EUCAST Breakpoints v1.0 2009

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

Version 1.0 December 2009
Notes
1. The EUCAST tables of clinical breakpoints v. 1.0 contain clinical MIC breakpoints (determined over the period 2002-2009) and their inhibition zone diameter correlates. The
latter are tentative for the period December 2009 - November 2010. During this period some additions will be made and the calibration between MICs and inhibition zone
diameters may be refined on the basis of more extensive data that will be available in 2010.
2. Numbered footnotes relate to MIC breakpoints. Lettered footnotes relate to disk diffusion test breakpoints.
3. Highlighted antimicrobial names link to EUCAST rationale document. Highlighted MIC breakpoints and disk diffusion breakpoints link to EUCAST MIC and zone diameter
distributions respectively.
4. A disk diffusion test breakpoint of "S≤50 mm" is an arbitrary "off scale" zone diameter breakpoint corresponding to MIC breakpoint situations where wild type isolates are
categorized as intermediate (i.e. no fully susceptible isolates exist).
Abbreviations
"-" indicates that susceptibility testing is not recommended as the species is a poor target for therapy with the drug.
"IE" indicates that there is insufficient evidence that the species in question is a good target for therapy with the drug.
NA = Not Applicable
IP = In Preparation
Enterobacteriaceae EUCAST Clinical Breakpoint Table v. 1.0 2009-12-22
Penicillins1 MIC breakpoint Disk Zone diameter Notes

(mg/L) content breakpoint (mm) Numbers for comments on MIC breakpoints
(µg) Letters for comments on disk diffusion
S≤ R> S≥ R<
1. For aminopenicillin breakpoints, the resistant breakpoint of >8 mg/L ensures that all isolates with resistance mechanisms are
reported resistant. The wide range of dosages and intravenous versus oral administration significantly affect therapeutic
efficacy. The unspecified susceptible breakpoint enables the user to categorise wild type Escherichia coli and Proteus
mirabilis as either susceptible or intermediate to the aminopenicillins depending on dosing, route of administration and whether
the infection is systemic or affects the urinary tract only.
Benzylpenicillin - - - -
Ampicillin Note1 8 10 NoteA 14 A. Clinical MIC breakpoints allow laboratories to decide on the basis of national dosing practices whether Enterobacteriaceae
without resistance mechanisms to aminopenicillins should be categorized as S or I. To categorize wild type Enterobacteriaceae
as S use disk diffusion breakpoints of 12/12 mm; to categorize as I use 50/12 mm.
Ampicillin-sulbactam 2 Note1 8 10-10 IP IP 2. For susceptibility testing purposes, the concentration of sulbactam is fixed at 4 mg/L.
Amoxicillin Note1 8 - NoteB NoteB B. Susceptibility inferred from ampicillin.
Amoxicillin-clavulanate
3
Note1 8 20-10 NoteA 12 3. For susceptibility testing purposes, the concentration of clavulanate is fixed at 2 mg/L.
Piperacillin 8 16 30 18 15
Piperacillin-tazobactam 4 8 16 30-6 18 15 4. For susceptibility testing purposes, the concentration of tazobactam is fixed at 4 mg/L.
Ticarcillin 8 16 75 23 22
Ticarcillin-clavulanate 3 8 16 75-10 23 22
Phenoxymethylpenicillin - - - -
Mecillinam (uncomplicated UTI only) 8 8 10 15 15
Cephalosporins1 MIC breakpoint Disk Zone diameter Notes

S≤ R> S≥ R<
1. The cephalosporin breakpoints for Enterobacteriaceae will detect resistance mediated by most ESBLs and other clinically
important beta-lactamases in Enterobacteriaceae. However, some ESBL-producing strains may appear susceptible or
intermediate with these breakpoints. For epidemiological or infection control purposes laboratories may want to use a test which
specifically screens for the presence of ESBLs.
Cefaclor - - - -
Cefadroxil (uncomplicated UTI only) 16 16 30 12 12
Cefalexin (uncomplicated UTI only) 16 16 30 IP IP
Cefazolin - - - -
Cefepime 1 8 30 24 18
Cefixime (uncomplicated UTI only) 1 1 5 17 17
Cefotaxime 1 2 5 21 18
Cefoxitin (screen) NA NA NA NA
Cefpodoxime (uncomplicated UTI only) 1 1 10 21 21
Ceftazidime 1 8 10 20 15
Ceftibuten (uncomplicated UTI only) 1 1 30 21 21
Ceftriaxone 1 2 30 23 20
Cefuroxime 82 8 30 18 18 2. The S/I breakpoint has been increased from 4 to 8 mg/L to avoid splitting the wild type MIC distributions of relevant
Enterobacteriacae. The breakpoint relates to a dosage of 1.5 g x 3 and to E. coli and Klebsiella spp only.
Cefuroxime axetil (uncomplicated UTI only) 8 8 30 18 18
Carbapenems MIC breakpoint Disk Zone diameter Notes

S≤ R> S≥ R<
Doripenem 1 4 10 24 18
Ertapenem 0.5 1 10 25 22
Imipenem 1 2 8 10 21 15 1. Proteus and Morganella species are considered poor targets for imipenem.
Meropenem 2 8 10 22 16
Monobactams MIC breakpoint Disk Zone diameter Notes

S≤ R> S≥ R<
Aztreonam 1 1 8 30 25 21 1. The aztreonam breakpoints for Enterobacteriaceae will detect resistance mediated by most ESBLs and other clinically
important beta-lactamases in Enterobacteriaceae. However, some strains that produce ESBLs appear susceptible or
intermediate with these breakpoints. For epidemiological or infection control purposes laboratories may want to use a test which
specifically screens for the presence of ESBLs.
Fluoroquinolones MIC breakpoint Disk Zone diameter Notes

S≤ R> S≥ R<
Ciprofloxacin1 0.5 1 5 22 19 1. Salmonella spp - there is clinical evidence for ciprofloxacin to indicate a poor response in systemic infections caused by
Salmonella spp with low-level fluoroquinolone resistance (MIC>0.064 mg/L). The available data relate mainly to S. typhi but
there are also case reports of poor response with other Salmonella species.
Levofloxacin 1 2 5 22 19
Moxifloxacin 0.5 1 5 20 17
Nalidixic acid (screen) 2 2 30 A A
Note Note 16 16 2/A. Nalidixic acid may be used to screen for fluoroquinolone resistance in Enterobacteriaceae. The zone diameter breakpoint
correlates to an MIC value of 16 mg/L in most Enterobacteriaceae. If Salmonella spp. are resistant report resistant to all
fluoroquinolones. If other Enterobacteriaceae are resistant, then test the agent in question.
Norfloxacin 0.5 1 10 22 19
Ofloxacin 0.5 1 5 22 19
Aminoglycosides1 MIC breakpoint Disk Zone diameter Notes

S≤ R> S≥ R<
1. Aminoglycoside breakpoints are based on once-daily administration of high aminoglycoside dosages. Most often
aminoglycosides are given in combination with beta-lactam agents.
Amikacin 8 16 30 16 13
Gentamicin 2 4 10 17 14
Netilmicin 2 4 10 15 12
Tobramycin 2 4 10 15 12
Macrolides, lincosamides and streptogramins MIC breakpoint Disk Zone diameter Notes
S≤ R> S≥ R<
Azithromycin
1 - - - - 1. Azithromycin has been used in the treatment of infections with Salmonella typhi (MIC ≤16 mg/L for wild type isolates) and
Shigella spp.
Tetracyclines MIC breakpoint Disk Zone diameter Notes

S≤ R> S≥ R<
Doxycycline - - - -
Minocycline - - - -
Tetracycline - - - -
Tigecycline1 1 2 15 18 15 1. The susceptible and resistant breakpoints were increased to avoid dividing wild type MIC distributions of relevant species.
Tigecycline has decreased activity against Morganella spp., Proteus spp. and Providencia spp.
Miscellaneous agents MIC breakpoint Disk Zone diameter Notes

S≤ R> S≥ R<
Chloramphenicol 8 8 30 17 17
Colistin 2 2 NoteA NoteA A. Test by MIC method only.
Daptomycin - - - -
Fosfomycin iv 32 32 - -
Fosfomycin-trometamol (uncomplicated UTI only) 32 32 - -
Fusidic acid - - - -
Linezolid - - - -
Metronidazole - - - -
Nitrofurantoin (uncomplicated UTI only) 64 64 100 11 11
Rifampicin - - - -
Spectinomycin - - - -
Trimethoprim (uncomplicated UTI only) 2 4 5 18 15
Trimethoprim-sulfamethoxazole (co-trimoxazole)2 2 4 1.25-23.75 16 13 2. Trimethoprim:sulfamethoxazole in the ratio 1:19. Breakpoints are expressed as the trimethoprim concentration.
Pseudomonas spp. EUCAST Clinical Breakpoint Table v. 1.0 2009-12-22
Penicillins MIC breakpoint Disk Zone diameter Notes

