Interpretive criteria and quality control parameters for testing of susceptibilities of Haemophilus influenzae and Streptococcus pneumoniae to trimethoprim and trimethoprim-sulfamethoxazole

Two hundred twenty-eight strains of Haemophilus influenzae and 234 strains of Streptococcus pneumoniae were tested by broth microdilution and disk diffusion methods for susceptibility to trimethoprim (TMP) and TMP-sulfamethoxazole (SMX) to evaluate proposed criteria. Data are presented to support the proposed TMP MIC breakpoints of less than or equal to 2.0 mu g/ml for susceptibility and greater than or equal to 4.0 mu g/ml for resistance for both species and TMP-SMX MIC breakpoints of less than or equal to 2.0-38 mu g/ml for susceptibility and greater than or equal to 4.0-76 mu g/ml for resistance. Corresponding zone diameter breakpoints for H. influenzae for both drugs are proposed: less than or equal to 10 mm = resistant; greater than or equal to 16 mm susceptible. A 10-laboratory study documented reproducibility of such tests with standard control strains. The following control limits are proposed for tests of H. influenzae ATCC 49247 against TMP: MIC, 0.12 to 0.5 mu g/ml; zone diameter, 27 to 33 mm. The current limits for TMP-SMX were confirmed, For tests of S. pneumoniae ATCC 49619, MICs of TMP were 1.0 to 4.0 mu g/ml and the current TMP-SMX MIC range was confirmed., Disk susceptibility tests of either drug against pneumococci were not reproducible, and consequently neither quality control limits nor interpretive criteria could be established. Endpoint interpretation and lot-to-lot variability in Mueller-Hinton agars were significant factors leading to interlaboratory variability.