Macrolides for treatment of Haemophilus ducreyi infection in sexually active adults.

BACKGROUND: Chancroid is a genital ulcerative disease caused by Haemophilus ducreyi. This microorganism is endemic in Africa, where it can cause up to 10% of genital ulcers. Macrolides may be an effective alternative to treat chancroid and, based on their oral administration and duration of therapy, could be considered as first line therapy. OBJECTIVES: To assess the effectiveness and safety of macrolides for treatment of H ducreyi infection in sexually active adults. SEARCH METHODS: We searched the Cochrane STI Group Specialized Register, CENTRAL, MEDLINE, Embase, LILACS, WHO ICTRP, ClinicalTrials.gov and Web of Science to 30 October 2017. We also handsearched conference proceedings and reference lists of retrieved studies. SELECTION CRITERIA: Randomized controlled trials (RCTs) comparing macrolides in different regimens or with other therapeutic alternatives for chancroid. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trials for inclusion, extracted data and assessed risk of bias. We resolved disagreements through consensus. We used the GRADE approach to assess the quality of the evidence. MAIN RESULTS: Seven RCTs (875 participants) met our inclusion criteria, of which four were funded by industry. Five studies (664 participants) compared macrolides with ceftriaxone, ciprofloxacin, spectinomycin or thiamphenicol. Low quality evidence suggested there was no difference between the groups after treatment in terms of clinical cure (risk ratio (RR) 1.09, 95% confidence interval (CI) 0.97 to 1.21; 2 studies, 340 participants with syndromic approach and RR 1.06, 95% CI 0.98 to 1.15; 5 studies, 348 participants with aetiological diagnosis) or improvement (RR 0.89, 95% CI 0.52 to 1.52; 2 studies, 340 participants with syndromic approach and RR 0.80, 95% CI 0.42 to 1.51; 3 studies, 187 participants with aetiological diagnosis). Based on low and very low quality evidence, there was no difference between macrolides and any other antibiotic treatments for microbiological cure (RR 0.93, 95% CI 0.74 to 1.16; 1 study, 45 participants) and minor adverse effects (RR 1.34, 95% CI 0.24 to 7.51; 3 studies, 412 participants).Two trials (269 participants) compared erythromycin with any other macrolide type. Low quality evidence suggested that, compared with azithromycin or rosaramicin, long courses of erythromycin did not increase clinical cure (RR 1.00, 95% CI 0.91 to 1.10; 2 studies, 269 participants with syndromic approach and RR 1.04, 95% CI 0.93 to 1.16; 2 studies, 211 participants with aetiological diagnosis), with a similar frequency of minor adverse effects between the groups (RR 1.14, 95% CI 0.63 to 2.06; 1 trial, 101 participants). For this comparison, subgroup analysis found no difference between HIV-positive participants (RR 1.02, 95% CI 0.73 to 1.43; 1 study, 38 participants) and HIV-negative participants (RR 1.04, 95% CI 0.94 to 1.14; 1 study, 89 participants). We downgraded the quality of evidence to low, because of imprecision, some limitations on risk of bias and heterogeneity.None of the trials reported serious adverse events, cost effectiveness and participant satisfaction. AUTHORS' CONCLUSIONS: At present, the quality of the evidence on the effectiveness and safety of macrolides for treatment of H ducreyi infection in sexually active adults is low, implying that we are uncertain about the estimated treatment effect. There is no statistically significant difference between the available therapeutic alternatives for the treatment of sexually active adults with genital ulcers compatible with chancroid. Low quality evidence suggests that azithromycin could be considered as the first therapeutic alternative, based on their mono-dose oral administration, with a similar safety and effectiveness profile, when it is compared with long-term erythromycin use.Due to sparse available evidence about the safety and effectiveness of macrolides to treat H ducreyi infection in people with HIV, these results should be taken with caution.

[Experimental study of cardioprotective and endothelioprotective action of macrolides and azalides].

The cardioprotective and endothelioprotective effects of the macrolide antibiotics roxithromycin, azythromycin, and midecamycin have been studied on laboratory animals with models of the coronaro-occlusional myocardial infarction and endothelial dysfunction. The drugs led to a dose-dependent decrease in lethality, reduced the zone of necrosis of the left ventricle after coronary occlusion, and produced a positive effect on the functioning of endothelium.

[Skin needle embedding for obese impaired glucose tolerance].