S≤ R> S≥ R<
Ampicillin - - - -
Ampicillin-sulbactam - - - -
Amoxicillin - - - -
Amoxicillin-clavulanate - - - -
Piperacillin1 16 16 30 19 19 1. Breakpoints are based on high dose therapy (with or without tazobactam, 4g x 4). The susceptible breakpoint was increased
from 4 to 8 mg/L to avoid dividing wild type MIC distributions.
Piperacillin-tazobactam
1,2 16 16 30-6 19 19 2. For susceptibility testing purposes, the concentration of beta-lactamase inhibitor is fixed at 4 mg/L.
Ticarcillin3 16 16 75 IP IP 3. Breakpoints are based on high dose therapy (with or without clavulanate, 3g x 4). The susceptible breakpoint was increased
from 8 to 16 mg/L to avoid dividing wild type MIC distributions.
Ticarcillin-clavulanate 2, 3 16 16 75-10 IP IP
Cephalosporins MIC breakpoint Disk Zone diameter Notes

S≤ R> S≥ R<
Cefaclor - - - -
Cefadroxil - - - -
Cefalexin - - - -
Cefazolin - - - -
Cefepime 81 8 30 18 18 1. The susceptible breakpoint has been increased from 4 to 8 mg/L to avoid dividing the MIC wild type distribution. The
breakpoints relate to high dose therapy (2 g x 3).
Cefixime - - - -
Cefotaxime - - - -
Cefoxitin NA NA NA NA
Cefpodoxime - - - -
Ceftazidime 81 8 10 16 16
Ceftibuten - - - -
Ceftriaxone - - - -
Cefuroxime - - - -
Cefuroxime axetil - - - -

S≤ R> S≥ R<
Ertapenem - - - -
Imipenem 41 8 10 20 17 1. The susceptible breakpoint was increased from 2 to 4 mg/L to avoid dividing the wild type MIC distribution. The breakpoints
relate to high dose, frequent therapy (1 g x 4).

S≤ R> S≥ R<
Aztreonam 1 161 30 50 16 1. The resistant breakpoint was increased from 8 to 16 mg/L to avoid dividing the wild type MIC distribution. The resistant
breakpoint relates to high dose therapy. The susceptible breakpoint is set to ensure that wild type isolates are reported
intermediate.

S≤ R> S≥ R<
Ciprofloxacin 0.5 1 5 25 22
Moxifloxacin - - - -
Nalidixic acid NA NA NA NA
Norfloxacin - - - -
Ofloxacin - - - -

S≤ R> S≥ R<
Amikacin 8 16 30 18 15
Gentamicin 42 4 10 15 15 2. The susceptible breakpoint was increased from 2 to 4 mg/L to avoid dividing the wild type MIC distribution.
Miscellaneous MIC breakpoint Disk Zone diameter Notes

S≤ R> S≥ R<
Chloramphenicol - - - -
Daptomycin - - - -
Fosfomycin iv1 32 32 NoteA NoteA 1. Intravenous fosfomycin may be used in combination with other drugs to treat Pseudomonas aeruginosa infections.
Fosfomycin-trometamol (uncomplicated UTI only) - - - -
Linezolid - - - -
Nitrofurantoin (uncomplicated UTI only) - - - -
Rifampicin - - - -
Trimethoprim (uncomplicated UTI only) - - - -
Trimethoprim-sulfamethoxazole (co-trimoxazole)2 43 43 1.25-23.75 IPB IPB 2. Trimethoprim:sulfamethoxazole in the ratio 1:19. Breakpoints are expressed as the trimethoprim concentration.
3/B. Stenotrophomonas maltophilia only.
Acinetobacter spp. EUCAST Clinical Breakpoint Table v. 1.0 2009-12-22

S≤ R> S≥ R<
1. Susceptibility testing of Acinetobacter spp. to penicillins is unreliable. In most instances Acinetobacter spp. are resistant to
penicillins.
Ampicillin - - - -
Ampicillin-sulbactam IE IE IE IE
Amoxicillin - - - -
Amoxicillin-clavulanate - - - -
Piperacillin IE IE IE IE
Piperacillin-tazobactam IE IE IE IE
Ticarcillin IE IE IE IE
Ticarcillin-clavulanate IE IE IE IE

S≤ R> S≥ R<
Ertapenem - - - -
Imipenem 2 8 10 23 17

S≤ R> S≥ R<
Aztreonam - - - -

S≤ R> S≥ R<
Ciprofloxacin 11 1 5 21 21 1. The susceptible breakpoint was increased from 0.5 to 1 mg/L to avoid dividing the wild type MIC distribution.
Moxifloxacin - - - -
Nalidixic acid
Norfloxacin - - - -
Ofloxacin - - - -

S≤ R> S≥ R<
Amikacin 8 16 30 18 15
Gentamicin 42 4 10 15 15 2. The susceptible breakpoint was increased from 2 to 4 mg/L to avoid dividing the wild type MIC distribution.

S< R> S≥ R<
Doxycycline - - - -
Minocycline IE IE IE IE
Tigecycline IE IE IE IE

S< R> S≥ R<
Daptomycin - - - -
Fosfomycin iv - - - -
Linezolid - - - -
Rifampicin - - - -
Staphylococcus spp. EUCAST Clinical Breakpoint Table v. 1.0 2009-12-22

S< R> S> R<
Benzylpenicillin 0.121,2 0.121,2 1 unit 26A,B 26A,B 1/A. Isolates without beta-lactamase and oxacillin/cefoxitin-susceptible are susceptible to all penicillins for which breakpoints
are given. The benzylpenicillin breakpoint will mostly, but not unequivocally, separate beta-lactamase producers from non-
producers. Most staphylococci are penicillinase-producers. Penicillinase-producing strains are resistant to benzylpenicillin,
phenoxymethylpenicillin, amino-, carboxy- and ureidopenicillins.
2/B. Isolates with methicillin resistance (oxacillin/cefoxitin resistant) are resistant to all currently available β-lactam agents,
including β-lactamase inhibitor combinations.
Ampicillin Note1,2 Note1,2 NoteA,B NoteA,B
Ampicillin-sulbactam Note1,2,3 Note1,2,3 NoteA,B,C NoteA,B,C 3/C. Isolates with beta-lactamase production but without methicillin (oxacillin/cefoxitin) resistance are susceptible to penicillin-
beta-lactamase inhibitor combinations and penicillinase-resistant penicillins (oxacillin, cloxacillin, dicloxacillin and flucloxacillin).
1,2 1,2 A,B A,B
Amoxicillin Note Note Note Note
Amoxicillin-clavulanate Note1,2,3 Note1,2,3 NoteA,B,C NoteA,B,C
Piperacillin Note1,2 Note1,2 NoteA,B NoteA,B
Piperacillin-tazobactam Note1,2,3 Note1,2,3 NoteA,B,C NoteA,B,C
1,2 1,2 A,B A,B
Ticarcillin Note Note Note Note
1,2,3 1,2,3 A,B,C A,B,C
Ticarcillin-clavulanate Note Note Note Note
Phenoxymethylpenicillin Note1,2 Note1,2 NoteA,B NoteA,B
Oxacillin2,3 Note1,2,3,4 Note1,2,3,4 NoteA,B,C NoteA,B,C 4. S. aureus and S. lugdunensis with oxacillin MIC values >2 mg/L are mostly methicillin resistant due to the presence of the
mecA gene. The corresponding oxacillin MIC for coagulase-negative staphylococci is >0.25 mg/L.
Cloxacillin Note1,2,3 Note1,2,3 NoteA,B,C NoteA,B,C
Dicloxacillin Note1,2,3 Note1,2,3 NoteA,B,C NoteA,B,C
Flucloxacillin Note1,2,3 Note1,2,3 NoteA,B,C NoteA,B,C
Mecillinam (uncomplicated UTI only) - - - -


