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  Table of Contents  
CORRESPONDENCE
Year : 2014  |  Volume : 32  |  Issue : 4  |  Page : 465-466
 

Azithromycin zone interpretation for Salmonella: Time to Adopt BSAC's zone diameters?


Department of Microbiology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India

Date of Submission03-Jul-2013
Date of Acceptance04-Feb-2014
Date of Web Publication4-Oct-2014

Correspondence Address:
S Rai
Department of Microbiology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0255-0857.142240

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How to cite this article:
Rai S. Azithromycin zone interpretation for Salmonella: Time to Adopt BSAC's zone diameters? . Indian J Med Microbiol 2014;32:465-6

How to cite this URL:
Rai S. Azithromycin zone interpretation for Salmonella: Time to Adopt BSAC's zone diameters? . Indian J Med Microbiol [serial online] 2014 [cited 2019 Sep 22];32:465-6. Available from: http://www.ijmm.org/text.asp?2014/32/4/465/142240


Dear Editor,

Clinical and Laboratory Standards Institutes (CLSI) does not mention breakpoint zone diameters or minimum inhibitory concentration (MIC) values for drugs like azithromycin and tigecycline against any member of family Enterobacteriaceae, therefore it is not possible to use M-100 S-22 document for zone interpretation for these antibiotics as used in the article published by Garg et al. [1],[2] The  British Society for Antimicrobial Chemotherapy (BSAC's) 2012 document nevertheless provides a zone diameter of ≤18 mm as resistant and ≥19 mm as resistant for a 15-μg azithromycin disc. [3] Even though, MIC breakpoints for azithromycin are not mentioned in this document, it has been stated that azithromycin has been used in the treatment of infections with  Salmonella More Details Typhi (MIC ≤16 mg/L for wild-type isolates) and some enteric infections. These breakpoints were unavailable before 2012, and therefore it was difficult for bacteriology laboratories to interpret results for azithromycin. With reference to the study published by Garg et al., in the previous issue, the MIC 90 value for azithromycin is not clear. [1] Among the 42 Salmonella isolates in their study, the MIC 90 would be that of the 38 th isolate in increasing order of MIC's, that is, 12 μg/mL, as per Garg et al., [Table 2]. [1] The MIC 90 in the study cited by them was twice the value (24 μg/mL) than their study. [4] However, the present authors have also augmented antibiotic recycling practices for treatment of enteric fever. Corroboration between both studies justifies cautious use of azithromycin for enteric fever in India and not to blindly follow its Western prescribing practices. With cautious use of azithromycin in S. Typhi in India and emergence of carbapenem-resistant Enterobacteriaceae, for which tigecycline is an effective drug, is it time to adopt BSAC zones for these two drugs?

 
 ~ References Top

1.Garg A, Verma S, Kanga A, Singh D, Singh B. Antimicrobial resistance pattern and in vivo activity of azithromycin in Salmonella isolates. Indian J Med Microbiol 2013;31:287-9.  Back to cited text no. 1
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2.Clinical and Laboratory Standards Institute. Performance Standards for Antimicrobial Susceptibility Testing, 22 nd Informational Supplement. Approved Standard. 22 nd ed. CLSI Document M 100-S22. Wayne: CLSI; 2012.  Back to cited text no. 2
    
3.British Standards for antimicrobial Chemotherapy. BSAC Methods for Antimicrobial Susceptibility Testing. Version 11.1. Approved Standard. Version 11.1 BSAC Document;  2012.  Back to cited text no. 3
    
4.Rai S, Jain S, Prasad KN, Ghoshal U, Dhole TN. Rationale of azithromycin prescribing practices for enteric fever in India. Indian J Med Microbiol 2012;30:30-3.  Back to cited text no. 4
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