OBJECTIVE: To explore the effect difference between the skin needle embedding therapy and western medication for obese impaired glucose tolerance (IGT). METHODS: A total of 300 cases of obese IGT were assigned into an embedding group and a western medication group by random number table, 150 cases in each one. Standardized diagnosis and treatment programs were applied to reduce blood pressure, lipid, weight, and exercise and scientific diet management were used. 0.25 g oral deltamine was prescribed three times a day in the western medication group. Thumb-tack needle for subcutaneous embedding was at bilateral Weiwanxiashu (EX-B 3), Ganshu (BL 18), Pishu (BL 20), Tianshu (ST 25) and Zusanli (ST 36) for 36 to 48 hours on Monday and Thursday, 3 months as a session, with other acupoints differentiated. All the treatment was given for 2 years. The indexes included the blood sugar indexes [fasting plasma glucose (FPG), 2 h postprandial blood glucose (2 h PG), glycosylated hemoglobin (HbA1c)], incidence of hypoglycemia, obesity indexes [waist circumference, body mass index (BMI)], blood lipid indexes [serum total cholesterol (TC), serum triacylglycerol (TG), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C)], liver and kidney function indexes [serum creatinine (Scr), blood urea nitrogen (BUN) and blood uric acid (UA), glutamic-pyruvic transaminase (ALT)] and TCM symptom score. The effects and the incidence of type 2 diabetes were evaluated. RESULTS: After treatment, 2 h PG and HbA1c reduced in the two groups (P<0.01, P<0.05) and the results in the embedding group were better (both P<0.05). After treatment, the incidence of hypoglycemia in the embedding group was 0.7% (1/150), and that in the western medication group was 1.3% (2/150), without statistical difference (P>0.05). After treatment, waist circumference and BMI reduced in the two groups (both P<0.01) and the improvements in the embedding group were better (both P<0.05). TC, TG and LDL-C after treatment were lower than those before treatment, and HDL-C were higher in the two groups (all P<0.05), without statistical different values before and after treatment between the two groups (all P>0.05). Scr, BUN, UA and ALT before and after treatment in the two groups had no statistical difference (all P>0.05), without statistical difference after treatment between the two groups (all P>0.05). The TCM score after treatment was lower than that before treatment in the embedding group (P<0.05), and the difference was not statistical in the western medication group (P>0.05). The different value of TCM score in the embedding group was better than that in the western medication group (P<0.01). The total effective rate in the embedding group was 98.0% (147/150), which was superior to 92.7% (139/150) in the western medication group (P<0.05). The incidence of type 2 diabetes was 2.0% (3/150) in the embedding group, and that was better than 7.3% (11/150) in the western medication group (P<0.05). CONCLUSION: Thumb-tack needle for subcutaneous embedding for 2 years could apparent improve the indexes of IGT, which is better than western medication, without liver and kidney damage.

Synthesis and copper-dependent antimycoplasmal activity of 1-amino-3-(2-pyridyl)isoquinoline derivatives. 1. Amides.

In order to investigate the antimycoplasmal activity of compounds structurally related to 2,2'-bipyridyl, a series of both aliphatic and aromatic amides derived from 1-amino-3-(2-pyridyl)isoquinoline were synthesized. The most active compounds appeared to be as active as Tylosin, an antimycoplasmal therapeutic that is used in veterinary practice, in the presence of a small nontoxic amount of copper. Furthermore, it was found that antimycoplasmal activity depends on the hydrophobic fragmental value of amide residue. A quantitative structure-activity relationship established the optimal hydrophobic fragmental value of the amide residue to be 0.30.

Comparative effects of cotrimoxazole (trimethoprim-sulphamethoxazole), pyrimethamine-sulphadiazine and spiramycin during avirulent infection with Toxoplasma gondii (Beverley strain) in mice.

The antitoxoplasm effects of cotrimoxazole (Ctx), spiramycin (Spir) and pyrimethamine-sulphadiazine (Pmm-Sdz) were compared during both proliferative and chronic phases of infection of mice with the Beverley (Bev) strain of Toxoplasma gondii of low virulence. The therapeutic efficacy of the drugs was determined according to the following criteria: (i) specific antibody response; (ii) acquired resistance to lethal challenge with the virulent RH strain of Toxoplasma; and (iii) persistence of parasites in tissues (brain, liver, spleen) of treated mice. The results indicated that Ctx, like Pmm-Sdz, had a greater effect than Spir upon toxoplasma organisms during the proliferative phase of infection. In contrast, none of the three drugs tested was active against tissue cysts in chronically infected mice.

Comparative effects of cotrimoxazole (trimethoprim-sulphamethoxazole) and spiramycin in pregnant mice infected with Toxoplasma gondii (Beverley strain).