S< R> S> R<
1. Susceptibility of staphylococci to cephalosporins is inferred from the methicillin susceptibility except for ceftazidime and
cefixime and ceftibuten, which do not have breakpoints and should not be used for staphylococcal infections.
Cefaclor2 Note1 Note1 NoteA NoteA 2. High-dose therapy is required for treatment of staphylococcal infections.
A. Susceptibility inferred from cefoxitin.
Cefadroxil Note1 Note1 NoteA NoteA
Cefalexin Note1 Note1 NoteA NoteA
Cefazolin Note1 Note1 NoteA NoteA
Cefepime Note1 Note1 NoteA NoteA
Cefixime - - - -
1 1 A A
Cefotaxime Note Note Note Note
3 3
Cefoxitin (screen) S.aureus, S.lugdunensis Note Note 30 22 22 3. S. aureus and S. lugdunensis with cefoxitin MIC values >4 mg/L are mostly methicillin resistant due to the presence of the
mecA gene whereas MIC for coagulase negative staphylococi other than S.lugdunensis is a poorer predictor of methicillin
resistance than the disk test.
Cefpoxitin (screen) Coagulase-negative staphylococci Note3 Note3 30 25 25
Cefpodoxime Note1 Note1 NoteA NoteA
Ceftazidime - - - -
Ceftibuten IE IE IE IE
1 1 A A
Ceftriaxone Note Note Note Note
Cefuroxime Note1 Note1 NoteA NoteA
Cefuroxime axetil Note1 Note1 NoteA NoteA
Carbapenems1 MIC breakpoint Disk Zone diameter Notes

S< R> S> R<
1/A. Susceptibility of staphylococci to carbapenems is inferred from the cefoxitin susceptibility.
Doripenem Note1 Note1 NoteA NoteA
Ertapenem Note1 Note1 NoteA NoteA
Imipenem Note1 Note1 NoteA NoteA
Meropenem Note1 Note1 NoteA NoteA
Fluoroquinolones1 MIC breakpoint Disk Zone diameter Notes

S< R> S> R<
1. For breakpoints for other fluoroquinolones (eg. pefloxacin and enoxacin) - refer to breakpoints determined by national
breakpoint committees.
Ciprofloxacin2 1 1 5 19 19 2. Breakpoints relate to high dose therapy.
Levofloxacin 1 2 5 IP IP
Norfloxacin (screen) NA NA 10 17A 17A A. Screen for fluoroquinolone resistance. Isolates categorized as susceptible can be reported susceptible to ciprofloxacin,
levofloxacin, moxifloxacin and ofloxacin. Isolates categorized as resistant should be tested for susceptibility to individual agents.
Ofloxacin
2 1 1 5 IP IP

S< R> S> R<
Amikacin2 8 16 30 18 15 2. Resistance to amikacin is most reliably determined by testing with kanamycin (zone diameter breakpoints under
development).
Gentamicin 1 1 10 18 18
Netilmicin 1 1 10 IP IP
Glycopeptides MIC breakpoint Disk Zone diameter Notes

S< R> S> R<
Teicoplanin, S. aureus, S.lugdunensis 21 21 NoteA NoteA 1. Staphylococcus aureus with vancomycin MIC values of 2 mg/L are on the border of the wild type MIC distribution and there
may be an impaired clinical response. The I/R breakpoint was reduced to 2 mg/L to avoid reporting "GISA" isolates
intermediate as serious infections with "GISA" isolates are not treatable with increased doses of vancomycin or teicoplanin.
Glycopeptide MICs are method dependent and should be determined by broth microdilution (reference ISO 20776 ).
A. Disk diffusion is unreliable and cannot distinguish between wild type organisms and those with non-vanA -mediated
resistance.
Teicoplanin, Coagulase-negative staphylococci 41 41 NoteA NoteA
1 1 1 A A
Vancomycin 2 2 Note Note
Macrolides1, lincosamides and streptogramins MIC breakpoint Disk Zone diameter Notes
S< R> S> R<
1/A. Erythromycin can be used to determine susceptibility to azithromycin, clarithromycin and roxithromycin.
Azithromycin1 1 2 NoteA NoteA
Clarithromycin1 1 2 NoteA NoteA
Erythromycin 1 2 15 21 18
1 2 A A
Roxithromycin1 Note Note
Telithromycin IE IE IE IE
Clindamycin2 0.25 0.5 2 21B 18B 2/B. Inducible clindamycin resistance can be detected only in the presence of a macrolide antibiotic. In disk diffusion tests look
for apparent antagonism of clindamycin by erythromycin (D-test).
Quinupristin-dalfopristin 1 2 15 NoteC NoteC C. Test by MIC method. Zone diameter breakpoints under development.
Tetracyclines1 MIC breakpoint Disk Zone diameter Notes

S< R> S> R<
Doxycycline 1 2 NoteA NoteA 1/A. Staphylococci susceptible to tetracycline are also susceptible to doxycycline and minocycline. Some staphylococci
resistant to tetracycline may be susceptible to minocycline and/or doxycycline.
Minocycline 0.5 1 30 IPA IPA
Tetracycline1 1 2 30 22 19
Tigecycline 0.52 0.5 15 18 18 2. Strains with MIC values above the S/I breakpoint are very rare or not yet reported. The identification and antimicrobial
susceptibility tests on any such isolate must be repeated and if the result is confirmed the isolate sent to a reference laboratory.
Until there is evidence regarding clinical response for confirmed isolates with MIC above the current resistant breakpoint (in
italics) they should be reported resistant.

S< R> S> R<
Colistin - - - -
Daptomycin 1 11 NoteA NoteA 1. Strains with MIC values above the susceptible breakpoint are very rare or not yet reported. The identification and
antimicrobial susceptibility tests on any such isolate must be repeated and if the result is confirmed the isolate sent to a
reference laboratory. Until there is evidence regarding clinical response for confirmed isolates with MIC above the current
resistant breakpoint they should be reported resistant.
A. Test by MIC method only.
Fosfomycin iv 32 32 NoteA NoteA
Fusidic acid 1 1 10 22 22
Linezolid 4 4 10 17 17
Rifampicin 0.06 0.5 5 25 22
Trimethoprim (uncomplicated UTI only) 2 4 5 17 14
Enterococcus spp. EUCAST Clinical Breakpoint Table v. 1.0 2009-12-22
Penicillins1,2 MIC breakpoint Disk Zone diameter Notes

S< R> S> R<
1. Refer to national or international endocarditis guidelines for breakpoints for Enterococcus spp. in endocarditis.
2. Enterococcus faecium resistant to penicillins can be considered resistant to all other beta-lactam agents including
carbapenems.
Ampicillin 4 8 2 10 8
Ampicillin-sulbactam 3 4 8 NoteA NoteA 3/A. Susceptibility to ampicillin and amoxicillin and pipercillin with and without beta lactamase inhibitor can be inferred from the
ampicillin susceptibility test.
Amoxicillin
3 4 8 NoteA NoteA
Amoxicillin-clavulanate 3 4 8 NoteA NoteA
Piperacillin3 Note3 Note3 NoteA NoteA
Piperacillin-tazobactam
3
Note3 Note3 NoteA NoteA
Ticarcillin4 - - - - 4. Enterococcus spp. are intrinsically resistant to ticarcillin with or without clavulanate.
Ticarcillin-clavulanate 4 - - - -

S< R> S> R<
Doripenem - - - -
Ertapenem - - - -
Imipenem 41 8 10 21 18
Meropenem - - - -
Aminoglycosides MIC breakpoint Disk Zone diameter Notes

S< R> S> R<
Amikacin1 - - NoteA NoteA 1/A. Aminoglycoside monotherapy is ineffective against enterococci. There is synergism between aminoglycosides and beta-
lactams against enterococci without acquired resistance mechanisms. There is no synergistic effect against enterococci with
high-level aminoglycoside resistance, i.e with gentamicin MIC>128 mg/L or an inhibition zone diameter <8 mm with a
gentamicin 30 mcg disk.
1 1 30 A A
Gentamicin1 Note Note Note Note
Netilmicin1 - - NoteA NoteA
Tobramycin1 - - NoteA NoteA

S< R> S> R<
Teicoplanin 21 2 30 16A 16A 1. The S/I breakpoint for vancomycin was raised to 4 mg/L to reduce division of the wild type MIC distributions of some
species. The I/R breakpoint for teicoplanin was reduced to 2 mg/L to avoid discrepant reporting of isolates with vanA -mediated
resistance.
A. Glycopeptide susceptible enterococci exhibit sharp zone edges. Suspect resistance when the zone edge is fuzzy or colonies
grow within the inhibition zone.
Some vanB isolates (vancomycin resistant, teicoplanin susceptible) are particularly difficult to detect with disk diffusion. An
alternative to disk diffusion is the agar screen method (Willey et al. J clin Microbiol 1992; 30: 1621-4) - BHI agar with
vancomycin 6 mg/L; inoculum 1-10uLspot of 0.5 McFarland density suspension: incubate in air at 35C for 24 h; >1 colony
indicates possible vancomycin resistance, which should be confirmed by MIC.
Vancomycin 1 4 5 A A
4 12 12
S< R> S> R<
Azithromycin - - - -
Clarithromycin - - - -
Erythromycin - - - -
Roxithromycin - - - -
Telithromycin - - - -
- -
Clindamycin - - - -
Quinupristin-dalfopristin1 1 4 15 NoteA NoteA 1. Quinopristin/dalfopristin breakpoints are valid for E. faecium only.
A. Test by MIC method. Zone diameter breakpoints under development.

