate is high-level resistant to
streptomycin. There will be no synergy with penicillins or glycopeptides.
Notes
A. Vancomycin susceptible enterococci exhibit sharp zone edges and do not exhibit colonies in the inhibition zone. Examine
zone edges with transmitted light (plate held up to light). If the zone edge is fuzzy, colonies grow within the zone or if you are
uncertain, then perform confirmatory testing with PCR or report resistant (see pictures below) even if the zone diameter is ≥
12 mm. Isolates must not be reported susceptible before 24 h incubation.
76
Notes
Notes
Notes
77
Notes
1. For more information, see http://www.eucast.org/guidance_documents/.
2/A. Lefamulin has insufficient activity against E. faecalis. For E. faecium, the ECOFF of 0.5 mg/L can be used to distinguish
wild type from non-wild type isolates.
3/B. The activity of trimethoprim and trimethoprim-sulfamethoxazole is uncertain against enterococci, and it is not possible to
predict clinical outcome. The ECOFF to categorise isolates as wild type or non-wild type for both E. faecalis and E. faecium is
1 mg/L, with a corresponding zone diameter ECOFF of 21 mm for trimethoprim and 23 mm for trimethoprim-
sulfamethoxazole.
4. Trimethoprim-sulfamethoxazole in the ratio 1:19. Breakpoints are expressed as the trimethoprim concentration.
d)
ant even if the zone diameter ≥ 12 mm.
78
Streptococcus groups A, B, C and G

Medium: Mueller-Hinton broth + 5% lysed horse blood and 20 mg/L β-NAD (MH-F broth)
visible growth.
Quality control: Streptococcus pneumoniae ATCC 49619. For agents not covered by this strain, see EUCAST
QC Tables.
This group of bacteria includes many species, which can be grouped as follows:
Group A: S. pyogenes
Group B: S. agalactiae
Group C: S. dysgalactiae (plus the more rarely isolated S. equi)
Group G: S. dysgalactiae and S. canis
S. dysgalactiae includes the subspecies equisimilis and dysgalactiae, S. equi includes the subspecies equi and zooepidemicus.

Benzylpenicillin (indications other than meningitis)2
0.25 0.25 1 unit 18 18
Benzylpenicillin (meningitis)2, S. agalactiae (group

0.125
B streptococci)
0.125 1 unit 19 19
Ampicillin Note1 Note1 NoteA NoteA

Ampicillin-sulbactam3 Note1 Note1 NoteA NoteA
Amoxicillin Note1 Note1 NoteA NoteA
Amoxicillin-clavulanic acid 3
Note 1
Note 1
Note A
NoteA
Piperacillin Note1 Note1 NoteA NoteA
Piperacillin-tazobactam3 Note1 Note1 NoteA NoteA
Ticarcillin - - - -
Temocillin - - - -
PhenoxymethylpenicillinStreptococcus groups A,Note
C and
1
G Note1 NoteA NoteA
Oxacillin Note1 Note1 NoteA NoteA

Streptococcus groups A, C and G
Cloxacillin Note1 Note1 NoteA NoteA
Dicloxacillin Note1 Note1 NoteA NoteA
Flucloxacillin Note1 Note1 NoteA NoteA
79

Cefaclor Note1 Note1 NoteA NoteA
Cefadroxil Note1 Note1 NoteA NoteA
Cefalexin Note 1
Note 1
Note A
NoteA
Cefazolin Note1 Note1 NoteA NoteA
Cefepime Note1 Note1 NoteA NoteA
Cefiderocol IE IE IE IE
Cefixime - - - -
Cefotaxime Note1 Note1 NoteA NoteA
Cefoxitin IE IE IE IE
Cefpodoxime Note1 Note1 NoteA NoteA
Ceftaroline Note1 Note1 NoteA NoteA
Ceftazidime - - - -
Ceftibuten Note1 Note1 NoteA NoteA
Ceftolozane-tazobactam2 IE IE IE IE
Ceftriaxone Note1 Note1 NoteA NoteA
Cefuroxime iv Note1 Note1 NoteA NoteA
Cefuroxime oral Note1 Note1 NoteA NoteA

Doripenem Note1 Note1 NoteA NoteA
Ertapenem Note1 Note1 NoteA NoteA
Imipenem Note1 Note1 NoteA NoteA
Imipenem-relebactam 2
Note 2
Note 2
Note B
NoteB
Meropenem Note1 Note1 NoteA NoteA
Meropenem-vaborbactam2 Note2 Note2 NoteB NoteB

80
Aztreonam - - - -

Ciprofloxacin - - - -
Delafloxacin 0.03 0.03 NoteA NoteA
Levofloxacin 0.001 2 5 50B 17B
Moxifloxacin 0.5 0.5 5 19B 19B
Norfloxacin (screen only) NA NA 10 12C NoteC
Ofloxacin - - - -
Aminoglycosides MIC breakpoints Disk Zone diameter

Amikacin - - - -
Gentamicin - - - -
Netilmicin - - - -
Tobramycin - - - -

Dalbavancin1 0.1252,3 0.1252 NoteA NoteA
Oritavancin1 0.252,3 0.252 NoteA NoteA
Teicoplanin1 2 2 30 15B 15B
Vancomycin1 2 2 5 13B 13B
81

Azithromycin 0.251 0.51 NoteA NoteA
Clarithromycin 0.251 0.51 NoteA NoteA
Erythromycin 0.251 0.51 15 21A 18A
Roxithromycin 0.51 11 NoteA NoteA
Telithromycin 0.25 0.5 15 20 17

Tigecycline2 0.1253 0.1253 15 19 19

Linezolid1 2 2 10 19 19
Tedizolid1 0.52 0.5 2 18A 18A
82

Colistin - - - -
Daptomycin1 12 12 NoteA NoteA
Fusidic acid IE IE IE IE
Lefamulin IE IE IE IE
Nitrofurantoin (uncomplicated UTI only), S. agalactiae
64 (group B
64streptococci) 100 15 15

Rifampicin 0.06 0.5 5 21 15
Trimethoprim (uncomplicated UTI only), S. agalactiae
2 (group B2streptococci) 5 IP IP
83

Medium: Mueller-Hinton agar + 5% defibrinated horse blood and 20 mg/L β-NAD (MH-F)
Incubation: 5% CO2, 35±1ºC, 18±2h
Reading: Unless otherwise stated, read zone edges as the point showing no growth viewed from the front of the plate with
the lid removed and with reflected light.
Quality control: Streptococcus pneumoniae ATCC 49619. For agents not covered by this strain, see EUCAST QC Tables.
Notes
1/A. The susceptibility of streptococcus groups A, B, C and G to penicillins is inferred from the benzylpenicillin susceptibility
(indications other than meningitis) with the exception of phenoxymethylpenicillin and isoxazolylpenicillins for streptococcus
group B.
3. The addition of a beta-lactamase inhibitor does not add clinical benefit.
84
Notes
1/A. The susceptibility of streptococcus groups A, B, C and G to cephalosporins is inferred from the benzylpenicillin
susceptibility.
Notes
1/A. The susceptibility of streptococcus groups A, B, C and G to carbapenems is inferred from the benzylpenicillin
susceptibility.
2/B. The addition of a beta-lactamase inhibitor does not add clinical benefit.
Notes
85
Notes
A. A disk diffusion test is not yet developed. Perform an MIC test.
B. The norfloxacin disk diffusion test can be used to screen for fluoroquinolone resistance. See Note C.
C. Isolates categorised as susceptible to norfloxacin can be reported susceptible to moxifloxacin and as "susceptible
increased exposure" (I) to levofloxacin. Isolates categorised as non-susceptible should be tested for susceptibility to
individual agents.
Notes
Notes
3. Isolates susceptible to vancomycin can be reported susceptible to dalbavancin and oritavancin.
A. Disk diffusion criteria have not been defined and an MIC method should be used.
B. Non-wild type isolates were not available when developing the disk diffusion method.
86
Notes
detected, then report as tested according to the clinical breakpoints. If detected, then report as resistant and consider adding
this comment to the report: "Clindamycin may still be used for short-term therapy of less serious skin and soft tissue
infections as constitutive resistance is unlikely to develop during such therapy". The clinical importance of inducible
clindamycin resistance in combination treatment of severe S. pyogenes infections is not known.
Notes
Notes
2/A. Isolates susceptible to linezolid can be reported susceptible to tedizolid.
87
Notes
2. Daptomycin MICs must be determined in the presence of Ca 2+ (50 mg/L in the medium for broth dilution methods; agar
A. Use an MIC method.
88
Streptococcus pneumoniae

visible growth.
QC Tables.

Benzylpenicillin (indications other than meningitis)2
0.061 21 NoteA NoteA
Benzylpenicillin (meningitis) 0.061 0.061 NoteA NoteA

Ampicillin (indications other than meningitis) 0.51 21 2 22A 16A
Ampicillin (meningitis) 0.51 0.51 NoteA,B NoteA,B

Ampicillin-sulbactam 3
Note1,4 Note1,4 Note A,C
NoteA,C
Amoxicillin iv (indications other than meningitis)Note1,4 Note1,4 NoteA,C NoteA,C
Amoxicillin iv (meningitis) 0.51 0.51 NoteA,B NoteA,B

Amoxicillin oral 0.51 11 NoteA,D NoteA,D
Amoxicillin-clavulanic acid iv3 Note1,4 Note1,4 NoteA,C NoteA,C
Amoxicillin-clavulanic acid oral 3 0.51,5 11,5 NoteA,D NoteA,D
Piperacillin Note1,4 Note1,4 NoteA,C NoteA,C
Piperacillin-tazobactam3 Note1,4 Note1,4 Note A,C
NoteA,C
Ticarcillin - - - -
Temocillin - - - -
Phenoxymethylpenicillin Note1 Note1 NoteA NoteA
Oxacillin (screen only) NA NA 1 20E NoteE
Cloxacillin - - - -
89

Cefaclor 0.001 0.5 30 50 28
Cefadroxil - - - -
Cefalexin - - - -
Cefazolin - - - -
Cefepime 1 2 NoteA NoteA
Cefixime - - - -
Cefotaxime (indications other than meningitis) 0.5 2 NoteA NoteA
Cefotaxime (meningitis) 0.5 0.5 NoteA,B NoteA,B