The effects of cotrimoxazole (CTX) and spiramycin (Spir) in mice infected in midpregnancy with the Beverley (Bev) strain of Toxoplasma gondii were compared. Therapeutic effectiveness was determined according to the following parameters: rate of successful delivery, litter size, offspring weight and survival. When compared with the uninfected untreated control group, CTX showed a more beneficial therapeutic effect than Spir, with a statistically significant increase in the rate of both successful delivery and offspring survival. Results based on antitoxoplasma antibody determinations in the offspring indicated a better in utero control of congenital infection by CTX than by Spir.

Roxithromycin. A review of its antibacterial activity, pharmacokinetic properties and clinical efficacy.

Roxithromycin is an acid-stable orally administered antibacterial macrolide structurally related to erythromycin. It has an in vitro antibacterial profile similar to that of erythromycin, with activity against Staphylococcus aureus, S. epidermidis, Streptococcus pneumoniae, S. pyogenes, Branhamella catarrhalis, Mycoplasma pneumoniae, Legionella pneumophila, Chlamydia trachomatis, Gardnerella vaginalis, Haemophilus ducreyi, some anaerobes and other less common pathogens. Roxithromycin has a pharmacokinetic profile that is characterised by excellent enteral absorption achieving high concentrations in most tissues and body fluids. The results of clinical studies with roxithromycin have confirmed the potential for its use in a variety of infections, which was suggested by its antibacterial activity in vitro and pharmacokinetic profile. Clinical efficacy has been confirmed in the treatment of respiratory tract infections, including community-acquired and atypical pneumonias, ear, nose and throat infections, genitourinary tract infections, and skin and soft tissue infections. In a relatively small number of patients roxithromycin has generally been shown to be as effective as erythromycin and other appropriate antibacterial drugs in some of the above indications. Roxithromycin is well tolerated and has less potential than erythromycin to produce clinically significant drug interactions. Thus, roxithromycin is an orally active drug which should prove a useful alternative when selecting antibacterial therapy for indications where macrolides are appropriate.

Penicillins and macrolides in the treatment of community-acquired respiratory tract infections.

The use of penicillins and macrolides in the management of community-acquired respiratory tract infections is evaluated in relation to such factors as antimicrobial activity, stability, pharmacokinetics and adverse reactions. Attention is directed to the side effects of drugs, e.g. to the clear advantages of 16 (e.g. spiramycin) vs. 14 (e.g. erythromycin)-membered ring macrolides, and examples are drawn to illustrate the tactics of antimicrobial therapy in the management of pneumonias.

Spiramycin vs. placebo for treatment of acute diarrhea caused by Cryptosporidium.

The efficacy of spiramycin was evaluated in a double blind, placebo-controlled study of 44 immunocompetent infants ages 2 to 13 months who had acute diarrhea caused by Cryptosporidium. Twenty-one patients received spiramycin (100 mg/kg/day) for 10 days and 23 received placebo. On admission the patients in both groups were comparable regarding demographic and clinical characteristics. The infants who were treated with spiramycin had a shorter duration of diarrhea (mean, 5.2 vs. 7.3 days; P = 0.002) and a shorter duration of excretion of oocysts in the stools (7.1 vs. 8.5 days; P = 0.032) compared with those treated with placebo. No clinical or parasitologic relapses were seen in patients of both groups. Mild adverse effects to spiramycin were observed in 2 patients (10%). Spiramycin appeared to hasten clinical recovery and decrease the duration of oocyst excretion in immunocompetent children with diarrheal illness caused by Cryptosporidium.

Five drug regimens for treatment of acute toxoplasmosis in squirrel monkeys.

Five drug regimens for the treatment of acute toxoplasmosis were compared in a monkey model. Systemic disease that is almost always fatal in squirrel monkeys within 7-9 days was produced by oral inoculation of a brain suspension made from mice chronically infected with the Beverly strain of Toxoplasma gondii. All untreated controls died of toxoplasmosis (6/6) while treatment gave the following results: sulfamethoxazole, 0/3; spiramycin, 5/5; clindamycin/sulfadiazine (CLD/SLD), 0/4; pyrimethamine/sulfadiazine (PYR/SLD), 0/5; trimethoprim/sulfamethoxazole (TMP/SMZ), 0/4. Three of the five monkeys treated with CLD/SLD died during or shortly after the experiment from probable CLD toxicity. Sulfonamides alone or in combination with PYR or TMP were significantly more effective than spiramycin in treating toxoplasmosis in this model. The dose regimen used in this study did not allow us to determine if the addition of PYR or TMP changed the protection of sulfa alone.

Enteric coccidiosis among patients with the acquired immunodeficiency syndrome.