S< R> S> R<
Doxycycline - - - -
Minocycline - - - -
Tigecycline 0.251 0.5 15 18 15 1. Strains with MIC values above the susceptible breakpoint are very rare or not yet reported. The identification and

S< R> S> R<
Colistin - - - -
Daptomycin IE IE IE IE
Rifampicin - - - -
Trimethoprim (uncomplicated UTI only)
1 0.03 1 5 50 21 1. The activity of trimethoprim is uncertain against enterococci, hence the wild type population is categorized as intermediate.
Trimethoprim-sulfamethoxazole (co-trimoxazole)2 0.03 1 1.25-23.75 50 21 2. Trimethoprim-sulfamethoxazole in the ratio 1:19. Breakpoints are expressed as the trimethoprim concentration.
Streptococcus groups A, B, C and G EUCAST Clinical Breakpoint Table v. 1.0 2009-12-22

S≤ R> S≥ R<
1/A. The beta-lactam susceptibility of beta-haemolytic streptococci groups A, B, C and G is inferred from the penicillin
susceptibility.
Benzylpenicillin2 0.25 0.25 1 unit 18 18 2. Strains with MIC values above the susceptible breakpoint are very rare or not yet reported. The identification and
Ampicillin 1 1 A A
Note Note Note Note
1 1 A
Ampicillin-sulbactam
3
Note Note Note NoteA 3. Streptococci groups A, B, C and G do not produce beta-lactamase. The addition of a beta-lactamase inhibitor does not add
clinical benefit.
Amoxicillin Note1 Note1 NoteA NoteA
3 1 1 A A
Amoxicillin-clavulanate Note Note Note Note
1 1 A
Piperacillin Note Note Note NoteA
Piperacillin-tazobactam 3 Note1 Note1 NoteA NoteA
Ticarcillin - - - -
Ticarcillin-clavulanate - - - -
Phenoxymethylpenicillin 1 1 A A
Note Note Note Note
Oxacillin (screen) NA NA NoteA NoteA

1 1 A
Cloxacillin Note Note Note NoteA
Dicloxacillin Note1 Note1 NoteA NoteA
Flucloxacillin 1 1 A A
Note Note Note Note

S≤ R> S≥ R<
1/A. The beta-lactam susceptibility of beta-haemolytic streptococci groups A, B, C and G is inferred from the penicillin
susceptibility.
Cefaclor Note1 Note1 NoteA NoteA
Cefadroxil Note1 Note1 NoteA NoteA
1 1 A
Cefalexin Note Note Note NoteA
1 1 A
Cefazolin Note Note Note NoteA
Cefepime 1 1 A A
Note Note Note Note
Cefixime - - - -
Cefotaxime Note1 Note1 NoteA NoteA
Cefpodoxime Note1 Note1 NoteA NoteA
Ceftazidime - - - -
Ceftibuten Note1 Note1 NoteA NoteA
1 1 A
Ceftriaxone Note Note Note NoteA
Cefuroxime 1 1 A A
Note Note Note Note
1 1 A
Cefuroxime axetil Note Note Note NoteA

S≤ R> S≥ R<
Doripenem 11 1 NoteA NoteA 1. Strains with MIC values above the susceptible breakpoint are very rare or not yet reported. The identification and
A. The beta-lactam susceptibility of beta-haemolytic streptococci groups A, B, C and G is inferred from the penicillin
susceptibility.
Ertapenem 0.51 0.5 NoteA NoteA
1 A
Imipenem 2 2 Note NoteA
Meropenem 21 2 NoteA NoteA

S≤ R> S≥ R<
Ciprofloxacin - - - -
Norfloxacin - - - -
Ofloxacin - - - -

S≤ R> S≥ R<
Teicoplanin 21 2 30 IPA IPA 1. Strains with MIC values above the susceptible breakpoint are very rare or not yet reported. The identification and
A. Zone diameter breakpoints are based on wild type distributions as there are currently no resistant isolates. There are
problems in detection of low level glycopeptide resistance with other organisms, where MIC methods have proved more reliable
than disk diffusion
Vancomycin 21 2 5 IPA IPA
S≤ R> S≥ R<
Azithromycin1 0.25 0.5 NoteA NoteA
Clarithromycin1 0.25 0.5 NoteA NoteA
Erythromycin 0.25 0.5 15 21 18
Roxithromycin1 0.5 1 NoteA NoteA
Telithromycin 0.25 0.5 15 IP IP
2 2 B B
Clindamycin 0.5 0.5 17 17 2/B. Inducible clindamycin resistance can be detected only in the presence of a macrolide antibiotic. In disk diffusion tests look
Quinupristin-dalfopristin - - - -

S≤ R> S≥ R<
Doxycycline1 1 2 NoteA NoteA 1/A. Isolates susceptible to tetracycline are also susceptible to doxycycline and minocycline. Some isolates resistant to
tetracycline may be susceptible to minocycline and/or doxycycline.
Minocycline1 0.5 1 30 IPA IPA
Tetracycline 1 2 30 23 20
Tigecycline 0.252 0.5 15 19 16 2. Strains with MIC values above the susceptible breakpoint are very rare or not yet reported. The identification and

S≤ R> S≥ R<
Chloramphenicol 8 8 30 IP IP
Colistin - - - -
Daptomycin 1 1 A A
1 Note Note 1. Strains with MIC values above the susceptible breakpoint are very rare or not yet reported. The identification and
resistant breakpoint (in italics) they should be reported resistant.
A. Test by MIC method only.
Fusidic acid IE IE IE IE
Rifampicin 0.06 0.5 5 21 15
Trimethoprim-sulfamethoxazole (co-trimoxazole)
2 1 2 1.25-23.75 18 15 2. Trimethoprim-sulfamethoxazole in the ratio 1:19. Breakpoints are expressed as the trimethoprim concentration.
Streptococcus pneumoniae EUCAST Clinical Breakpoint Table v. 1.0 2009-12-22

S≤ R> S≥ R<
1. Most MIC values for penicillin, ampicillin, amoxicillin and piperacillin (with or without a beta-lactamase inhibitor) differ by no
more than one dilution step and isolates fully susceptible to benzylpenicillin (MIC≤0.064 mg/L; susceptible by oxacillin disk
screen, see note A) can be reported susceptible to beta-lactam agents that have been given breakpoints.
A. Screen for beta-lactam resistance with the oxacillin 1 mcg disk. Isolates categorized as susceptible can be reported
susceptible to phenoxymethylpenicillin and to benzylpenicillin and aminopenicillins (with or without beta-lactamase inhibitor)
irrespective of clinical indication. Isolates categorized as oxacillin resistant can be reported resistant to phenoxymethylpenicillin
and to benzylpenicillin in meningitis. For other beta-lactams determine the MIC of the agent considered for clinical use.
Benzylpenicillin2 0.06 2 1 unit NoteA NoteA 2. In pneumonia, when a dose of 1.2 g x 4 is used, isolates with MIC ≤0.5 mg/L should be regarded as susceptible to
benzylpenicillin.
In pneumonia, when a dose of 2.4 g x 4 or 1.2 g x 6 is used, isolates with MIC ≤1 mg/L should be regarded as susceptible to
benzylpenicillin.
In pneumonia, when a dose of 2.4 g x 6 is used, isolates with MIC ≤2.0 mg/L should be regarded as susceptible.
In meningitis, only isolates with MICs ≤0.06 mg/L (susceptible by oxacillin disk screen, see note A) should be categorised
susceptible to benzylpenicillin, otherwise report resistant.
For other indications, use breakpoints of 0.06/2 mg/L for categorisation of benzylpenicillin susceptibility.
See note A.
Ampicillin1,3 0.5 2 2 28A,B 22A,B 3/B. Isolates fully susceptible to benzylpenicillin (MIC≤0.064 mg/L; susceptible by oxacillin disk screen, see note A) can be
reported susceptible to ampicillin, amoxicillin and piperacillin (with or without beta-lactamase inhibitor) without further testing.
Otherwise use ampicillin to categorize susceptibility to ampicillin, amoxicillin and piperacillin.
Ampicillin-sulbactam Note1,3 Note1,3 NoteA,B NoteA,B
Amoxicillin Note1,3 Note1,3 NoteA,B NoteA,B
1,3 1,3 A,B
Amoxicillin-clavulanate Note Note Note NoteA,B
Piperacillin Note1,3 Note1,3 Note
A,B
Note
A,B
Piperacillin-tazobactam Note1,3 Note1,3 NoteA,B NoteA,B