Cefpodoxime 0.25 0.5 NoteA NoteA
Ceftaroline 0.25 0.25 NoteA NoteA
Ceftazidime - - - -
Ceftibuten - - - -
Ceftobiprole 0.5 0.5 NoteA NoteA
Ceftriaxone (indications other than 0.5 2 NoteA NoteA
meningitis)
Ceftriaxone (meningitis) 0.5 0.5 NoteA,B NoteA,B
Cefuroxime iv 0.5 1 NoteA NoteA
Cefuroxime oral 0.25 0.5 NoteA NoteA
Carbapenems1,2 MIC breakpoints Disk Zone diameter

Doripenem 1 1 NoteA NoteA
Ertapenem 0.5 0.5 NoteA NoteA
Imipenem 2 2 NoteA NoteA
Imipenem-relebactam3 Note3 Note3 NoteB NoteB
Meropenem (indications other than meningitis) 2 2 Note A
NoteA
Meropenem (meningitis) 0.25 0.25 NoteA,C NoteA,C

90

Aztreonam - - - -

Levofloxacin 0.001 2 5 50A 16A
Moxifloxacin 0.5 0.5 5 22A 22A
Norfloxacin (screen only) NA NA 10 10B NoteB
Ofloxacin - - - -

Amikacin - - - -
Gentamicin - - - -
Netilmicin - - - -
Tobramycin - - - -

Dalbavancin IE IE IE IE
Oritavancin IE IE IE IE
Teicoplanin1 2 2 30 17A 17A
Vancomycin1 2 2 5 16A 16A
91



Tedizolid IE IE IE IE
92

Chloramphenicol1 8 8 30 21 21
Colistin - - - -
Daptomycin IE IE IE IE
Fosfomycin iv IE IE IE IE
Lefamulin 0.5 0.5 5 12 12
Rifampicin 0.125 0.5 5 22 17
93
Screening for beta-lactam resistance in S. pneumoniae
Oxacillin 1 µg disk test or benzylpenicillin MIC
Oxacillin zone diameter ≥20 mm or Oxacillin zone diameter <20 mm* or

benzylpenicillin MIC ≤0.06 mg/L benzylpenicillin MIC >0.06 mg/L*
Excludes all beta-lactam resistance mechanisms Beta-lactam resistance mechanism detected
Report susceptible (S) to any beta-lactam agents for which clinical

breakpoints are available, including those with “Note”, except for cefaclor,
which if reported, should be reported “susceptible, increased exposure”
(I)
Benzylpenicillin Benzylpenicillin Ampicillin, amoxicillin and piperacillin

(meningitis) (indications other than (without and with
and meningitis) beta-lactamase inhibitor),
phenoxymethylpenicillin cefepime, cefotaxime, ceftaroline,
(all indications) ceftobiprole and ceftriaxone
Report resistant (R) Determine the MIC and Oxacillin

interpret according to the zone ≥8 mm
clinical breakpoints
Report susceptible
(S)
For intravenous ampicillin, amoxicillin and For oral amoxicillin (without and
piperacillin (without and with inhibitor), with inhibitor), see breakpoint
infer susceptibility from ampicillin recommendations
* In meningitis confirm by determining the MIC for the agent considered for clinical use.
94
95

Inoculum: McFarland 0.5 from blood agar or McFarland 1.0 from chocolate agar
Notes
1/A. The oxacillin 1 µg disk screen test or a benzylpenicillin MIC test shall be used to exclude beta-lactam resistance
mechanisms. When the screen is negative (oxacillin inhibition zone ≥20 mm, or benzylpenicillin MIC ≤0.06 mg/L) all beta-
lactam agents for which clinical breakpoints are available, including those with “Note” can be reported susceptible without
further testing, except for cefaclor, which if reported, should be reported as “susceptible, increased exposure” (I). When the
screen is positive (inhibition zone <20 mm, or benzylpenicillin MIC >0.06 mg/L), see flow chart below.
2. Breakpoints for penicillins other than "benzylpenicillin (meningitis)" relate only to non-meningitis isolates.
2. For breakpoints and dosing in pneumonia, see table of dosages.
4/C. Susceptibility inferred from ampicillin (indications other than meningitis).
B. For isolates with oxacillin inhibition zone <20 mm, or benzylpenicillin MIC >0.06 mg/L, determine the MIC.
D. Perform an MIC or infer susceptibility from the ampicillin 2 µg disk diffusion test with ampicillin breakpoints S≥22, R<19
mm.
E. For interpretation of the oxacillin disk screen, see flow chart below.
96
Notes
B. For isolates with oxacillin inhibition zone <20 mm, or benzylpenicillin MIC >0.06 mg/L, determine the MIC.
Notes
2. Meropenem is the only carbapenem used for meningitis.
C. For isolates with oxacillin inhibition zone <20 mm, or benzylpenicillin MIC >0.06 mg/L, determine the MIC for meropenem.
97
Notes
Notes
A. The norfloxacin disk diffusion test can be used to screen for fluoroquinolone resistance. See Note B.
B. Isolates categorised as susceptible to norfloxacin can be reported susceptible to moxifloxacin and as "susceptible
increased exposure" (I) to levofloxacin. Isolates categorised as non-susceptible should be tested for susceptibility to
individual agents.
Notes
Notes
A. Non-wild type isolates were not available when developing the disk diffusion method.
98
Notes
detected, then report as tested according to the clinical breakpoints. If detected, then report as resistant.
Notes
Notes
99
Notes
1. For chloramphenicol treatment in meningitis, see table of dosages.
100
n MIC See the EUCAST warning on the use of benzylpenicillin

gradient tests at http://www.eucast.org/warnings/.
Oxacillin zone diameter <20 mm* or

benzylpenicillin MIC >0.06 mg/L*
eta-lactam resistance mechanism detected
amoxicillin and piperacillin Other beta-

(without and with lactam agents
-lactamase inhibitor),
e, cefotaxime, ceftaroline,
biprole and ceftriaxone
n Oxacillin zone Determine the MIC and

mm <8 mm interpret according to the
clinical breakpoints
eptible
thout and For cefepime, cefotaxime, ceftaroline, ceftobiprole and

eakpoint ceftriaxone,
ns determine the MIC and interpret according to the clinical breakpoints
101
Viridans group streptococci
In endocarditis, refer to national or international endocarditis guidelines for breakpoints for viridans group streptococci.

visible growth.
QC Tables.
This group of bacteria includes many species, which can be grouped as follows:
S. anginosus group: S. anginosus, S. constellatus, S. intermedius
S. mitis group: S. australis, S. cristatus, S. infantis, S. mitis, S. oligofermentans, S. oralis,S. peroris, S. pseudopneumoniae, S. sinensis
S. sanguinis group: S. sanguinis, S. parasanguinis, S. gordonii
S. bovis group: S. equinus, S. gallolyticus (S. bovis), S. infantarius
S. salivarius group: S. salivarius, S. vestibularis, S. thermophilus
S. mutans group: S. mutans, S. sobrinus

Benzylpenicillin 0.25 2 1 unit 18 12
Benzylpenicillin (screen only) 0.251 Note1 1 unit 18A NoteA
Ampicillin 0.5 2 2 21 15
Ampicillin-sulbactam2 Note1,3 Note1,3 NoteA,B NoteA,B
Amoxicillin 0.5 2 NoteA,B NoteA,B
Amoxicillin-clavulanic acid2 Note1,3 Note1,3 NoteA,B NoteA,B
Piperacillin Note1,3 Note1,3 Note A,B
NoteA,B
Piperacillin-tazobactam2 Note1,3 Note1,3 NoteA,B NoteA,B
Ticarcillin-clavulanic acid2 IE IE IE IE
Temocillin - - - -
Phenoxymethylpenicillin IE IE IE IE
Oxacillin - - - -
Cloxacillin - - - -
102

Cefaclor - - - -
Cefadroxil - - - -
Cefalexin - - - -
Cefazolin - - - -
Cefepime 0.5 0.5 30 25A 25A
Cefixime - - - -
Cefotaxime 0.5 0.5 5 23A 23A
Cefpodoxime - - - -
Ceftaroline - - - -
Ceftazidime - - - -
Ceftibuten - - - -
Ceftolozane-tazobactam1, S. anginosus group IE IE IE IE
Ceftriaxone 0.5 0.5 30 27A 27A

Cefuroxime iv 0.5 0.5 30 26A 26A

Doripenem 1 1 NoteA NoteA
Ertapenem 0.5 0.5 NoteA NoteA
Imipenem 2 2 NoteA NoteA
Imipenem-relebactam2 21 21 NoteA,B NoteA,B
Meropenem 2 2 NoteA NoteA

Aztreonam - - - -
103

Delafloxacin, S. anginosus group 0.03 0.03 NoteA NoteA
Levofloxacin IE IE IE IE
Moxifloxacin Note1 Note1 NoteB NoteB
Ofloxacin - - - -

Amikacin Note2 Note2 - -
Gentamicin (test for high-level aminoglycoside resistance)
Note2 Note2 - -
Netilmicin Note2 Note2 - -

Tobramycin Note2 Note2 - -

Dalbavancin1, S. anginosus group 0.1252,3 0.1252 NoteA NoteA
Oritavancin1, S. anginosus group 0.252,3 0.252 NoteA NoteA
Teicoplanin1 2 2 30 16B 16B
Vancomycin1 2 2 5 15B 15B
104

Azithromycin IE IE IE IE
Clarithromycin IE IE IE IE
Erythromycin IE IE 15 IE IE
Roxithromycin IE IE IE IE
Telithromycin IE IE IE IE
Clindamycin1 0.5 0.5 2 19A 19A
Quinupristin-dalfopristin IE IE IE IE

Doxycycline - - - -
Eravacycline 0.125 0.125 20 17 17
Minocycline - - - -

Linezolid IE IE IE IE
Tedizolid, S. anginosus group 0.5 0.5 2 18 18
105

Colistin - - - -
Daptomycin - - - -
Rifampicin Note1 Note1 NoteA NoteA
Trimethoprim-sulfamethoxazole - - - -
106
cci.

