MPEP Mycobacterium Tuberculosis Results

CDC Model Performance Evaluation Program (MPEP) for Mycobacterium tuberculosis and Nontuberculous Mycobacteria Drug Susceptibility Testing

MPEP M tuberculosis worksheet changes reflected

MPEP Mycobacterium Tuberculosis Results

OMB: 0920-0600

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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 Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorYakrus, Mitchell (CDC/OID/NCHHSTP)
File Modified0000-00-00
File Created2021-01-24

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