Ticarcillin - - - -
Ticarcillin-clavulanate - - - -
Phenoxymethylpenicillin4 Note4 Note4 NoteA,C NoteA,C 4/C. Isolates fully susceptible to benzylpenicillin (MIC≤0.064 mg/L; susceptible by oxacillin disk screen, see note A) can be
reported susceptible to phenoxymethylpenicillin. Otherwise report as phenoxymethylpenicillin resistant without further testing.
Oxacillin (screen) NA NA 1 18A 18A

Cloxacillin - - - -
Dicloxacillin - - - -
Flucloxacillin - - - -


S≤ R> S≥ R<
Cefaclor 0.03 0.5 30 50 28

Cefadroxil - - - -
Cefalexin - - - -
Cefazolin - - - -
Cefepime 1 2 30 32 29
Cefixime - - - -
Cefotaxime 1 2 A A
0.5 Note Note 1. Strains with MIC values above the susceptible breakpoint are very rare or not yet reported. The identification and
susceptible to cefepime, cefotaxime, cefpodoxime, ceftriaxone and cefuroxime+/-axetil.
Isolates categorized as oxacillin resistant should be tested by an MIC method with the agent considered for clinical use.
Cefpodoxime 0.25 0.5 10 28 25
Ceftazidime - - - -
Ceftibuten IE IE IE IE
Ceftriaxone 0.51 2 NoteA NoteA
A
Cefuroxime 0.5 1 Note NoteA
Cefuroxime axetil 0.25 0.5 A A
Note Note

S≤ R> S≥ R<
Doripenem 1 12 1 NoteA NoteA 1. Not for meningitis (meropenem is the only carbapenem used for meningitis).
2. Strains with MIC values above the susceptible breakpoint are very rare or not yet reported. The identification and
susceptible to doripenem, ertapenem, imipenem and meropenem. Isolates categorized as oxacillin resistant should be tested
by an MIC metod.
Ertapenem 1 0.52 0.5 NoteA NoteA
Imipenem 1 22 2 NoteA NoteA
Meropenem (infections other than meningitis)3 2 2 NoteA,B NoteA,B 3. Meropenem is the only carbapenem used for meningitis. Meropenem breakpoints in meningitis are S ≤0.25 mg/L, R>1
mg/L.
B. For use in meningitis determine the meropenem MIC.
Fluoroquinolones1 MIC breakpoint Disk Zone diameter Notes (numbers for comments on MIC breakpoints, letters for comments on disk diffusion)
(mg/L) content breakpoint (mm)
(µg)
S≤ R> S≥ R<
1/A. Screen for fluoroquinolone resistance using the norfloxacin disk. Isolates categorized as susceptible can be reported
susceptible to levofloxacin and moxifloxacin and intermediate to ciprofloxacin and ofloxacin. Isolates categorized as resistant
should be tested for susceptibility to individual agents.
Ciprofloxacin2 0.12 2 5 IPA IPA 2. Wild type S.pneumoniae are not considered susceptible to ciprofloxacin and are therefore categorized as intermediate.
3 2 2 5 A A
Levofloxacin 19 19 3. The breakpoints for levofloxacin relate to high dose therapy. The S/I breakpoint was increased from 1 to 2 mg/L to avoid
dividing the wild type MIC distribution.
Moxifloxacin 0.5 0.5 5 22A 22A
Norfloxacin (screen) NA NA 10 12A 12A
Ofloxacin4 0.12 4 5 50A 15A 4. Wild type S. pneumoniae are not considered susceptible to ofloxacin and are therefore categorized as intermediate. The
resistant breakpoint was increased from 1 to 4 mg/L to avoid dividing the wild type MIC distribution.

S≤ R> S≥ R<
Teicoplanin 21 2 30 IP IP
Vancomycin 21 2 5 15A 15A 1. Strains with MIC values above the susceptible breakpoint are very rare or not yet reported. The identification and
than disk diffusion
S≤ R> S≥ R<
Azithromycin1 0.25 0.5 NoteA NoteA 1/A. Erythromycin can be used to determine susceptibility to azithromycin, clarithromycin and roxithromycin.
A
Clarithromycin
1 0.25 0.5 Note NoteA
Clindamycin2 0.5 0.5 2 19B 19B 2/B. Inducible clindamycin resistance can be detected only in the presence of a macrolide antibiotic. In disk diffusion tests look

S≤ R> S≥ R<
1/A. Isolates susceptible to tetracycline are also susceptible to doxycycline and minocycline. Some isolates resistant to
Doxycycline1 1 2 NoteA NoteA
Minocycline1 0.5 1 30 NoteA NoteA


S≤ R> S≥ R<
Colistin - - - -
Daptomycin IE IE IE IE
Fosfomycin iv IE IE IE IE
Rifampicin 0.06 0.5 5 22 17
Other streptococci EUCAST Clinical Breakpoint Table v. 1.0 2009-12-22

S≤ R> S≥ R<
1. In endocarditis, refer to national or international endocarditis guidelines for breakpoints for viridans streptococci.
Benzylpenicillin 0.25 2 1 unit 18 12
Ampicillin 0.5 2 2 21 15 A. Use the ampicillin disk to categorize susceptibility to ampicillin, amoxicillin and piperacillin (with or without beta-lactamase
inhibitor).
Ampicillin-sulbactam Note1 Note1 NoteA NoteA
Amoxicillin 0.5 2 NoteA NoteA
Amoxicillin-clavulanate Note1 Note1 NoteA NoteA
1 1 A
Piperacillin Note Note Note NoteA
Piperacillin-tazobactam Note1 Note1 NoteA NoteA
Phenoxymethylpenicillin IE IE IE IE
Oxacillin - - - -
Cloxacillin - - - -
Dicloxacillin - - - -
Flucloxacillin - - - -

S≤ R> S≥ R<
Cefaclor - - - -
Cefadroxil - - - -
Cefalexin - - - -
Cefazolin 0.5 0.5 30 IP IP
Cefepime 0.5 0.5 30 25 25
Cefixime - - - -
Cefotaxime 0.5 0.5 5 23 23
Cefpodoxime - - - -
Ceftazidime - - - -
Ceftibuten - - - -
Ceftriaxone 0.5 0.5 30 27 27
Cefuroxime 0.5 0.5 30 26 26
Cefuroxime axetil - - - -

S≤ R> S≥ R<
Doripenem 11 1 10 25 25 1. Strains with MIC values above the susceptible breakpoint are very rare or not yet reported. The identification and
Ertapenem 0.51 0.5 10 22 22
Imipenem 21 2 10 30 30
Meropenem 21 2 10 25 25

S≤ R> S≥ R<
Ciprofloxacin - - - -
Levofloxacin IE IE IE IE
Moxifloxacin IE IE IE IE
Norfloxacin - - - -
Ofloxacin - - - -

S≤ R> S≥ R<
Teicoplanin 21 2 30 16A 16A 1. Strains with MIC values above the susceptible breakpoint are very rare or not yet reported. The identification and
than disk diffusion.
Vancomycin 21 2 5 15A 15A
S≤ R> S≥ R<
Azithromycin IE IE IE IE
Clarithromycin IE IE IE IE
Erythromycin IE IE IE IE
Roxithromycin IE IE IE IE
Telithromycin IE IE IE IE
Clindamycin1 0.5 0.5 2 19A 19A 1/A. Inducible clindamycin resistance can be detected only in the presence of a macrolide antibiotic. In disk diffusion tests look
Quinupristin-dalfopristin IE IE IE IE

S≤ R> S≥ R<
Doxycycline - - - -
Minocycline - - - -
Haemophilus influenzae EUCAST Clinical Breakpoint Table v. 1.0 2009-12-22

S≤ R> S≥ R<
Benzylpenicillin IE IE IE IE
Ampicillin1,2,3 1 1 2 16 16 1. Always test for beta-lactamase and report positive strains resistant to penicillins without beta-lactamase inhibitors.
2. Breakpoints relate only to beta-lactamase negative strains. Strains may be resistant to penicillins , aminopenicillins and/or
cephalosporins due to changes in PBPs (BLNAR, beta-lactamase negative ampicillin resistant) and a few strains have both
resistance mechanisms (BLPACR, beta-lactamase positive, amoxicillin/clavulanate resistant).
3. Isolates susceptible to ampicillin and amoxicillin are also susceptible to piperacillin and piperacillin-tazobactam and isolates
susceptible to amoxicillin-clavulanate are also susceptible to piperacillin-tazobactam.
Ampicillin-sulbactam 4 1 1 10-10 IP IP 4. For susceptibility testing purposes, the concentration of sulbactam is fixed at 4 mg/L.
Amoxicillin1,2,3 1 1 NoteA NoteA A. Susceptibility inferred from ampicillin.
Amoxicillin-clavulanate 1,2,3,5 1 1 20-10 20 20 5. For susceptibility testing purposes, the concentration of clavulanate is fixed at 2 mg/L.
Piperacillin Note3 Note3 NoteA NoteA
3 3 B
Piperacillin-tazobactam Note Note Note NoteB B. Susceptibility inferred from amoxicillin-clavulanate.
C
Phenoxymethylpenicillin (screen) IE IE 10 NA 15 C. Phenoxymethylpenicillin can be used to screen for but not to distinguish between beta-lactamase producing H. influenzae
and BLNAR. Check isolates categorised as resistant for beta-lactamase and non-beta-lactamase-mediated resistance to
ampicillin and/or cephalosporins. See "Cephalosporins, note A".