sinensis
Notes
1/A. Benzylpenicillin (MIC or disk diffusion) can be used to screen for beta-lactam resistance in viridans group streptococci.
Isolates categorised as screen negative can be reported susceptible to beta-lactam agents for which clinical breakpoints are
listed (including those with “Note”). Isolates categorised as screen positive should be tested for susceptibility to individual
agents.
3/B. For benzylpenicillin screen negative isolates (inhibition zone ≥18 mm or MIC ≤0.25 mg/L), susceptibility can be inferred
from benzylpenicillin or ampicillin. For benzylpenicillin screen positive isolates (inhibition zone <18 mm or MIC >0.25 mg/L),
susceptibility is inferred from ampicillin.
107
Notes
A. Benzylpenicillin (MIC or disk diffusion) can be used to screen for beta-lactam resistance in viridans group streptococci.
See Note 1/A on penicillins.
Notes
A. Benzylpenicillin (MIC or disk diffusion) can be used to screen for beta-lactam resistance in viridans group streptococci.
See Note 1/A on penicillins.
Notes
108
Notes
1/B. There are no clinical breakpoints for viridans group streptococci and moxifloxacin, but moxifloxacin has been used for
oral step-down treatment of endocarditis caused by viridans group streptococci .The moxifloxacin MIC ECOFF (0.5 mg/L)
can be used to screen for resistance mechanisms. When screen negative, the isolate should be reported “wild type” or
“devoid of fluoroquinolone resistance mechanisms”, but not as susceptible to moxifloxacin.
A. A disk diffusion test is not yet developed. Perform an MIC test.
Notes
1. Viridans group streptococci are intrinsically resistant to aminoglycosides and aminoglycoside monotherapy is ineffective.
There is likely to be synergy between aminoglycosides and penicillins or glycopeptides against streptococci without acquired
high-level aminoglycoside resistance. All testing is therefore to distinguish between intrinsic and high-level acquired
resistance.
2. Gentamicin can be used to screen for high-level aminoglycoside resistance (HLAR).
Negative test: Isolates with gentamicin MIC ≤128 mg/L. The isolate is wild type for gentamicin and low-level intrinsic
resistant. For other aminoglycosides, this may not be the case. Synergy with penicillins or glycopeptides can be expected if
the isolate is susceptible to the penicillin or glycopeptide.
Positive test: Isolates with gentamicin MIC >128 mg/L. The isolate is high-level resistant to gentamicin and other
aminoglycosides except streptomycin. There will be no synergy with penicillins or glycopeptides.
Notes
3. Isolates susceptible to vancomycin can be reported susceptible to dalbavancin and oritavancin.
A. Disk diffusion criteria have not been defined and an MIC method should be used.
B. Non-wild type isolates were not available when developing the disk diffusion method.
109
Notes
detected, then report as tested according to the clinical breakpoints. If detected, then report as resistant.
A. Place the erythromycin and clindamycin disks 12-16 mm apart (edge to edge) and look for antagonism (the D
Notes
Notes
110
Notes
1/A. There are no clinical breakpoints for viridans group streptococci and rifampicin, but rifampicin has been used for oral
step-down treatment of endocarditis caused by viridans group streptococci. The rifampicin MIC ECOFF (0.125 mg/L) can be
used to screen for resistance mechanisms. When screen negative, the isolate should be reported “wild type” or “devoid
rifampicin resistance mechanisms”, but not as susceptible to rifampicin.
111
Haemophilus influenzae
EUCAST breakpoints have been defined for H. influenzae only. Clinical data for other Haemophilus species are scarce. MIC distributions for H. parainfluenzae are similar to those for H. influenzae. In the absence of specific breakpoints, the H.
influenzae MIC breakpoints can be applied to H. parainfluenzae.

visible growth.
Quality control: Haemophilus influenzae ATCC 49766. For agents not covered by this strain and for control of

Benzylpenicillin IE IE IE IE
Benzylpenicillin (screen only)1 NA NA 1 unit 12A,B NoteA,B
Ampicillin (indications other than meningitis) 2 1 1 2 18A,B 18A,B
Ampicillin (meningitis)2 IE IE IE IE
Ampicillin-sulbactam 13,4 13,4 10-10 NoteA,D NoteA,D
Amoxicillin iv (indications other than meningitis)2 2 2 NoteA,E NoteA,E
Amoxicillin iv (meningitis)2 IE IE IE IE
Amoxicillin oral2 0.001 2 NoteA,F NoteA,F
Amoxicillin-clavulanic acid iv 25 25 2-1 15A,B 15A,B
Amoxicillin-clavulanic acid oral 0.0015 25 2-1 50A,B 15A,B
Piperacillin2 IE IE IE IE
Piperacillin-tazobactam 0.256 0.256 30-6 27A,B 27A,B 24-27B,C
Temocillin IE IE IE IE
Phenoxymethylpenicillin IE IE IE IE
Oxacillin - - - -
Cloxacillin - - - -
112

Cefaclor - - - -
Cefadroxil - - - -
Cefalexin - - - -
Cefazolin - - - -
Cefepime 0.25 0.25 30 28A,B 28A,B 28-33B,C
Cefixime 0.125 0.125 5 26A,B 26A,B
Cefotaxime4 0.125 0.125 5 27A,B 27A,B 25-27B,C
Cefpodoxime 0.25 0.25 10 26A,B 26A,B 26-29B,C
Ceftaroline 0.03 0.03 NoteA NoteA
Ceftazidime - - - -
Ceftibuten 1 1 30 25A,B 25A,B
Ceftolozane-tazobactam (pneumonia)2 0.5 0.5 30-10 23A,B 23A,B 22-23B,C
Ceftriaxone4 0.125 0.125 30 32A,B 32A,B 31-33B,C
Cefuroxime iv 1 2 23 30 27A,B 25A,B 25-27B,C
Cefuroxime oral 0.001 1 30 50A,B 27A,B 25-27B,C
Carbapenems1,2 MIC breakpoints Disk Zone diameter

Doripenem1 1 1 10 23A,B 23A,B
Ertapenem 0.5 0.5 10 23A,B 23A,B
Imipenem 2 2 10 20A,B 20A,B 6-19B,C
Imipenem-relebactam3 Note3 Note3 NoteE NoteE
Meropenem (indications other than meningitis) 2 2 10 20A,B 20A,B
Meropenem (meningitis) 0.25 0.25 NoteA,D NoteA,D

Meropenem-vaborbactam 3
Note 3
Note 3
Note E
NoteE

113
Aztreonam IE IE IE IE

Ciprofloxacin 0.06 0.06 5 30A 30A
Levofloxacin 0.06 0.06 5 30A 30A
Nalidixic acid (screen only) NA NA 30 23B NoteB
Ofloxacin 0.06 0.06 5 30A 30A

Amikacin IE IE IE IE
Gentamicin IE IE IE IE
Tobramycin IE IE IE IE

Dalbavancin - - - -
Oritavancin - - - -
Teicoplanin - - - -
Telavancin - - - -
Vancomycin - - - -
114
Macrolides1, lincosamides and MIC breakpoints Disk Zone diameter

Azithromycin Note1 Note1 NoteA NoteA
Clarithromycin Note1 Note1 NoteA NoteA
Erythromycin Note1 Note1 Note A
NoteA
Roxithromycin Note1 Note1 NoteA NoteA
Telithromycin Note1 Note1 NoteA NoteA
Clindamycin - - - -

Minocycline 11 11 30 24A 24A

Linezolid - - - -
Tedizolid - - - -
115

Chloramphenicol1 2 2 30 28 28
Colistin - - - -
Daptomycin - - - -
Rifampicin (for prophylaxis only) 1 1 5 18 18
Trimethoprim-sulfamethoxazole2 0.5 1 1.25-23.75 23 20
Examples of inhibition zones for H. influenzae and a beta-lactam agent where an otherwise clear inhibition zone contains an area of growth around the disk.
Read the outer edge of zones where an otherwise clear inhibition zone contains an area of growth around the disk.
116
Screening for beta-lactam resistance in H. influenzae
Benzylpenicillin (PCG) 1 unit disk test

Always perform in parallel with testing of other beta-lactam agents
PCG 1 unit zone diameter ≥ 12 mm PCG 1 unit zone diameter < 12 mm*
Excludes all beta-lactam resistance mechanisms Beta-lactam resistance mechanism detected
(Beta-lactamase and/or PBP3 mutations)
Report susceptible (S) to any beta-lactam agents for which clinical

breakpoints are available, including those with “Note”, except for the oral
preparations of amoxicillin, amoxicillin-clavulanic acid and cefuroxime, which Test for beta-lactamase
if reported, should be reported “susceptible, increased exposure” (I).
Beta-lactamase positive
With or without PBP3 mutations
Report ampicillin, amoxicillin and piperacillin Other beta-lactam

(without beta-lactamase inhibitor) resistant agents
(R)
Amoxicillin-clavulanic acid 2-1 µg ≥ 15 mm Amoxicillin-clavulanic acid 2-1 µg < 15 mm

Beta-lactamase only Beta-lactamase and PBP3 mutations
Report susceptible (S) to any beta-lactam agents for which clinical breakpoints are available, Report according to the clinical breakpoints for the agent in
including those with “Note”, except for the oral preparations of amoxicillin-clavulanic acid and question. For cefepime, cefpodoxime and imipenem,
cefuroxime, which if reported, should be reported as “susceptible, increased exposure” (I). see below**
** For cefepime, cefpodoxime and imipenem, if resistant by both screen and agent disk diffusion test, report resistant. If resistant by screen test and susceptible by agent
disk diffusion test, determine the MIC of the agent and interpret according to the clinical breakpoints.
117
118
. MIC distributions for H. parainfluenzae are similar to those for H. influenzae. In the absence of specific breakpoints, the H.

