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Reevaluation of antibiotic breakpoints
1University of London, London, United Kingdom. iphillips@attglobal.net
Abstract:
Differences in antibiotic breakpoints have resulted from differences in clinical practice and in interpretation of the parameters that are considered when breakpoints are set. Differences in the first of these are less common for newer agents, whereas differences in the latter could be resolved by consensus discussions. Greater difficulty arises when common pathogens acquire resistance, especially when this occurs by degrees, as has happened with penicillin for gonococci and the pneumococci, and for the fluoroquinolones in relation to a wide variety of bacterial species. Changes to breakpoints under such circumstances should be introduced only after the most careful consideration and the education of diagnostic microbiologists and clinicians.
Insights
Antibiotic breakpoint variations stem from clinical practice and interpretation differences. Addressing these, especially with emerging pathogen resistance, requires careful consideration and education for microbiologists and clinicians.
Area of Science:
- Microbiology
- Pharmacology
- Clinical Science
Background:
- Antibiotic breakpoints vary due to differing clinical practices and interpretation of breakpoint-setting parameters.
- Discrepancies in clinical practice are less frequent for newer antimicrobial agents.
- Variations in parameter interpretation can potentially be resolved through consensus discussions.
Purpose of the Study:
- To analyze the reasons behind variations in antibiotic breakpoint setting.
- To discuss the challenges posed by evolving antimicrobial resistance in relation to breakpoints.
- To recommend a cautious approach for breakpoint adjustments.
Main Methods:
- Review of factors influencing antibiotic breakpoint determination.
- Analysis of historical and current trends in antimicrobial resistance.
- Examination of case studies involving resistance development (e.g., penicillin resistance in gonococci and pneumococci, fluoroquinolone resistance).
Main Results:
- Differences in breakpoint setting primarily arise from interpretation variations and, less commonly, from clinical practice differences.
- Emerging resistance in common pathogens, particularly gradual resistance, presents significant challenges.
- Specific examples include the development of penicillin resistance in Neisseria gonorrhoeae and Streptococcus pneumoniae, and broad-spectrum fluoroquinolone resistance.
Conclusions:
- Adjustments to antibiotic breakpoints necessitate careful deliberation.
- Comprehensive education for diagnostic microbiologists and clinicians is crucial before implementing breakpoint changes.
- A unified approach to breakpoint interpretation and resistance monitoring is essential for effective antimicrobial stewardship.