S≤ R> S≥ R<
Cefaclor 0.51 0.5 30 NA 15A 1. MIC-breakpoints render all H.influenzae resistant for cefaclor.
A. The disk diffusion test can be used to screen for BLNAR. Isolates with <15 mm should be checked for ampicillin and
cephalosporin resistance.
Cefadroxil - - - -
Cefalexin - - - -
Cefazolin - - - -
Cefepime 0.252 0.25 30 25 25 2. Strains with MIC values above the susceptible breakpoint are very rare or not yet reported. The identification and
Cefixime 0.122 0.12 5 22 22
Cefotaxime 0.122 0.12 5 22 22
Cefpodoxime 0.252 0.5 30 24 21
Ceftazidime - - - -
Ceftibuten 12 1 30 24 24
Ceftriaxone 0.122 0.12 30 27 27
Cefuroxime 1 2 30 25 22
Cefuroxime axetil 0.12 1 30 50 25

S≤ R> S≥ R<
Doripenem 1 12 1 10 20 20 1. Not for meningitis (meropenem is the only carbapenem used for meningitis).
2. Strains with MIC values above the susceptible breakpoint are very rare or not yet reported. The identification and
Ertapenem 1 0.52 0.5 10 20 20
Imipenem
1
22 2 10 16 16
Meropenem (infections other than meningitis)3 22 2 10 20A 20A 3. Meropenem is the only carbapenem used for meningitis. Meropenem breakpoints in meningitis are S ≤0.25 mg/L, R>1
mg/L.
A. For use in meningitis determine the meropenem MIC value.

S≤ R> S≥ R<
Aztreonam IE IE IE IE
Fluoroquinolones1,2 MIC breakpoint Disk Zone diameter Notes

S≤ R> S≥ R<
1. Low-level fluoroquinolone resistance (ciprofloxacin MICs of 0.12-0.5 mg/L) may occur but there is no evidence that this
resistance is of clinical importance in respiratory tract infections with H. influenzae.
Ciprofloxacin 0.52 0.5 5 23 23 2. Strains with MIC values above the susceptible breakpoint are very rare or not yet reported. The identification and
Moxifloxacin 0.52 0.5 5 23 23
Nalidixic acid (screen) NA NA 30 23 23A A. Screen for fluoroquinolone resistance. Isolates with zone diameters ≥23 mm can be reported susceptible to levofloxacin,
ciprofloxacin, moxifloxacin and ofloxacin. Isolates with zone diameters <23 mm may have fluoroquinolone resistance and
should be tested against the appropriate agent.
Norfloxacin - - - -
Ofloxacin 0.52 0.5 5 21 21

S≤ R> S≥ R<
Amikacin IE IE IE IE
Gentamicin IE IE IE IE
Netilmicin IE IE IE IE
Tobramycin IE IE IE IE
S≤ R> S≥ R<
Azithromycin1,2 0.12 4 NoteA NoteA 2. Correlation between macrolide MICs and clinical outcome is weak for H. influenzae . Therefore, breakpoints for macrolides
and related antibiotics were set to categorise wild type H. influenzae as intermediate.
Clarithromycin1,2 1 32 NoteA NoteA
Erythromycin 0.5 16 15 50 12
Roxithromycin1,2 1 16 NoteA NoteA
Telithromycin2 0.12 8 15 IP IP
Clindamycin - - - -

S≤ R> S≥ R<
Doxycycline1 1 2 NoteA NoteA 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.
Minocycline1 1 2 30 IPA IPA

S≤ R> S≥ R<
Colistin - - - -
Daptomycin - - - -
Linezolid - - - -
Rifampicin 0.5 0.5 5 18 18
Trimethoprim-sulfamethoxazole (co-trimoxazole)1 0.5 1 1.25-23.75 23 20 1. Trimethoprim:sulfamethoxazole in the ratio 1:19. Breakpoints are expressed as the trimethoprim concentration.
Moraxella catarrhalis EUCAST Clinical Breakpoint Table v. 1.0 2009-12-22

S≤ R> S> R<
Ampicillin1 1 1 10 IPA IPA 1/A. 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.
Ampicillin-sulbactam 2,3 1 1 10-10 IPB IPB 2. For susceptibility testing purposes, the concentration of sulbactam is fixed at 4 mg/L.
3/B. Susceptibility inferred from amoxicillin-clavulanate.
Amoxicillin1 1 1 10 IPA IPA
Amoxicillin-clavulanate 4 1 1 20-10 IPB IPB 4. For susceptibility testing purposes, the concentration of clavulanate is fixed at 2 mg/L.
Piperacillin1 IP IP 30 IPA IPA

Piperacillin-tazobactam 3 IP IP 30-6 IPB IPB

S≤ R> S> R<
Cefaclor 0.5 0.5 30 IP IP

Cefadroxil - - - -
Cefalexin - - - -
Cefazolin - - - -
Cefepime 1 30 IP IP
0.25 0.25 1. Strains with MIC values above the susceptible breakpoint are very rare or not yet reported. The identification and
Cefixime 0.51 1 5 IP IP
Cefotaxime 11 2 5 IP IP
Cefpodoxime 0.251 0.5 30 IP IP
Ceftazidime - - - -
Ceftibuten 11 1 30 IP IP
Ceftriaxone 11 2 30 IP IP
Cefuroxime 1 2 30 IP IP
Cefuroxime axetil 0.12 2 30 IP IP

S≤ R> S> R<
Doripenem 11 1 10 IP IP 1. Strains with MIC values above the susceptible breakpoint are very rare or not yet reported. The identification and
Ertapenem 0.51 0.5 10 IP IP
Imipenem 21 2 10 IP IP
Meropenem 21 2 10 IP IP

S≤ R> S> R<
Aztreonam IE IE IE IE
Fluoroquinolones1 MIC breakpoint Disk Zone diameter Notes

S≤ R> S> R<
1. Isolates with MIC values above the susceptible breakpoint are very rare or not yet reported. The identification and
Ciprofloxacin 0.51 0.5 5 23 23
Levofloxacin 11 1 5 IP IP
Moxifloxacin 0.51 0.5 5 IP IP
Norfloxacin - - - -
Ofloxacin 0.51 0.5 5 IP IP

S≤ R> S> R<
Amikacin IE IE IE IE
Gentamicin IE IE IE IE
Netilmicin IE IE IE IE
Tobramycin IE IE IE IE
S≤ R> S> R<
Azithromycin1 0.5 0.5 NoteA NoteA
Clarithromycin1 0.25 0.5 NoteA NoteA
Clindamycin - - - -

S≤ R> S> R<
Doxycycline1 1 2 NoteA NoteA 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.
30 A A
Minocycline1 1 2 IP IP

S≤ R> S> R<
Chloramphenicol 1 2 30 IP IP
Colistin - - - -
Daptomycin - - - -
Linezolid - - - -
Rifampicin 0.5 0.5 5 IP IP
Trimethoprim-sulfamethoxazole (co-trimoxazole)1 0.5 1 1.25-23.75 18 15 1. Trimethoprim:sulfamethoxazole in the ratio 1:19. Breakpoints are expressed as the trimethoprim concentration.
Disk diffusion criteria for antimicrobial susceptibility testing of Neisseria gonorrhoeae have not yet been determined.
Neisseria gonorrhoeae EUCAST Clinical Breakpoint Table v. 1.0 2009-12-22
Penicillins1 MIC breakpoint Notes