Quality control: Haemophilus influenzae ATCC 49766. For agents not covered by this strain and for control of the inhibitor
Notes
1/A. The benzylpenicillin 1 unit disk screen test shall be used to exclude beta-lactam resistance mechanisms. When the
screen is negative (inhibition zone ≥12 mm) all penicillins for which clinical breakpoints are available, including those with
“Note”, can be reported susceptible without further testing, except for amoxicillin oral and amoxicillin-clavulanic acid oral,
which if reported, should be reported “susceptible, increased exposure” (I). When the screen is positive (inhibition zone <12
mm), see flow chart below.
2. Beta-lactamase positive isolates can be reported resistant to ampicillin, amoxicillin and piperacillin without inhibitors. Tests
based on a chromogenic cephalosporin can be used to detect the beta-lactamase.
4/D. Susceptibility can be inferred from amoxicillin-clavulanic acid iv.
B. Read the outer edge of zones where an otherwise clear inhibition zone contains an area of growth around the disk, see
pictures below.
C. ATU relevant only if the benzylpenicillin 1 unit disk screen is positive (inhibition zone <12 mm).
E. Susceptibility can be inferred from ampicillin.
F. Isolates susceptible to ampicillin can be reported "susceptible, increased exposure” (I) to amoxicillin oral.
119
Notes
screen is negative (inhibition zone ≥12 mm) all cephalosporins for which clinical breakpoints are available, including those
with “Note”, can be reported susceptible without further testing, except for cefuroxime oral, which if reported, should be
reported “susceptible, increased exposure” (I). When the screen is positive (inhibition zone <12 mm), see flow chart below.
3/C. ATU relevant only if the benzylpenicillin 1 unit disk screen is positive (inhibition zone <12 mm).
4. The breakpoints also apply to meningitis.
pictures below.
Notes
screen is negative (inhibition zone ≥12 mm) all carbapenems for which clinical breakpoints are available, including those with
“Note”, can be reported susceptible without further testing. When the screen is positive (inhibition zone <12 mm), see flow
chart below.
2. Meropenem is the only carbapenem used for meningitis.
3/E. The beta-lactamases produced by the organism either do not modify the parent carbapenem or are not affected by the
pictures below.
C. ATU relevant only if the benzylpenicillin 1 unit disk screen is positive (inhibition zone <12 mm).
D. For benzylpenicillin 1 unit disk screen positive isolates (inhibition zone <12 mm), determine the MIC for meropenem.
Notes
120
Notes
A. The nalidixic acid disk diffusion test can be used to screen for fluoroquinolone resistance. See Note B.
B. Isolates categorised as susceptible to nalidixic acid can be reported susceptible to ciprofloxacin, levofloxacin, moxifloxacin
and ofloxacin. Isolates categorised as non-susceptible may have fluoroquinolone resistance and should be tested against the
appropriate agent.
Notes
Notes
121
Notes
1/A. Clinical evidence for the efficacy of macrolides in H. influenzae respiratory infections is conflicting due to high
spontaneous cure rates. Should there be a need to test any macrolide against this species, the epidemiological cut-offs
(ECOFFs) should be used to detect strains with acquired resistance. The ECOFFs for each agent are: azithromycin 4 mg/L,
clarithromycin 32 mg/L, erythromycin 16 mg/L and telithromycin 8 mg/L. There are insufficient data available to establish an
ECOFF for roxithromycin.
Notes
Notes
122
Notes
1. For chloramphenicol treatment in meningitis, see table of dosages.
ear inhibition zone contains an area of growth around the disk.

ound the disk.
123
disk test
r beta-lactam agents
PCG 1 unit zone diameter < 12 mm*

ta-lactam resistance mechanism detected
Beta-lactamase and/or PBP3 mutations)
Test for beta-lactamase
Beta-lactamase negative
PBP3 mutations only
xicillin-clavulanic acid 2-1 µg < 15 mm

eta-lactamase and PBP3 mutations
Report according to the clinical breakpoints for the agent in

question. For cefepime, cefpodoxime and imipenem,
see below**
est, report resistant. If resistant by screen test and susceptible by agent

ts.
124
125

visible growth.

Ampicillin -1 -1 - -
Ampicillin-sulbactam 12,3 12,3 NoteA NoteA
Amoxicillin -1 -1 - -
Amoxicillin-clavulanic acid 14 14 2-1 19 19
Piperacillin -1 -1 - -
Piperacillin-tazobactam Note3 Note3 NoteA NoteA
Temocillin IE IE IE IE
Oxacillin - - - -
Cloxacillin - - - -
126

Cefaclor - - - -
Cefadroxil - - - -
Cefalexin - - - -
Cefazolin - - - -
Cefepime 4 4 30 20 20
Cefixime 0.5 1 5 21 18
Cefotaxime 1 2 5 20 17
Cefpodoxime IP IP 10 IP IP
Ceftaroline IE IE IE IE
Ceftazidime - - - -
Ceftibuten IE IE IE IE
Ceftolozane-tazobactam IE IE IE IE
Ceftriaxone 1 2 30 24 21
Cefuroxime iv 4 8 30 21 18
Cefuroxime oral 0.001 4 30 50 21

Doripenem1 1 1 10 30 30
Ertapenem1 0.5 0.5 10 29 29
Imipenem1 2 2 10 29 29
Imipenem-relebactam2 Note2 Note2 NoteA NoteA
Meropenem1 2 2 10 33 33
Meropenem-vaborbactam2 Note2 Note2 NoteA NoteA

Aztreonam IE IE IE IE
127

Ofloxacin 0.25 0.25 5 28A 28A

Amikacin IE IE IE IE
Tobramycin IE IE IE IE

Dalbavancin - - - -
Oritavancin - - - -
Teicoplanin - - - -
Telavancin - - - -
Vancomycin - - - -

Clindamycin - - - -
128

Minocycline 11 11 30 25A 25A

Linezolid - - - -
Tedizolid - - - -

Chloramphenicol Note1 Note1 NoteA NoteA
Colistin - - - -
Daptomycin - - - -
Rifampicin - - - -
Trimethoprim-sulfamethoxazole2 0.5 1 1.25-23.75 18 15
129

Notes
1. Most M. catarrhalis produce beta-lactamase, although beta-lactamase production is slow and may give weak results with
in vitro tests. Beta-lactamase producers should be reported resistant to penicillins and aminopenicillins without inhibitors.
3/A. Susceptibility can be inferred from amoxicillin-clavulanic acid.
130
Notes
Notes
2/A. The beta-lactamases produced by the organism either do not modify the parent carbapenem or are not affected by the
Notes
131
Notes
B. Isolates categorised as susceptible to nalidixic acid can be reported susceptible to ciprofloxacin, levofloxacin, moxifloxacin
and ofloxacin. Isolates categorised as non-susceptible may have fluoroquinolone resistance and should be tested against the
appropriate agent.
Notes
Notes
Notes
132
EUCAST
1/A. Erythromycin can Clinical
be used to determine Breakpoint
susceptibility Tables
to azithromycin, v. 11.0,and
clarithromycin valid from 2021-01-01
roxithromycin.
Notes
Notes
Notes
1/A. For topical use of chloramphenicol, see tables of topical agents.
133
Neisseria gonorrhoeae EUCAST Clinical Breakpoint Tables v. 11.0, valid from 2021-01-01
For comments on dosages related to breakpoints, see the table of dosages.
Disk diffusion criteria for antimicrobial susceptibility testing of Neisseria gonorrhoeae have not yet been defined and an MIC
method should be used. If a commercial MIC method is used, follow the manufacturer´s instructions. Laboratories with few
isolates are encouraged to refer these to a reference laboratory for testing.
Penicillins1 MIC breakpoints Notes

(mg/L) Numbered notes relate to general comments and/or MIC breakpoints.
S≤ R> ATU
Benzylpenicillin (surrogate agent)1 0.061 1 1. Always test for beta-lactamase (tests based on a chromogenic cephalosporin can be used). If beta-lactamase positive, report
Ampicillin1 Note1 Note1 resistant to ampicillin and amoxicillin. If beta-lactamase negative, determine the MIC of benzylpenicillin. Infer the susceptibility to
ampicillin and amoxicillin from the benzylpenicillin MIC (do not report benzylpenicillin susceptibility).
Ampicillin-sulbactam IE IE
Amoxicillin1 Note1 Note1
Amoxicillin-clavulanic acid IE IE
Piperacillin - -
Piperacillin-tazobactam - -
Ticarcillin - -
Ticarcillin-clavulanic acid - -
Temocillin IE IE
Phenoxymethylpenicillin - -
Oxacillin - -
Cloxacillin - -
Dicloxacillin - -
Flucloxacillin - -
Mecillinam oral (pivmecillinam) (uncomplicated UTI only) - -
134
Cephalosporins MIC breakpoints Notes

S≤ R> ATU
Cefaclor - -
Cefadroxil - -
Cefalexin - -
Cefazolin - -
Cefepime - -
Cefiderocol IE IE
Cefixime 0.125 0.125
Cefotaxime 0.125 0.125
Cefoxitin IE IE
Cefpodoxime - -
Ceftaroline - -
Ceftazidime - -
Ceftazidime-avibactam - -
Ceftibuten - -
Ceftobiprole - -
Ceftolozane-tazobactam - -
Ceftriaxone 0.125 0.125
Cefuroxime iv - -
Cefuroxime oral - -
Carbapenems MIC breakpoints Notes

S≤ R> ATU
Doripenem IE IE
Ertapenem IE IE
Imipenem IE IE
Imipenem-relebactam IE IE
Meropenem IE IE
Meropenem-vaborbactam IE IE
Monobactams MIC breakpoints Notes

S≤ R> ATU
Aztreonam IE IE
135
Fluoroquinolones MIC breakpoints Notes

S≤ R> ATU
Ciprofloxacin 0.03 0.06
Delafloxacin IE IE
Levofloxacin IE IE
Moxifloxacin IE IE
Nalidixic acid (screen only) NA NA
Norfloxacin (uncomplicated UTI only) - -
Ofloxacin 0.125 0.25
Aminoglycosides MIC breakpoints Notes

S≤ R> ATU
Amikacin - -
Gentamicin - -
Netilmicin - -
Tobramycin - -
Glycopeptides and lipoglycopeptides MIC breakpoints Notes

S≤ R> ATU
Dalbavancin - -
Oritavancin - -
Teicoplanin - -
Telavancin - -
Vancomycin - -
Macrolides, lincosamides and streptogramins MIC breakpoints Notes

S≤ R> ATU
Azithromycin Note1 Note1 1. Azithromycin is always used in conjunction with another effective agent. For testing purposes with the aim of detecting acquired
Clarithromycin - - resistance mechanisms, the ECOFF is 1 mg/L.
Erythromycin - -
Roxithromycin - -
Telithromycin - -
Clindamycin - -
Quinupristin-dalfopristin - -
136
Tetracyclines MIC breakpoints Notes

S≤ R> ATU
Doxycycline IE IE
Eravacycline IE IE
Minocycline IE IE
Tetracycline 0.5 1
Tigecycline IE IE
Oxazolidinones MIC breakpoints Notes

S≤ R> ATU
Linezolid - -
Tedizolid - -
Miscellaneous agents MIC breakpoints Notes

S≤ R> ATU
Chloramphenicol - -
Colistin - -
Daptomycin - -
Fosfomycin iv - -
Fosfomycin oral - -
Fusidic acid - -
Lefamulin IE IE
Metronidazole - -
Nitrofurantoin (uncomplicated UTI only) - -
Nitroxoline (uncomplicated UTI only) - -
Rifampicin - -
Spectinomycin 64 64
Trimethoprim (uncomplicated UTI only) - -
Trimethoprim-sulfamethoxazole - -
137
Neisseria meningitidis EUCAST Clinical Breakpoint Tables v. 11.0, valid from 2021-01-01
Disk diffusion criteria for antimicrobial susceptibility testing of Neisseria meningitidis have not yet been defined and an MIC
method should be used. If a commercial MIC method is used, follow the manufacturer´s instructions.

