title: Reassessment of cefaclor breakpoints for Haemophilus influenzae.
abstract: We previously reported that standard methods overestimate cefaclor minimum inhibitory concentrations (MICs) for Streptococcus pneumoniae due to in vitro chemical instability. This study aimed to ascertain if standard methods accurately measure cefaclor MICs to Haemophilus influenzae. Cefuroxime was used as a comparator. Standard NCCLS broth microdilution and E-Test MICs were determined for eight isolates of H. influenzae. Kill curves determined the "bacteriostatic" MIC, defined as the concentration showing no significant growth or kill over six hours taking into account cefaclor instability. On average, cefaclor and cefuroxime bacteriostatic MICs were 0.2 x MIC and 0.6 x MIC determined by NCCLS methodology respectively. The mean MIC determined by NCCLS methodology was 3.0 mg/L for cefaclor and 0.8 mg/L for cefuroxime. Cefaclor MICs by NCCLS methodology were overestimated due to chemical instability over 18-24 hours. The bacteriostatic MICs by kill curve were not significantly different from those of cefuroxime.
authors.affiliation: Medical Microbiology Department, Aberdeen Royal Infirmary, Foresterhill, Aberdeen, AB25 2ZN Scotland, UK.
authors.forename: F M
authors.initials: FM
authors.lastname: MacKenzie
authors.forename: K E
authors.initials: KE
authors.lastname: Milne
authors.forename: I M
authors.initials: IM
authors.lastname: Gould
mesh_terms: D002433:Cefaclor / Q000494:pharmacology*; D002444:Cefuroxime / Q000494:pharmacology*; D024881:Drug Resistance, Bacterial; D006192:Haemophilus Infections / Q000175:diagnosis / Q000188:drug therapy; D006193:Haemophilus influenzae / Q000187:drug effects* / Q000302:isolation & purification*; D006801:Humans; D008826:Microbial Sensitivity Tests; D012494:Sampling Studies; D012680:Sensitivity and Specificity; D006113:United Kingdom
chemical_list: D002433:Cefaclor; D002444:Cefuroxime