Revision of fluoroquinolone breakpoints used for interpretation of antimicrobial susceptibility testing of canine bacterial isolates

The fluoroquinolone antimicrobial agents, enrofloxacin and marbofloxacin, were US Food and Drug Administration (FDA) approved in the United States for use in dogs in 1988 and 1999, respectively. There have been many advances since then concerning the pharmacokinetic-pharmacodynamic (PK-PD) evaluation of fluoroquinolones, and there are data available on the susceptibility of targeted pathogens since the original approval. Using this information, the Clinical and Laboratory Standards Institute (CLSI) Veterinary Antimicrobial Susceptibility Testing Subcommittee (VAST) revised its antimicrobial susceptibility testing breakpoints. The previous breakpoints (used in older editions of CLSI standards) for enrofloxacin in dogs were susceptible (S), <= 0.5 kig/mL, intermediate (I) 1-2 kig/mL, and resistant (R) >= 4 kig/mL. The new breakpoints are S <= 0.06 kig/mL for a dose of 5 mg/kg, 0.12 kig/mL for a dose of 10 mg/kg, 0.25 kig/mL for a high dose of 20 mg/kg, and R >= 0.5 kig/mL. The breakpoints of 0.12 and 0.25 kig/mL represent a new susceptible-dose dependent (SDD) category. For marbofloxacin, previous breakpoints were S, <= 1 kig/mL, I 2 kig/mL, and R >= 4 kig/mL. The new breakpoints are S <= 0.12 kig/mL for a dose of 2.8 mg/kg, 0.25 kig/mL for a dose of 5.5 mg/kg (SDD), and R >= 0.5 kig/mL. The new breakpoints will be published in the next edition of CLSI-Vet01(S) and deviate considerably from the prior breakpoints. Laboratories are encouraged to revise their testing standards. These changes will likely reduce the unnecessary use of these fluoroquinolones in dogs.