S≤ R> ATU
Benzylpenicillin 0.25 0.25 1. All breakpoints pertain to iv administration.
Ampicillin (indications other than meningitis) 0.125 1
Ampicillin (meningitis) IE IE
Ampicillin-sulbactam IE IE
Amoxicillin (indications other than meningitis) 0.125 1
Amoxicillin (meningitis) IE IE
Amoxicillin-clavulanic acid - -
Piperacillin - -
Piperacillin-tazobactam - -
Ticarcillin - -
Ticarcillin-clavulanic acid - -
Temocillin - -
Phenoxymethylpenicillin - -
Oxacillin - -
Cloxacillin - -
Dicloxacillin - -
Flucloxacillin - -
138

S≤ R> ATU
Cefaclor - - 1. Non-susceptible isolates are rare or not yet reported. The identification and antimicrobial susceptibility test result on any such isolate
Cefadroxil - - must be confirmed and the isolate sent to a reference laboratory.
Cefalexin - -
Cefazolin - -
Cefepime - -
Cefiderocol IE IE
Cefixime - -
Cefotaxime1 0.125 0.125
Cefoxitin - -
Cefpodoxime - -
Ceftaroline - -
Ceftazidime - -
Ceftibuten - -
Ceftobiprole - -
Ceftolozane-tazobactam - -
Ceftriaxone1 0.125 0.125
Cefuroxime iv - -
Cefuroxime oral - -
Carbapenems1,2 MIC breakpoints Notes

S≤ R> ATU
Doripenem Note2 Note2 1. Non-susceptible isolates are rare or not yet reported. The identification and antimicrobial susceptibility test result on any such isolate
Ertapenem IE IE must be confirmed and the isolate sent to a reference laboratory.
2. Breakpoints for serious N. meningitidis systemic infections (meningitis with or without septicemia) have been determined for
Imipenem Note2 Note2 meropenem only. The meningitis breakpoint can be used to categorise meropenem for other serious infections.
Imipenem-relebactam 3
Note 2,3
Note2,3 3. The beta-lactamases produced by the organism either do not modify the parent carbapenem or are not affected by the inhibitor.
Therefore the addition of the beta-lactamase inhibitor does not add clinical benefit.
Meropenem (indications other than meningitis) Note2 Note2
Meropenem (meningitis)1,2 0.25 0.25
Meropenem-vaborbactam3 Note2,3 Note2,3

S≤ R> ATU
Aztreonam - -
139

S≤ R> ATU
Ciprofloxacin 0.031 0.031 1. Breakpoints apply only to use in the prophylaxis of meningococcal disease.
Delafloxacin IE IE
Levofloxacin IE IE
Moxifloxacin IE IE
Ofloxacin IE IE

S≤ R> ATU
Amikacin - -
Gentamicin - -
Netilmicin - -
Tobramycin - -

S≤ R> ATU
Dalbavancin - -
Oritavancin - -
Teicoplanin - -
Telavancin - -
Vancomycin - -

S≤ R> ATU
Azithromycin - -
Clarithromycin - -
Erythromycin - -
Roxithromycin - -
Telithromycin - -
Clindamycin - -
140

S≤ R> ATU
Doxycycline - - 1. Tetracycline can be used to predict susceptibility to minocycline for prophylaxis against N. meningitidis infections.
Eravacycline IE IE
Minocycline 11 11
Tetracycline 21 21
Tigecycline IE IE

S≤ R> ATU
Linezolid - -
Tedizolid - -

S≤ R> ATU
Chloramphenicol (meningitis) 1 2 2 1. For chloramphenicol treatment in meningitis, see table of dosages.
Colistin - - 2. For prophylaxis of meningitis only (refer to national guidelines).
Daptomycin - -
Fosfomycin iv - -
Fosfomycin oral - -
Fusidic acid - -
Lefamulin - -
Metronidazole - -
Rifampicin2 0.25 0.25
Spectinomycin - -
141
Gram-positive anaerobes EUCAST Clinical Breakpoint Tables v. 11.0, valid from 2021-01-01
except Clostridioides difficile
Disk diffusion criteria for antimicrobial susceptibility testing of anaerobes have not yet been defined and an MIC method
should be used. If a commercial MIC method is used, follow the manufacturer´s instructions.
This group of bacteria includes many genera. The most frequently isolated Gram-positive anaerobes are: Actinomyces, Bifidobacterium, Clostridioides, Clostridium, Cutibacterium, Eggerthella, Eubacterium,
Lactobacillus, and Propionibacterium.The group also includes a number of anaerobic Gram-positive cocci, including Staphylococcus saccharolyticus. Anaerobes are most frequently defined by no growth on culture
plates incubated in a CO2 enriched atmosphere, but many Gram-positive, non-spore forming rods such as Actinomyces spp., many C. acnes and some Bifidobacterium spp. can grow on incubation in CO 2 and may be
tolerant enough to grow poorly in air, but are still considered as anaerobic bacteria. Several species of Clostridium, including C. carnis, C. histolyticum and C. tertium, can grow but not sporulate in air. For all these
species, susceptibility testing should be performed in anaerobic environment.

S≤ R> ATU
Benzylpenicillin2 0.25 0.5 1. Aminopenicillin breakpoints in Gram-positive anaerobic bacteria are based on intravenous administration.
Ampicillin2 4 8 2. Susceptibility to ampicillin, amoxicillin, piperacillin and ticarcillin can be inferred from susceptibility to benzylpenicillin.
Ampicillin-sulbactam 43 83 4. For susceptibility testing purposes, the concentration of clavulanic acid is fixed at 2 mg/L.
Amoxicillin2 4 8 5. For susceptibility testing purposes, the concentration of tazobactam is fixed at 4 mg/L.
Amoxicillin-clavulanic acid 44 84
Piperacillin2 8 16
Piperacillin-tazobactam 85 165
Ticarcillin2 8 16
Ticarcillin-clavulanic acid 84 164
Temocillin - -
Phenoxymethylpenicillin IE IE
Oxacillin - -
Cloxacillin - -
Dicloxacillin - -
Flucloxacillin - -
142

S≤ R> ATU
Cefaclor - -
Cefadroxil - -
Cefalexin - -
Cefazolin - -
Cefepime - -
Cefiderocol IE IE
Cefixime - -
Cefotaxime - -
Cefoxitin IE IE
Cefpodoxime - -
Ceftaroline - -
Ceftazidime - -
Ceftibuten - -
Ceftobiprole - -
Ceftolozane-tazobactam IE IE
Ceftriaxone - -
Cefuroxime iv - -
Cefuroxime oral - -

S≤ R> ATU
Doripenem 1 1 1. For susceptibility testing purposes, the concentration of relebactam is fixed at 4 mg/L.
Ertapenem 0.5 0.5 2. The addition of a beta-lactamase inhibitor does not add clinical benefit.
Imipenem 2 4
Imipenem-relebactam2 21 21
Meropenem 2 8
Meropenem-vaborbactam2 Note2 Note2

S≤ R> ATU
Aztreonam - -
143

S≤ R> ATU
Ciprofloxacin - -
Delafloxacin - -
Levofloxacin - -
Moxifloxacin IE IE
Ofloxacin - -

S≤ R> ATU
Amikacin - -
Gentamicin - -
Netilmicin - -
Tobramycin - -

S≤ R> ATU
Dalbavancin IE IE
Oritavancin IE IE
Teicoplanin IE IE
Telavancin IE IE
Vancomycin 2 2
144

S≤ R> ATU
Azithromycin - -
Clarithromycin - -
Erythromycin IE IE
Roxithromycin - -
Telithromycin - -
Clindamycin 4 4
Tetracyclines1 MIC breakpoints Notes

S≤ R> ATU
Doxycycline Note1 Note1 1. For anaerobic bacteria there is clinical evidence of activity in mixed intra-abdominal infections, but no correlation between MIC
Eravacycline IE IE values, PK-PD data and clinical outcome. Therefore no breakpoints for susceptibility testing are given.
Minocycline Note1 Note1

Tetracycline Note1 Note1
Tigecycline Note1 Note1

S≤ R> ATU
Linezolid - -
Tedizolid - -
145

S≤ R> ATU
Chloramphenicol 8 8
Colistin - -
Daptomycin - -
Fosfomycin iv - -
Fosfomycin oral - -
Fusidic acid - -
Lefamulin IE IE
Metronidazole 4 4
Rifampicin - -
Spectinomycin - -
146
Clostridioides difficile EUCAST Clinical Breakpoint Tables v. 11.0, valid from 2021-01-01
Disk diffusion criteria for antimicrobial susceptibility testing of Clostridiodes difficile have not yet been defined and an MIC

S≤ R> ATU
Moxifloxacin -1 -1 1. Not used clinically. May be tested for epidemiological purposes only (ECOFF 4 mg/L).
Glycopeptides MIC breakpoints Notes

S≤ R> ATU
Vancomycin 21 21 1. The breakpoints are based on epidemiological cut-off values (ECOFFs) and apply to oral treatment of C. difficile infections with
vancomycin. There are no conclusive clinical data regarding the relation between MICs and outcomes.

S≤ R> ATU
Tigecycline -1,2 -1,2 1. For tigecycline broth microdilution MIC determination, the medium must be prepared fresh on the day of use.
2. Not used clinically. May be tested for epidemiological purposes only (ECOFF 0.25 mg/L).

