MPEP Mycobacterium tuberculosis Results Worksheet
Enter your drug susceptibility test results for each culture by using the data entry forms below. There is one form for entering conventional drug susceptibility results and another for entering molecular test results. You can either enter your results directly on the forms or print them out to enter results manually. Fill in other test concentrations used for each drug by using the open fields.
Drug Susceptibility Worksheet for Culture:
Drug |
Conc. μg/ml |
Resistant |
Susceptible |
Borderline |
Contaminated |
No Growth |
Not Done |
Rifampin |
1.00 |
|
|
|
|
|
|
Rifampin |
2.00 |
|
|
|
|
|
|
Rifampin |
|
|
|
|
|
|
|
Rifampin |
|
|
|
|
|
|
|
Isoniazid |
0.10 |
|
|
|
|
|
|
Isoniazid |
0.20 |
|
|
|
|
|
|
Isoniazid |
0.40 |
|
|
|
|
|
|
isoniazid |
1.00 |
|
|
|
|
|
|
Isoniazid |
|
|
|
|
|
|
|
Isoniazid |
|
|
|
|
|
|
|
Pyrazinamide |
100.00 |
|
|
|
|
|
|
Pyrazinamide |
300.00 |
|
|
|
|
|
|
Pyrazinamide |
|
|
|
|
|
|
|
Pyrazinamide |
|
|
|
|
|
|
|
Ethambutol |
2.50 |
|
|
|
|
|
|
Ethambutol |
5.00 |
|
|
|
|
|
|
Ethambutol |
7.50 |
|
|
|
|
|
|
Ethambutol |
|
|
|
|
|
|
|
Ethambutol |
|
|
|
|
|
|
|
Streptomycin |
1.00 |
|
|
|
|
|
|
Streptomycin |
2.00 |
|
|
|
|
|
|
Streptomycin |
4.00 |
|
|
|
|
|
|
Streptomycin |
10.00 |
|
|
|
|
|
|
Streptomycin |
|
|
|
|
|
|
|
Streptomycin |
|
|
|
|
|
|
|
Ethionamide |
2.00 |
|
|
|
|
|
|
Ethionamide |
5.00 |
|
|
|
|
|
|
Ethionamide |
4.00 |
|
|
|
|
|
|
Ethionamide |
10.00 |
|
|
|
|
|
|
Ethionamide |
|
|
|
|
|
|
|
Ethionamide |
|
|
|
|
|
|
|
Rifabutin |
0.50 |
|
|
|
|
|
|
Rifabutin |
|
|
|
|
|
|
|
Rifabutin |
|
|
|
|
|
|
|
Amikacin |
1.00 |
|
|
|
|
|
|
Amikacin |
4.00 |
|
|
|
|
|
|
Amikacin |
|
|
|
|
|
|
|
Amikacin |
|
|
|
|
|
|
|
Kanamycin |
5.00 |
|
|
|
|
|
|
Kanamycin |
6.00 |
|
|
|
|
|
|
Kanamycin |
|
|
|
|
|
|
|
Kanamycin |
|
|
|
|
|
|
|
Capreomycin |
1.25 |
|
|
|
|
|
|
Capreomycin |
2.50 |
|
|
|
|
|
|
Capreomycin |
10.00 |
|
|
|
|
|
|
Capreomycin |
|
|
|
|
|
|
|
Capreomycin |
|
|
|
|
|
|
|
Ciprofloxacin |
1.00 |
|
|
|
|
|
|
Ciprofloxacin |
2.00 |
|
|
|
|
|
|
Ciprofloxacin |
|
|
|
|
|
|
|
Ciprofloxacin |
|
|
|
|
|
|
|
Levofloxacin |
1.50 |
|
|
|
|
|
|
Levofloxacin |
|
|
|
|
|
|
|
Ofloxacin |
2.00 |
|
|
|
|
|
|
Ofloxacin |
|
|
|
|
|
|
|
Moxifloxacin |
0.25 |
|
|
|
|
|
|
Moxifloxacin |
0.50 |
|
|
|
|
|
|
Moxifloxacin |
|
|
|
|
|
|
|
Cycloserine |
30.00 |
|
|
|
|
|
|
Cycloserine |
60.00 |
|
|
|
|
|
|
Cycloserine |
|
|
|
|
|
|
|
Para-Amino Salicyclic Acid |
2.00 |
|
|
|
|
|
|
Para-Amino Salicyclic Acid |
8.00 |
|
|
|
|
|
|
Para-Amino Salicyclic Acid |
|
|
|
|
|
|
|
Molecular Results Worksheet for Culture:
Drug |
Resistant |
Susceptible |
No Result |
Not Done |
Rifampin |
|
|
|
|
Isoniazid |
|
|
|
|
Pyrazinamide |
|
|
|
|
Ethambutol |
|
|
|
|
Streptomycin |
|
|
|
|
Ethionamide |
|
|
|
|
Rifabutin |
|
|
|
|
Amikacin |
|
|
|
|
Kanamycin |
|
|
|
|
Capreomycin |
|
|
|
|
Ciprofloxacin |
|
|
|
|
Levofloxacin |
|
|
|
|
Ofloxacin |
|
|
|
|
Moxifloxacin |
|
|
|
|
Cycloserine |
|
|
|
|
Para-Amino Salicyclic Acid |
|
|
|
|
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Yakrus, Mitchell (CDC/OID/NCHHSTP) |
| File Modified | 0000-00-00 |
| File Created | 2021-01-25 |