(mg/L) Numbers for comments on MIC breakpoints
Letters for comments on disk diffusion
S≤ R>
1. Always test for beta-lactamase. If positive, report resistant to benzylpenicillin, ampicillin and amoxicillin. The
susceptibility of beta-lactamase negative isolates to ampicillin and amoxicillin can be inferred from the susceptibility to
benzylpenicillin.
Benzylpenicillin 0.06 1
Ampicillin
1
Note1 Note1
Ampicillin-sulbactam IE IE
Amoxicillin1 Note1 Note1
1
Amoxicillin-clavulanate Note Note1
Piperacillin - -
Piperacillin-tazobactam - -
Ticarcillin - -
Ticarcillin-clavulanate - -
Phenoxymethylpenicillin - -
Cephalosporins MIC breakpoint Notes

S≤ R>
Cefaclor - -
Cefadroxil - -
Cefalexin - -
Cefazolin - -
Cefepime - -
Cefixime1 0.12 0.12 1. Neisseria gonorrhoeae without resistance mechanisms to cefixime have MICs of ≤0.06 mg/L and can be treated
with current standard dosing. The implications of alternative dosing schedules and recent data relating MIC to
outcome are under consideration.
Cefotaxime 0.12 0.12
Cefoxitin - -
Cefpodoxime IE IE
Ceftazidime - -
Ceftibuten IE IE
Ceftriaxone 0.12 0.12
Cefuroxime - -
Cefuroxime axetil - -
Carbapenems MIC breakpoint Notes

S≤ R>
Doripenem IE IE
Ertapenem IE IE
Imipenem IE IE
Meropenem IE IE
Monobactams MIC breakpoint Notes

S≤ R>
Aztreonam IE IE
Fluoroquinolones1 MIC breakpoint Notes

S≤ R>
Ciprofloxacin 0.03 0.06

Levofloxacin IE IE
Moxifloxacin IE IE
Nalidixic acid NA NA
Norfloxacin IE IE
Ofloxacin 0.12 0.25
Macrolides1, lincosamides and streptogramins MIC breakpoint Notes

S≤ R>
Azithromycin 0.25 0.5

Clarithromycin - -
Erythromycin - -
Roxithromycin - -
Telithromycin - -
Clindamycin - -
Quinupristin-dalfopristin - -
Tetracyclines1 MIC breakpoint Notes

S≤ R>
Doxycycline1 IE IE 1. Isolates susceptible to tetracycline are also susceptible to doxycycline and minocycline, but some resistant to
Minocycline1 0.5 1
Tetracycline 0.5 1
Tigecycline IE IE
Miscellaneous agents MIC breakpoint Notes

S≤ R>
Chloramphenicol - -
Colistin - -
Daptomycin - -
Fosfomycin iv - -
Fosfomycin-trometamol (uncomplicated UTI only) - -
Fusidic acid - -
Linezolid - -
Metronidazole - -
Nitrofurantoin (uncomplicated UTI only) - -
Rifampicin - -
Spectinomycin 64 64
Trimethoprim (uncomplicated UTI only) - -
Trimethoprim-sulfamethoxazole (co-trimoxazole) - -
Disk diffusion criteria for antimicrobial susceptibility testing of Neisseria meningitidis have not yet been determined.
Neisseria meningitidis EUCAST Clinical Breakpoint Table v. 1.0 2009-12-22
Penicillins MIC breakpoint Notes

S≤ R>
Benzylpenicillin 0.06 0.25

Ampicillin 0.12 1
Ampicillin-sulbactam IE IE
Amoxicillin 0.12 1
Amoxicillin-clavulanate - -
Piperacillin - -
Piperacillin-tazobactam - -
Ticarcillin - -
Ticarcillin-clavulanate - -
Phenoxymethylpenicillin - -
Cephalosporins MIC breakpoint Notes

S≤ R>
Cefaclor - -
Cefadroxil - -
Cefalexin - -
Cefazolin - -
Cefepime - -
Cefixime - -
Cefotaxime 0.121 0.12 1. Strains with MIC values above the susceptible breakpoint are very rare or not yet reported. The identification and
antimicrobial susceptibility tests on any such isolate must be repeated and if the result is confirmed the isolate sent to
a reference laboratory. Until there is evidence regarding clinical response for confirmed isolates with MIC above the
current resistant breakpoint they should be reported resistant.
Cefoxitin
Cefpodoxime - -
Ceftazidime - -
Ceftibuten - -
Ceftriaxone 0.121 0.12
Cefuroxime - -
Cefuroxime axetil - -

S≤ R>
Doripenem IE IE
Ertapenem - -
Imipenem - -
Meropenem 1 0.252 0.25 1. Strains with MIC values above the susceptible breakpoint are very rare or not yet reported. The identification and
antimicrobial susceptibility tests on any such isolate must be repeated and if the result is confirmed the isolate sent to
a reference laboratory. Until there is evidence regarding clinical response for confirmed isolates with MIC above the
current resistant breakpoint they should be reported resistant.
2. Breakpoints relate to meningitis only.
Fluoroquinolones MIC breakpoint Notes

S≤ R>
Ciprofloxacin 0.031 0.061 1. Breakpoints apply only to use in the prophylaxis of meningococcal disease.
Levofloxacin IE IE
Moxifloxacin IE IE
Norfloxacin - -
Ofloxacin IE IE
Tetracyclines MIC breakpoint Notes

S≤ R>
Doxycycline - -
Minocycline1 1 2 1. Tetracycline can be used to predict susceptibility to minocycline for prophylaxis against N. meningitidis infections.
Tetracycline 1 2
Tigecycline IE IE

S≤ R>
Chloramphenicol 2 4
Colistin - -
Daptomycin - -
Fosfomycin iv - -
Fusidic acid - -
Linezolid - -
Metronidazole - -
Rifampicin 0.25 0.25 1. For prophylaxis of meningitis only (refer to national guidelines).
Spectinomycin - -
Disk diffusion criteria for antimicrobial susceptibility testing of anaerobes have not yet been determined.
Gram-positive anaerobes EUCAST Clinical Breakpoint Table v. 1.0 2009-12-22

S≤ R>
Benzylpenicillin1 0.25 0.5 1. Susceptibility to ampicillin, amoxicillin and piperacillin without beta-lactamase inhibitors can be inferred from
susceptibility to benzylpenicillin.
Ampicillin 4 8
Ampicillin-sulbactam 4 8
Amoxicillin 4 8
Amoxicillin-clavulanate 4 8
Piperacillin 8 16
Piperacillin-tazobactam 8 16
Ticarcillin 8 16
Ticarcillin-clavulanate 8 16
Phenoxymethylpenicillin IE IE

S≤ R>
Doripenem 1 1
Ertapenem 1 1 1 1. The susceptible breakpoint was increased from 0.5 to 1 mg/L to avoid dividing wild type MIC distributions of
relevant species.
Imipenem 2 8
Meropenem 2 8

S≤ R>
Ciprofloxacin - -
Levofloxacin - -
Moxifloxacin IE IE
Norfloxacin - -
Ofloxacin - -
Glycopeptides MIC breakpoint Notes

S≤ R>
Teicoplanin - -
Vancomycin 2 2
Macrolides, lincosamides and streptogramins MIC breakpoint Notes

S≤ R>
Azithromycin - -
Clarithromycin - -
Erythromycin IE IE
Roxithromycin - -
Telithromycin - -
Clindamycin 4 4
Quinupristin/dalfopristin - -

S≤ R>
1. For anaerobic bacteria there is clinical evidence of activity in mixed intra-abdominal infections, but no correlation
between MIC values, Pk/Pd data and clinical outcome. Therefore no breakpoints for susceptibility testing are given.
Doxycycline1 Note1 Note1

Minocycline1 Note1 Note1
Tetracycline1 Note1 Note1
Tigecycline1 Note1 Note1

S≤ R>
Chloramphenicol 8 8
Colistin - -
Daptomycin - -
Fosfomycin iv - -
Fusidic acid - -
Linezolid - -
Metronidazole 4 4
Rifampicin - -
Spectinomycin - -
Disk diffusion criteria for antimicrobial susceptibility testing of anaerobes have not yet been determined.
Gram-negative anaerobes EUCAST Clinical Breakpoint Table v. 1.0 2009-12-22

S≤ R>
Benzylpenicillin1 0.25 0.5 1. Susceptibility to ampicillin, amoxicillin and piperacillin without beta-lactamase inhibitors can be inferred from
susceptibility to benzylpenicillin.
Ampicillin1 0.5 2
Ampicillin-sulbactam 1 4 8
Amoxicillin1 0.5 2
1 4 8
Amoxicillin-clavulanate
1 16 16
Piperacillin
Piperacillin-tazobactam 1 8 16
1
Ticarcillin 16 16
Ticarcillin-clavulanate 1 8 16