S≤ R> ATU
Daptomycin -1,2 -1,2 1. Daptomycin MICs must be determined in the presence of Ca 2+ (50 mg/L in the medium for broth dilution methods; agar dilution
Fusidic acid - 3
- 3 methods have not been validated). Follow the manufacturers' instructions for commercial systems.
2. Not used clinically. May be tested for epidemiological purposes only (ECOFF 4 mg/L).
Fidaxomicin IE4 IE4 3. Not used clinically. May be tested for epidemiological purposes only (ECOFF 2 mg/L).
Metronidazole 25 25 4. Fidaxomicin breakpoints and ECOFF have not been set because the available data show major variation in MIC distribution
between studies.
Rifampicin -6 -6 5. The breakpoints are based on epidemiological cut-off values (ECOFFs) and apply to oral treatment of C. difficile infections with
metronidazole. There are no conclusive clinical data regarding the relation between MICs and outcomes.
6. Not used clinically. May be tested for epidemiological purposes only (ECOFF 0.004 mg/L).
147
Gram-negative anaerobes EUCAST Clinical Breakpoint Tables v. 11.0, valid from 2021-01-01
Disk diffusion criteria for antimicrobial susceptibility testing of anaerobes have not yet been defined and an MIC method
should be used. If a commercial MIC method is used, follow the manufacturer´s instructions.
This group of bacteria includes many genera. The most frequently isolated Gram-negative anaerobes are Bacteroides, Bilophila, Fusobacterium, Mobiluncus, Parabacteroides, Porphyromonas and Prevotella.
Anaerobes are most frequently defined by no growth on culture plates incubated in a CO 2 enriched atmosphere. For all these species, susceptibility testing should be performed in anaerobic environment.
Penicillins MIC breakpoints Notes

S≤ R> ATU
Benzylpenicillin1 0.25 0.5 1. Susceptibility to ampicillin, amoxicillin, piperacillin and ticarcillin can be inferred from susceptibility to benzylpenicillin.
Ampicillin1 0.5 2 2. For susceptibility testing purposes, the concentration of sulbactam is fixed at 4 mg/L.
Ampicillin-sulbactam 42 82 4. For susceptibility testing purposes, the concentration of tazobactam is fixed at 4 mg/L.
Amoxicillin1 0.5 2
Piperacillin1 16 16
Ticarcillin1 16 16
Temocillin - -
Oxacillin - -
Cloxacillin - -
Dicloxacillin - -
Flucloxacillin - -
148

S≤ R> ATU
Cefaclor - -
Cefadroxil - -
Cefalexin - -
Cefazolin - -
Cefepime - -
Cefiderocol - -
Cefixime - -
Cefotaxime - -
Cefoxitin IE IE
Cefpodoxime - -
Ceftaroline - -
Ceftazidime - -
Ceftibuten - -
Ceftobiprole - -
Ceftolozane-tazobactam IE IE
Ceftriaxone - -
Cefuroxime iv - -
Cefuroxime oral - -

S≤ R> ATU
Ertapenem 0.5 0.5 2. The beta-lactamases produced by the organisms either do not modify the parent carbapenem or are not affected by the inhibitor.
Therefore the addition of the beta-lactamase inhibitor does not add clinical benefit.
Imipenem 2 4
Imipenem-relebactam2 21 21
Meropenem 2 8
Meropenem-vaborbactam2 Note2 Note2

S≤ R> ATU
Aztreonam - -
149

S≤ R> ATU
Ciprofloxacin - -
Delafloxacin - -
Levofloxacin - -
Moxifloxacin IE IE
Ofloxacin - -

S≤ R> ATU
Amikacin - -
Gentamicin - -
Netilmicin - -
Tobramycin - -

S≤ R> ATU
Dalbavancin - -
Oritavancin - -
Teicoplanin - -
Telavancin - -
Vancomycin - -

S≤ R> ATU
Azithromycin - -
Clarithromycin - -
Erythromycin IE IE
Roxithromycin - -
Telithromycin - -
Clindamycin 4 4
150
Tetracyclines1 MIC breakpoints Notes

S≤ R> ATU
Doxycycline Note1 Note1 1. For anaerobic bacteria there is clinical evidence of activity in mixed intra-abdominal infections, but no correlation between MIC
Eravacycline IE IE values, PK-PD data and clinical outcome. Therefore no breakpoints for susceptibility testing are given.
Minocycline Note1 Note1

Tetracycline Note1 Note1
Tigecycline Note1 Note1

S≤ R> ATU
Linezolid - -
Tedizolid - -

S≤ R> ATU
Chloramphenicol 8 8
Colistin - -
Daptomycin - -
Fosfomycin iv - -
Fosfomycin oral - -
Fusidic acid - -
Lefamulin - -
Metronidazole 4 4
Rifampicin - -
Spectinomycin - -
151
Helicobacter pylori EUCAST Clinical Breakpoint Tables v. 11.0, valid from 2021-01-01
Disk diffusion criteria for antimicrobial susceptibility testing of Helicobacter pylori have not yet been defined and an MIC

S≤ R> ATU
Amoxicillin oral 0.125 0.125

S≤ R> ATU
Levofloxacin 1 1
Macrolides MIC breakpoints Notes

S≤ R> ATU
Clarithromycin 0.25 0.5

S≤ R> ATU
Tetracycline 1 1

S≤ R> ATU
Metronidazole 8 8
Rifampicin 1 1
152
Listeria monocytogenes

visible growth.
QC Tables.

Benzylpenicillin (indications other than meningitis)1 1 1 unit 13 13
Benzylpenicillin (meningitis) IE IE IE IE
Ampicillin iv 1 1 2 16 16

Meropenem 0.25 0.25 10 26 26
Macrolides MIC breakpoints Disk Zone diameter

Erythromycin 1 1 15 25 25

Trimethoprim-sulfamethoxazole1 0.06 0.06 1.25-23.75 29 29
153
Disk diffusion (EUCAST standardised disk diffusion method )

Notes
Notes
Notes
Notes
154
Pasteurella multocida

visible growth.

Benzylpenicillin 0.5 0.5 1 unit 17 17
Ampicillin 1 1 NoteA NoteA
Amoxicillin 1 1 NoteA NoteA
Amoxicillin-clavulanic acid 11
11
2-1 15 15

Cefotaxime 0.03 0.03 5 26 26

155
Pasteurella multocida

Tetracycline (screen only) NA NA 30 24A 24A

156

Notes
A. Infer susceptibility from benzylpenicillin susceptibility.
Notes
Notes
B. Isolates categorised as susceptible to nalidixic acid can be reported susceptible to ciprofloxacin and levofloxacin. Isolates
categorised as non-susceptible may have fluoroquinolone resistance and should be tested against the appropriate agent.
157
Notes
A. Susceptibility inferred from tetracycline screen test.
Notes
158
Campylobacter jejuni and coli

Incubation: Microaerobic environment, 41±1ºC, 24h. Isolates with insufficient growth after 24h incubation are
reincubated immediately and MICs read after a total of 40-48h incubation.
visible growth.
Quality control: Staphylococcus aureus ATCC 29213 (standard conditions for staphylococci)

Macrolides MIC breakpoints Disk Zone diameter

Azithromycin Note1 Note1 NoteA NoteA
Clarithromycin Note1 Note1 NoteA NoteA
Erythromycin, C. jejuni 41 41 15 20A 20A
Erythromycin, C. coli 81 81 15 24A 24A

Doxycycline Note1 Note1 NoteA NoteA
159

Medium: Mueller-Hinton agar + 5% defibrinated horse blood and 20 mg/L β-NAD (MH-F). The MH-F plates should be dried
prior to inoculation to reduce swarming (at 20-25°C overnight or at 35°C, with the lid removed, for 15 min).
Incubation: Microaerobic environment, 41±1ºC, 24h. Isolates with insufficient growth after 24h incubation are reincubated
immediately and inhibition zones read after a total of 40-48h incubation.
Quality control: Campylobacter jejuni ATCC 33560
Notes
Notes
1/A. Erythromycin can be used to determine susceptibility to azithromycin and clarithromycin.
Notes
1/A. Tetracycline can be used to determine susceptibility to doxycycline.
160
Corynebacterium spp.
Breakpoints for corynebacteria were developed for species other than C. diphtheriae. In an ongoing study, the preliminary results indicate that the current breakpoints for benzylpenicillin and rifampicin are not useful for C. diphtheriae.

Incubation: Sealed panels, air, 35±1ºC, 18±2h. Isolates with insufficient growth after 16-20h incubation are
visible growth.
QC Tables.


Ciprofloxacin 0.001 1 5 50 25
Moxifloxacin 0.5 0.5 5 25 25

Glycopeptides MIC breakpoints Disk Zone diameter

161
Corynebacterium spp.
Macrolides and lincosamides MIC breakpoints Disk Zone diameter

Erythromycin IP IP 15 IP IP
Clindamycin1 0.5 0.5 2 20 20

Tetracycline 2 2 30 24 24


Rifampicin 0.06 0.5 5 30 25
162
nary results indicate that the current breakpoints for benzylpenicillin and rifampicin are not useful for C. diphtheriae.

Incubation: 5% CO2, 35±1ºC, 18±2h. Isolates with insufficient growth after 16-20h incubation are reincubated immediately
and inhibition zones read after a total of 40-44h incubation.
Notes
Notes
Notes
Notes
163
Notes
1. Inducible clindamycin resistance may occur in Corynebacteria. This can be detected by antagonism of clindamycin activity
by a macrolide agent. The clinical significance is unknown. There is currently no recommendation for testing.
Notes
Notes
Notes
164
Aerococcus sanguinicola and urinae
MIC determination (broth microdilution according to ISO standard 20776-1) 1

visible growth.
QC Tables.
1
For fluoroquinolones, agar dilution may produce clearer endpoints.

Ampicillin 0.25 0.25 2 26 26
Amoxicillin Note1 Note1 NoteA NoteA

Meropenem 0.25 0.25 10 31 31

Ciprofloxacin (uncomplicated UTI only) 2 2 5 21A 21A
Levofloxacin (uncomplicated UTI only) 21 21 5 NoteB NoteB
Norfloxacin (screen only) NA NA 10 17C 17C
165
Aerococcus sanguinicola and urinae


Nitrofurantoin (uncomplicated UTI only) 16 16 100 16 16
Rifampicin 0.125 0.125 5 25 25
166

Notes
1/A. Infer susceptibility from ampicillin susceptibility.
Notes
Notes
1. Susceptibility can be inferred from ciprofloxacin susceptibility.
A. Susceptibility can be inferred from norfloxacin susceptibility. See Note C.

