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Antimicrobial susceptibility testing of Haemophilus influenzae, Branhamella catarrhalis, and Neisseria gonorrhoeae

During the last two decades, resistance to selected antimicrobial agents commonly used to treat infections caused by Haemophilus influenzae and Neisseria gonorrhoeae has become increasingly prevalent. In addition, during the last 10 years, information has accumulated which supports the role of Branhamella catarrhalis as the etiologic agent of a variety of human infections. It is now clear that most clinical isolates of B. catarrhalis produce 3-lactamase and are, therefore, possibly not susceptible to beta-lactam antimicrobial agents such as penicillin, ampicillin, and amoxicillin, agents often considered the drugs of choice for treating infections such as those with which B. catarrhalis is often associated. The recognition of antimicrobial resistance among these three organisms has led to a need for in vitro susceptibility test procedures and interpretive criteria for the results which reliably predict therapeutic outcome. Because of the fastidious nature of these three organisms, susceptibility testing procedures which effectively assess the in vitro activity of antimicrobial agents for rapidly growing bacteria are of questionable value. The intent of this review is to provide specific recommendations for in vitro susceptibility testing of H. influenzae, B. catarrhalis, and N. gonorrhoeae.