MIC Results Form

[NCHHSTP] CDC Model Performance Evaluation Program (MPEP) for Mycobacterium tuberculosis Drug Susceptibility Testing

Att. 9-MIC Results Form

Minimum Inhibitory Concentration Reports

OMB: 0920-0600

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CDC Model Performance Evaluation Program (MPEP) for

Mycobacterium tuberculosis Drug Susceptibility Testing





Attachment 9

MPEP Mycobacterium tuberculosis Minimum Inhibitory

Concentration (MIC) Results Worksheet





MPEP Mycobacterium tuberculosis Minimum Inhibitory Concentration (MIC)

Results Worksheet

Enter your categorical drug susceptibility test result interpretation and minimum inhibitory concentration (MIC) for each isolate tested by Sensititre by using the data worksheet below. For laboratories who customize Sensititre plates, please use ‘Other’ for any additional antituberculosis drugs tested.

This worksheet is provided as a tool for recording results prior to online data entry.



MPEP Number                      Isolate           

Drug

Susceptible

Resistant

Intermediate

Contaminated/ No Growth

No Interpretation

Not Done

MIC (µg/ml)

Rifampin


Isoniazid


Ethambutol


Streptomycin


Ofloxacin


Ciprofloxacin


Moxifloxacin


Levofloxacin


Amikacin


Kanamycin


Capreomycin


Ethionamide


Rifabutin


Cycloserine


Para-aminosalicylic Acid


Rifapentine


Bedaquiline


Linezolid


Clofazimine


Delamanid


Pretomanid


Other: __________


Other: __________





File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorYakrus, Mitchell (CDC/OID/NCHHSTP)
File Modified0000-00-00
File Created2025-09-19

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