B. Susceptibility can be inferred from ciprofloxacin or norfloxacin susceptibility. See Note C.
C. The norfloxacin disk diffusion test can be used to screen for fluoroquinolone resistance.
167
Notes
Notes
168
Kingella kingae

reincubated immediately and inhibition zones read after a total of 40-44h incubation.
visible growth.
Quality control: Haemophilus influenzae ATCC 49766. For agents not covered by this strain, see EUCAST QC
Tables.

Ampicillin 0.062 0.062 NoteA NoteA
Amoxicillin 0.1252 0.1252 NoteA NoteA
Amoxicillin-clavulanic acid Note3 Note3 NoteB NoteB

Cefotaxime 0.125 0.125 5 27 27
Ceftriaxone 0.06 0.06 30 30 30
Cefuroxime iv 0.5 0.5 30 29 29

Meropenem 0.03 0.03 10 30 30

Levofloxacin 0.125 0.125 5 28 28
169
Kingella kingae

Erythromycin 0.5 0.5 15 20 20
Clindamycin - - - -

Doxycycline 0.51 0.51 NoteA NoteA
Tetracycline 0.5 0.5 30 28 28

Rifampicin 0.5 0.5 5 20 20
170

Quality control: Haemophilus influenzae ATCC 49766. For agents not covered by this strain, see EUCAST QC Tables.
Notes
1. Beta-lactamase positive isolates can be reported resistant to benzylpenicillin and to ampicillin and amoxicillin without
inhibitors. Tests based on a chromogenic cephalosporin can be used to detect the beta-lactamase. Beta-lactam resistance
mechanisms other than beta-lactamase production have not yet been described for K. kingae.
2. Susceptibility can be inferred from benzylpenicillin susceptibility.
3/B. The intrinsic activity of clavulanic acid in K. kingae is such that the organism is inhibited by 2 mg/L clavulanic acid.
Therefore no breakpoints for amoxicillin-clavulanic acid can be given.
A. Infer susceptibility from benzylpenicillin susceptibility.
Notes
Notes
Notes
171
Notes
1. Susceptibility can be inferred from erythromycin susceptibility.
A. Infer susceptibility from erythromycin susceptibility.
Notes
1/A. Isolates susceptible to tetracycline are also susceptible to doxycycline, but some resistant to tetracycline may be
susceptible to doxycycline. An MIC method should be used to test doxycycline susceptibility of tetracycline resistant isolates
if required.
Notes
172
Aeromonas spp.

visible growth.
Quality control: Pseudomonas aeruginosa ATCC 27853. For agents not covered by this strain, see EUCAST
QC Tables.

Cefepime 1 4 30 27 24
Ceftazidime 1 4 10 24 21

Aztreonam 1 4 30 29 26

173
Aeromonas spp.

Trimethoprim-sulfamethoxazole1 2 4 1.25-23.75 19A 16A
a) b) c)
Examples of inhibition zones for Aeromonas spp. with trimethoprim-sulfamethoxazole.

a-c) Read the obvious zone edge and disregard haze or growth within the inhibition zone.
174

Notes
Notes
Notes
175
Notes
A. Read the obvious zone edge and disregard haze or growth within the inhibition zone (see pictures below).
176
Achromobacter xylosoxidans

visible growth.
Quality control: Pseudomonas aeruginosa ATCC 27853. For agents not covered by this strain, see EUCAST
QC Tables.

Piperacillin-tazobactam 41 41 30-6 26 26

Meropenem 1 4 10 26 20

Trimethoprim-sulfamethoxazole1 0.125 0.125 1.25-23.75 26A 26A
a) b) c)
Examples of inhibition zones for Achromobacter xylosoxidans with trimethoprim-sulfamethoxazole.

a-b) An outer zone can be seen. Read the outer zone edge and interpret according to the breakpoints.
177
Achromobacter xylosoxidans
c) Growth up to the disk and no sign of inhibition zone. Report resistant.
178

Notes
Notes
Notes
179
Bacillus spp.
except B. anthracis

visible growth.
Quality control: Staphylococcus aureus ATCC 29213. For agents not covered by this strain, see EUCAST QC
Tables.
This genus includes several species. The most frequent species belong to the Bacillus cereus complex (B. cereus, B. thuringiensis, B. mycoides and B. weihenstephanensis). The breakpoints are not validated for Bacillus anthracis.

(µg)
S≤ R> ATU S≥ R< ATU
Imipenem 0.5 0.5 10 30 30
Meropenem 0.25 0.25 10 25 25

Levofloxacin 0.001 1 5 50A 23A
Norfloxacin (screen only) NA NA 10 21B 21B

180
Bacillus spp.
except B. anthracis

Erythromycin 0.5 0.5 15 24 24
Clindamycin 1 1 2 17 17

181

Quality control: Staphylococcus aureus ATCC 29213. For agents not covered by this strain, see EUCAST QC Tables.
thuringiensis, B. mycoides and B. weihenstephanensis). The breakpoints are not validated for Bacillus anthracis.
Notes
Notes
A. The norfloxacin disk diffusion test can be used to screen for fluoroquinolone resistance. See Note B.
B. Isolates categorised as susceptible to norfloxacin can be reported "susceptible increased exposure" (I) to ciprofloxacin and
levofloxacin. Isolates categorised as resistant to norfloxacin can be reported resistant to ciprofloxacin and levofloxacin.
Notes
182
Notes
Notes
183
Burkholderia pseudomallei

visible growth.
Quality control: Escherichia coli ATCC 25922. For agents not covered by this strain, see EUCAST QC Tables.

Amoxicillin-clavulanic acid 0.0011 81 20-10 50 22

Ceftazidime 0.001 8 10 50 18

Imipenem 2 2 10 29 29
Meropenem 2 2 10 24 24

Doxycycline 0.001 2 NoteA NoteA
Tetracycline (screen only) NA NA 30 50A 23A
184
Burkholderia pseudomallei

Chloramphenicol 0.001 8 30 50 22
Trimethoprim-sulfamethoxazole1 0.001 4 1.25-23.75 50A 17A
a) b) c)
Examples of inhibition zones for Burkholderia pseudomallei with trimethoprim-sulfamethoxazole.

a-b) An outer zone can be seen. Read the outer zone edge and interpret according to the breakpoints.
c) Growth up to the disk and no sign of inhibition zone. Report resistant.
185

Quality control: Escherichia coli ATCC 25922. For agents not covered by this strain, see EUCAST QC Tables.
Notes
Notes
Notes
Notes
A. Susceptibility inferred from tetracycline disk diffusion screen test.
186
Notes
187
Burkholderia cepacia complex EUCAST Clinical Breakpoint Tables v. 11.0, valid from 2021-01-01
EUCAST has not determined breakpoints for Burkholderia cepacia complex organisms since accurate and reproducible methods for antimicrobial susceptibility testing are lacking due to technical diffic
Burkholderia cepacia complex currently includes at least 21 closely related species: B. ambifaria (genomovar VII), B. anthina (genomovar VIII), B. arboris (BCC3), B. cepacia
(genomovar I), B. cenocepacia (genomovar III), B. contaminans (group K, BBC AT), B. diffusa (BCC2), B. dolosa (genomovar VI), B. lata (group K), B. latens (BCC1), B.
metallica (BCC8), B. multivorans (genomovar II), B. paludis, B. pseudomultivorans, B. pyrrocinia (genomovar IX), B. seminalis (BCC7), B. stabilis (genomovar IV), B.
stagnalis (BCC B), B. territorii (BCC L), B. ubonensis (genomovar X), B. vietnamiensis (genomovar V).
188
Legionella pneumophila EUCAST Clinical Breakpoint Tables v. 11.0, valid from 2021-01-01
EUCAST has not determined breakpoints for Legionella pneumophila as there is no established reference method or any documentation of clinical outcome related to antimicrobial susceptibility testing
189
Mycobacterium tuberculosis EUCAST Clinical Breakpoint Tables v. 11.0, valid from 2021-01-01
Listed breakpoints have been set in parallel with marketing authorisation by EMA. Breakpoints for other agents have not yet been established. Infections with M. tuberculosis are always treated with two or more agents.
MIC determination using broth microdilution according to the EUCAST reference method for the Mycobacterium tuberculosis complex
Medium: Middlebrook 7H9 with 10% OADC in polystyrene plates
Incubation: Plates sealed with a plastic lid, air, 36±1°C, 7-21 days
Reading: At the earliest time point (7, 14 or 21 days) when the 1% growth control shows visible growth, read MICs at the lowest concentration of the agent that completely inhibits visible growth
Quality control: Mycobacterium tuberculosis H37Rv ATCC 27294
The Mycobacterium tuberculosis complex includes different species and variants such as M. tuberculosis var. tuberculosis, M. tuberculosis var. africanum and M. tuberculosis var. bovis. Breakpoints have only been
established for M. tuberculosis var. tuberculosis.
Antimicrobial agent MIC breakpoints Notes

S≤ R> ATU
Bedaquiline 0.251 0.251 1. Breakpoints were determined on MICs performed on Middlebrook 7H11/7H10 medium. The comparability of tests performed by
Delamanid 0.06 0.06 other media has not been established. There is ongoing work to review breakpoints using the EUCAST reference method (described
above).
Pretomanid IE2 IE2 2. MIC data have been generated with MGIT system and not with the EUCAST reference method. Therefore, it has not been possible
to set an ECOFF, nor calibrate MGIT MIC values against the reference method. Consequently, EUCAST cannot endorse the tentative
breakpoint set by EMA based on the MGIT method. Breakpoints are pending MIC data with the reference method.
190
Topical agents EUCAST Clinical Breakpoint Tables v. 11.0, valid from 2021-01-01
Screening cut-off values for detection of phenotypic resistance
In the absence of clinical data on outcome related to MIC of infecting organisms EUCAST has not been able to determine relevant clinical breakpoints for topical use of antimicrobial agents. Laboratories are advised to
Colistin(for polymyxin B)
Chloramphenicol
Screening cut-off values for
(screen only)1
(screen only)1
(screen only)1
Ciprofloxacin
Nalidixic acid
Levofloxacin
Retapamulin
Fusidic acid
(framycetin)
Tobramycin
Gentamicin
Norfloxacin
Bacitracin
Mupirocin
Pefloxacin
the detection of phenotypic
Ofloxacin
Neomycin
resistance (based on MIC and
Organisms inhibition zone diameter
ECOFFs for one or several
relevant species)
Disk content (µg) 10 10 5 10 30 5 5 5 30 - 10 10 - 200 -

