Proposed criteria for interpretation of susceptibilities of strains of Neisseria gonorrhoeae to ciprofloxacin, ofloxacin, enoxacin, lomefloxacin, and norfloxacin

Abstract

The susceptibilities of 45 strains of Neisseria gonorrhoeae, including 25 strains susceptible to ciprofloxacin (MICs, < or = 0.06 microgram/ml) and 20 strains exhibiting decreased susceptibilities to ciprofloxacin (MICs, > or = 0.125 microgram/ml), to ciprofloxacin, ofloxacin, enoxacin, lomefloxacin, norfloxacin, and nalidixic acid were determined by agar dilution and disk diffusion. On the basis of theoretical calculations of predicted susceptibilities at which infections may fail therapy (supported by observed failures of infections to respond to the therapeutic doses of enoxacin and ciprofloxacin), the Centers for Disease Control and Prevention has adopted the following agar dilution breakpoints for interpretation of resistance to these agents: MICs of > or = 1.0 microgram of ciprofloxacin, enoxacin, and norfloxacin per ml and MICs of > or = 2.0 micrograms of ofloxacin and lomefloxacin per ml. The corresponding disk diffusion breakpoints for these agents were as follows: ciprofloxacin, < or = 29 mm; ofloxacin, < or = 24 mm; enoxacin, < or = 31 mm; lomefloxacin, < or = 26 mm; and norfloxacin, < or = 32 mm. The Centers for Disease Control and Prevention recommends two strains as interim quality control strains for susceptibility testing of ciprofloxacin and ofloxacin. These are N. gonorrhoeae CDC-10,328 (MIC of ciprofloxacin, 0.125 to 0.25 microgram/ml [inhibition zone diameter range, 30 to 34 mm]; MIC of ofloxacin, 0.5 microgram/ml [inhibition zone diameter range, 27 to 32 mm]) and N. gonorrhoeae CDC-10,329 (MIC of ciprofloxacin, 1.0 to 2.0 micrograms/ml [zone inhibition diameter range, 21 to 26 mm]; MIC of ofloxacin 2.0 micrograms/ml [inhibition zone diameter range, 18 to 21 mm]).