S≤ R>
Doripenem 1 1
Ertapenem 1 1 1 1. The susceptible breakpoint was increased from 0.5 to 1 mg/L to avoid dividing wild type MIC distributions of
relevant species.
Imipenem 2 8
Meropenem 2 8
Monobactams MIC breakpoint Notes

S≤ R>
Aztreonam - -

S≤ R>
Ciprofloxacin - -
Levofloxacin - -
Moxifloxacin IE IE
Norfloxacin - -
Ofloxacin - -
Macrolides, lincosamides and streptogramins MIC breakpoint Notes

S≤ R>
Azithromycin - -
Clarithromycin - -
Erythromycin IE IE
Roxithromycin - -
Telithromycin - -
Clindamycin 4 4
Quinupristin/dalfopristin - -

S≤ R>
1. For anaerobic bacteria there is clinical evidence of activity in mixed intra-abdominal infections, but no correlation
between MIC values, Pk/Pd data and clinical outcome. Therefore no breakpoints for susceptibility testing are given.
1 1 1
Doxycycline Note Note
1
Minocycline 1
Note Note1
Tetracycline1 Note1 Note1
Tigecycline1 Note1 Note1

S≤ R>
Chloramphenicol 8 8
Colistin - -
Daptomycin - -
Fosfomycin iv - -
Fusidic acid - -
Linezolid - -
Metronidazole 4 4
Rifampicin - -
Spectinomycin - -
Non-species related breakpoints EUCAST Clinical Breakpoint Table v. 1.0 2009-12-22
Penicillins MIC breakpoint

S≤ R>
Benzylpenicillin 0.25 2
Ampicillin 2 8
Ampicillin-sulbactam 2 8
Amoxicillin 2 8
Amoxicillin-clavulanate 2 8
Piperacillin 4 16
Piperacillin-tazobactam 4 16
Ticarcillin 8 16
Ticarcillin-clavulanate 8 16
Oxacillin IE IE
Cloxacillin IE IE
Dicloxacillin IE IE
Flucloxacillin IE IE
Mecillinam (uncomplicated UTI only) IE IE
Cephalosporins MIC breakpoint

S≤ R>
Cefaclor IE IE
Cefadroxil IE IE
Cefalexin IE IE
Cefazolin 1 2
Cefepime 4 8
Cefixime IE IE
Cefotaxime 1 2
Cefoxitin IE IE
Cefpodoxime IE IE
Ceftazidime 4 8
Ceftibuten IE IE
Ceftriaxone 1 2
Cefuroxime 4 8
Cefuroxime axetil IE IE
Carbapenems MIC breakpoint

S≤ R>
Doripenem 1 4
Ertapenem 0.5 1
Imipenem 2 8
Meropenem 2 8
Monobactams MIC breakpoint

S≤ R>
Aztreonam 4 8
Fluoroquinolones MIC breakpoint

S≤ R>
Ciprofloxacin 0.5 1
Levofloxacin 1 2
Moxifloxacin 0.5 1
Norfloxacin 0.5 1
Ofloxacin 0.5 1
Aminoglycosides MIC breakpoint

S≤ R>
Amikacin 8 16
Gentamicin 2 4
Netilmicin 2 4
Tobramycin 2 4
Glycopeptides MIC breakpoint

S≤ R>
Teicoplanin 2 4
Vancomycin 2 4
Macrolides, lincosamides and streptogramins MIC breakpoint

S≤ R>
Azithromycin IE IE
Clarithromycin IE IE
Erythromycin IE IE
Roxithromycin IE IE
Telithromycin IE IE
Clindamycin IE IE
Quinupristin/dalfopristin IE IE
Tetracyclines MIC breakpoint

S≤ R>
Doxycycline IE IE
Minocycline IE IE
Tetracycline IE IE
Tigecycline 0.25 0.5
Miscellaneous MIC breakpoint

S≤ R>
Chloramphenicol IE IE
Colistin IE IE
Daptomycin IE IE
Fosfomycin iv IE IE
Fosfomycin-trometamol (uncomplicated UTI only) IE IE
Fusidic acid IE IE
Linezolid 2 4
Metronidazole IE IE
Nitrofurantoin (uncomplicated UTI only) IE IE
Rifampicin IE IE
Spectinomycin IE IE
Trimethoprim (uncomplicated UTI only) IE IE
Trimethoprim-sulfamethoxazole (co-trimoxazole) IE IE

EUCAST Breakpoints v1.0 2009

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European Committee on Antimicrobial Susceptibility Testing

Breakpoint tables for interpretation of MICs and zone diameters

Penicillins1 MIC breakpoint Disk Zone diameter Notes

Mecillinam (uncomplicated UTI only) 8 8 10 15 15

Cephalosporins1 MIC breakpoint Disk Zone diameter Notes

Carbapenems MIC breakpoint Disk Zone diameter Notes

Monobactams MIC breakpoint Disk Zone diameter Notes

Fluoroquinolones MIC breakpoint Disk Zone diameter Notes

Aminoglycosides1 MIC breakpoint Disk Zone diameter Notes

Tetracyclines MIC breakpoint Disk Zone diameter Notes

Miscellaneous agents MIC breakpoint Disk Zone diameter Notes

Penicillins MIC breakpoint Disk Zone diameter Notes

Cephalosporins MIC breakpoint Disk Zone diameter Notes

Carbapenems MIC breakpoint Disk Zone diameter Notes

Monobactams MIC breakpoint Disk Zone diameter Notes

Fluoroquinolones MIC breakpoint Disk Zone diameter Notes

Aminoglycosides1 MIC breakpoint Disk Zone diameter Notes

Miscellaneous MIC breakpoint Disk Zone diameter Notes

Penicillins1 MIC breakpoint Disk Zone diameter Notes

Carbapenems MIC breakpoint Disk Zone diameter Notes

Monobactams MIC breakpoint Disk Zone diameter Notes

Fluoroquinolones MIC breakpoint Disk Zone diameter Notes

Aminoglycosides1 MIC breakpoint Disk Zone diameter Notes

Tetracyclines MIC breakpoint Disk Zone diameter Notes

Miscellaneous MIC breakpoint Disk Zone diameter Notes

Penicillins MIC breakpoint Disk Zone diameter Notes

Phenoxymethylpenicillin Note1,2 Note1,2 NoteA,B NoteA,B

Mecillinam (uncomplicated UTI only) - - - -

Cephalosporins1 MIC breakpoint Disk Zone diameter Notes

Carbapenems1 MIC breakpoint Disk Zone diameter Notes

Fluoroquinolones1 MIC breakpoint Disk Zone diameter Notes

Aminoglycosides1 MIC breakpoint Disk Zone diameter Notes

Glycopeptides MIC breakpoint Disk Zone diameter Notes

Tetracyclines1 MIC breakpoint Disk Zone diameter Notes

Miscellaneous MIC breakpoint Disk Zone diameter Notes

Penicillins1,2 MIC breakpoint Disk Zone diameter Notes

Carbapenems MIC breakpoint Disk Zone diameter Notes

Aminoglycosides MIC breakpoint Disk Zone diameter Notes

Glycopeptides MIC breakpoint Disk Zone diameter Notes

Tetracyclines MIC breakpoint Disk Zone diameter Notes

Miscellaneous MIC breakpoint Disk Zone diameter Notes

Penicillins1 MIC breakpoint Disk Zone diameter Notes

Oxacillin (screen) NA NA NoteA NoteA

Cephalosporins1 MIC breakpoint Disk Zone diameter Notes

Carbapenems MIC breakpoint Disk Zone diameter Notes

Fluoroquinolones MIC breakpoint Disk Zone diameter Notes

Glycopeptides MIC breakpoint Disk Zone diameter Notes

Tetracyclines1 MIC breakpoint Disk Zone diameter Notes

Miscellaneous agents MIC breakpoint Disk Zone diameter Notes

Penicillins1 MIC breakpoint Disk Zone diameter Notes

Piperacillin-tazobactam Note1,3 Note1,3 NoteA,B NoteA,B

Oxacillin (screen) NA NA 1 18A 18A

Mecillinam (uncomplicated UTI only) - - - -

Cephalosporins MIC breakpoint Disk Zone diameter Notes

Cefaclor 0.03 0.5 30 50 28

Carbapenems MIC breakpoint Disk Zone diameter Notes

Glycopeptides MIC breakpoint Disk Zone diameter Notes

Tetracyclines MIC breakpoint Disk Zone diameter Notes

Minocycline1 0.5 1 30 NoteA NoteA

Miscellaneous agents MIC breakpoint Disk Zone diameter Notes