MIC (mg/L) 2 2 - - - 0.125 0.25 0.25 16 2 - 8 - - -
Enterobacterales
Zone diameter (mm) 17 16 24 - - Note1 Note1 Note1 17 - - 12 - - -
MIC (mg/L) 8 2 - - - 0.5 2 2 ND 4 - ND - - -
P. aeruginosa
Zone diameter (mm) 15 18 - - - 26 20 ND ND - - ND - - -
MIC (mg/L) 4 4 - - - 1 0.5 1 ND 2 - ND - - -
Acinetobacter spp.
Zone diameter (mm) 17 17 - - - 21 23 ND ND - - ND - - -
MIC (mg/L) 2 2 - - - 1 0.5 1 16 - 0.5 1 ND 12 0.5
S. aureus
Zone diameter (mm) 18 18 - 17 - Note1 Note1 Note1 18 - 24 14 ND 302 ND
MIC (mg/L) - - - - - 4 2 4 8 - ND - ND - -
S. pneumoniae
Zone diameter (mm) - - - 10 - Note1 Note1 Note1 21 - ND - ND - -
Streptococcus groups MIC (mg/L) - - - - - 2 2 4 8 - 32 - ND 0.5 0.125
A, B, C and G Zone diameter (mm) - - - 12 - Note1 Note1 Note1 21 - ND - ND ND ND
MIC (mg/L) 4 8 - - - 0.06 0.06 0.06 2 - ND ND - - -
H. influenzae
Zone diameter (mm) ND ND - - 23 Note1 Note1 Note1 28 - ND ND - - -
MIC (mg/L) ND ND - - - 0.125 0.125 0.25 2 - ND ND - - -
M. catarrhalis
Zone diameter (mm) ND ND - - 23 Note1 Note1 Note1 31 - ND ND - - -
Notes
1. Screening agent for detection of fluoroquinolone resistance (pefloxacin for Enterobacterales, norfloxacin for gram positive organisms and nalidixic acid for H.influenzae and M. catarrhalis).
2. Breakpoints for nasal decontamination S ≤1, R >256 mg/L (S ≥30, R <18 mm for the mupirocin 200 µg disk). Isolates in the I category are associated with short term suppression (useful preoperatively) but, unlike fully susceptible isolates, long term
eradication rates are low.
ND = No ECOFF available.
191
PK-PD (Non-species related) breakpoints EUCAST Clinical Breakpoint Tables v. 11.0, valid from 2021-01-01
These breakpoints are used only when there are no species-specific breakpoints or other recommendations (a dash or a note) in the species-specific tables.If the MIC is greater than the PK-PD resistant breakpoint, advise against use of the agent.If the MIC is less than or

(mg/L)
S≤ R>
Benzylpenicillin 0.25 2 1. For susceptibility testing purposes, the concentration of sulbactam is fixed at 4 mg/L.
Ampicillin 2 8 2. For susceptibility testing purposes, the concentration of clavulanic acid is fixed at 2 mg/L.
Ampicillin-sulbactam 21 81
Amoxicillin 2 8
Piperacillin 8 16
Ticarcillin 8 16
Temocillin IE IE
Oxacillin IE IE
Cloxacillin IE IE
Dicloxacillin IE IE
Flucloxacillin IE IE
Mecillinam oral (pivmecillinam) (uncomplicated UTI only) IE IE
192

(mg/L)
S≤ R>
Cefaclor IE IE 1. Broth microdilution MIC determination must be performed in iron-depleted Mueller-Hinton broth and specific reading instructions
Cefadroxil IE IE must be followed. For testing conditions and reading instructions, see http://www.eucast.org/guidance_documents/.
2. Based on PK-PD target for Gram-negative organisms.
Cefalexin IE IE 3. For susceptibility testing purposes, the concentration of avibactam is fixed at 4 mg/L.
Cefazolin 1 2 4. Breakpoints are based on ceftolozane data.
Cefepime 4 8
Cefiderocol 21 21
Cefixime IE IE
Cefotaxime 1 2
Cefoxitin IE IE
Cefpodoxime IE IE
Ceftaroline 0.52 0.52
Ceftazidime 4 8
Ceftazidime-avibactam 83 83
Ceftibuten IE IE
Ceftobiprole 4 4
Ceftolozane-tazobactam 44.5 44.5
Ceftriaxone 1 2
Cefuroxime iv 4 8
Cefuroxime oral IE IE

(mg/L)
S≤ R>
Ertapenem 0.5 0.5 2. For susceptibility testing purposes, the concentration of vaborbactam is fixed at 8 mg/L.
Imipenem 2 4
Imipenem-relebactam 21 21
Meropenem 2 8
Meropenem-vaborbactam 82 82

(mg/L)
S≤ R>
Aztreonam 4 8
193

(mg/L)
S≤ R>
Ciprofloxacin 0.25 0.5
Delafloxacin IE IE
Levofloxacin 0.5 1
Moxifloxacin 0.25 0.25
Nalidixic acid (screen only) IE IE
Norfloxacin IE IE
Ofloxacin 0.25 0.5

(mg/L)
S≤ R>
Amikacin 1 1
Gentamicin 0.5 0.5
Netilmicin IE IE
Tobramycin 0.5 0.5

(mg/L)
S≤ R>
Dalbavancin 0.251 0.251 1. For broth microdilution MIC determination, the medium must be supplemented with polysorbate-80 to a final concentration of
Oritavancin 0.1251,2 0.1251,2 0.002%.
2. PK-PD breakpoints are based on S. aureus. For S. pyogenes there is uncertainty regarding the PK-PD target.
Teicoplanin IE IE
Telavancin IE IE
Vancomycin IE IE

(mg/L)
S≤ R>
Azithromycin IE IE
Clarithromycin IE IE
Erythromycin IE IE
Roxithromycin IE IE
Telithromycin IE IE
Clindamycin IE IE
Quinupristin-dalfopristin IE IE
194

(mg/L)
S≤ R>
Doxycycline IE IE 1. For tigecycline broth microdilution MIC determination, the medium must be prepared fresh on the day of use.
Eravacycline IE IE
Minocycline IE IE
Tetracycline IE IE
Tigecycline 0.51 0.51

(mg/L)
S≤ R>
Linezolid 2 2
Tedizolid IE IE

(mg/L)
S≤ R>
Chloramphenicol IE IE
Colistin IE IE
Daptomycin IE IE
Fosfomycin iv IE IE
Fosfomycin oral 8 8
Fusidic acid IE IE
Lefamulin 0.25 0.25
Metronidazole IE IE
Nitrofurantoin IE IE
Nitroxoline IE IE
Rifampicin IE IE
Spectinomycin IE IE
Trimethoprim IE IE
Trimethoprim-sulfamethoxazole IE IE
195

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European Committee on Antimicrobial Susceptibility Testing

Breakpoint tables for interpretation of MICs and zone diameters

Content Page Additional information

Pseudomonas spp. General

Acinetobacter spp. General

Staphylococcus spp. General

Streptococcus groups A, B, C and G General

Streptococcus pneumoniae General

Haemophilus influenzae General

Gram-positive anaerobes New breakpoints

Gram-negative anaerobes New breakpoints

Listeria monocytogenes General

2. PK-PD (Non-species related) breakpoints are listed separately.

MIC determination (broth microdilution according to ISO standard 20776-1)

Antimicrobial agent MIC breakpoint Disk Zone diameter breakpoint

Breakpoints in brackets are used to

Disk diffusion (EUCAST standardised disk diffusion method)

but is interpreted as the values between the

Area of Technical Uncertainty

A. Comment on disk diffusion

Changes from previous

Zone diameter breakpoints

nsufficient evidence that the

Penicillins Standard dosage High dosage Uncomplicated UTI Special situations

Pneumonia caused by S. pneumoniae: breakpoints are related to dosage:

Ampicillin-sulbactam (2 g ampicillin + 1 g sulbactam) x 3 iv (2 g ampicillin + 1 g sulbactam) x 4 iv

Amoxicillin oral 0.5 g x 3 oral 0.75-1 g x 3 oral 0.5 g x 3 oral

Piperacillin 4 g x 4 iv 4 g x 4 iv High dosage for more serious infections.

Cephalosporins Standard dosage High dosage Uncomplicated UTI Special situations

Cefadroxil 0.5-1 g x 2 oral None 0.5-1 g x 2 oral

Cefuroxime iv 0.75 g x 3 iv 1.5 g x 3 iv

Cefuroxime oral 0.25 g x 2 oral 0.5 g x 2 oral 0.25 g x 2 oral

Carbapenems Standard dosage High dosage Uncomplicated UTI Special situations

Ertapenem 1 g x 1 iv over 30 minutes None

* HAP/VAP = hospital-acquired pneumonia/ventilator-associated pneumonia

Monobactams Standard dosage High dosage Uncomplicated UTI Special situations

Fluoroquinolones Standard dosage High dosage Uncomplicated UTI Special situations

Aminoglycosides Standard dosage High dosage Uncomplicated UTI Special situations

Tetracyclines Standard dosage High dosage Uncomplicated UTI Special situations

Oxazolidinones Standard dosage High dosage Uncomplicated UTI Special situations

Daptomycin (cSSTI** with concurrent S. aureus bacteraemia;

Fidaxomicin 0.2 g x 2 oral None

** cSSTI = complicated skin and skin structure infection

• Include the uncertainty as part of the report

Penicillins1 MIC breakpoints Disk Zone diameter

Cephalosporins1 MIC breakpoints Disk Zone diameter

Ceftaroline 0.5 0.5 5 23 23 22-23

Cefuroxime oral (uncomplicated UTI only), E. 8 8 30 19 19

Carbapenems1 MIC breakpoints Disk Zone diameter

Imipenem2, Morganellaceae 0.001 4 10 50 19

Monobactams MIC breakpoints Disk Zone diameter

Fluoroquinolones MIC breakpoints Disk Zone diameter

Aminoglycosides1,2 MIC breakpoints Disk Zone diameter

Gentamicin (systemic infections) (2)1 (2)1 10 (17)A (17)A

Glycopeptides and MIC breakpoints Disk Zone diameter

Macrolides, lincosamides and MIC breakpoints Disk Zone diameter

Tetracyclines MIC breakpoints Disk Zone diameter

Oxazolidinones MIC breakpoints Disk Zone diameter

Miscellaneous agents MIC breakpoints Disk Zone diameter

Nitroxoline (uncomplicated UTI only), E. coli 16 16 30 15 15