Ten patients were identified at Jackson Memorial hospital/University of Miami Hospitals and Clinics with enteric coccidial infection due to Cryptosporidium spp. or Isospora belli. All had the acquired immunodeficiency syndrome as manifested by Kaposi's sarcoma or multiple opportunistic infections, or both. They presented with profuse diarrhea associated with weakness, anorexia, and weight loss. Routine examinations of stools for eggs and parasites as performed by the hospital laboratory were negative in all patients. Sugar flotation and modified acid fast techniques were used in the Tropical Disease Laboratory to identify oocysts of Cryptosporidium spp. in stools of seven patients. Malabsorption, characterized by a low 5-hour D-xylose and positive fecal fat, was observed in 6/6 of these patients. In three other patients Isospora belli oocysts were identified in stool specimens or via a duodenal string test. Spiramycin was the only drug found to be effective in treating patients with cryptosporidiosis. Patients with Isospora belli responded to a prolonged course of trimethoprim-sulfamethoxazole.

Pharmacokinetics of a new macrolide, roxithromycin, in infants and children.

The pharmacokinetics of roxithromycin was investigated after oral administration of 2.5 mg/kg doses given 12 hours apart during 6 days in infants and children. These 18 subjects suffering from a respiratory tract infection were divided into three age groups: group I less than 18 months, group II less than 5 years, group III less than 13 years. At day 6, the elimination plasma half-life had an average value (mean +/- SD) of 19.8 +/- 9.7 h (group I), 21.0 +/- 9.4 h (group II) and 20.8 +/- 6.9 h (group III), respectively. The maximum concentration of roxithromycin (Cmax) was attained between 1 and 2 hours after dosing with mean values of 10.1 +/- 3.0 mg/l (group I), 8.7 +/- 4.9 mg/l (group II), 8.8 +/- 7.0 mg/l (group III). All the calculated pharmacokinetic parameters did not significantly differ from one group to another. The kinetics of roxithromycin in infants and children seemed to be age independent and showed no accumulation after repeated doses. During 12 hours, the plasma concentrations were above MIC of microorganisms generally present in respiratory tract infections. Two daily doses of 2.5 mg/kg of roxithromycin 12 hours apart may be proposed in infants and children.

Pathogenicity of capsulate and non-capsulate members of Bacteroides fragilis and B. melaninogenicus groups in mixed infection with Escherichia coli and Streptococcus pyogenes.

The relationships between capsulate and non-capsulate Bacteroides fragilis strains and Escherichia coli, and between capsulate and non-capsulate strains of the B. melaninogenicus group and Streptococcus pyogenes, were studied in a subcutaneous abscess model in mice. Selective antimicrobial agents directed against either aerobic or anaerobic bacteria were used alone or in combination to explore the effect of eradication of one component of the mixed infection. Single agent therapy effective against both aerobic and anaerobic flora was also employed. Single therapy of mixed infection directed at the elimination of only one organism (S. pyogenes, E. coli or Bacteroides sp.) caused significant reductions in the numbers of sensitive organisms and also smaller yet significant decreases in the numbers of insensitive organisms. However, the abscesses were not eliminated after such therapy. Combination therapy or use of a single agent (cefoxitin) directed against the aerobic and anaerobic components of the infection was more effective. Non-capsulate Bacteroides spp. became capsulate after passage in mice mixed with either S. pyogenes or E. coli. Therapy directed at the elimination of S. pyogenes and E. coli did not prevent the emergence of capsulate Bacteroides spp. These data demonstrate the synergy between all members of the B. fragilis group and E. coli and between the B. melaninogenicus group and S. pyogenes, and reiterate the need to direct antimicrobial therapy at the eradication of the aerobic and anaerobic components of mixed infections.

Current concepts in antimicrobial therapy of prostatitis.

Acute prostatitis usually is caused by aerobic gram-negative organisms or, to a lesser extent, the enterococci. The treatment of acute prostatitis requires the use of an antimicrobial with the appropriate spectrum for ten to fourteen days. However, treatment of chronic prostatitis is a more difficult therapeutic problem because of the relative impermeability of the noninflamed prostate to the majority of antimicrobial agents. The organisms most commonly responsible for chronic prostatitis include the aerobic gram-negative organisms, as well as chlamydia. Chlamydia may be the sole pathogens, or may be found as a copathogen with gram-negative organisms. Relatively few antibiotics have the appropriate physiochemical characteristics to penetrate the subacutely inflamed prostate. The most important determinant of tissue penetration in chronic prostatitis is the lipid solubility of the antibiotic, to a lesser extent its pKa (ionization potential), and the molecular size of the antibiotic. In general, penicillins, cephalosporins, and aminoglycosides do not penetrate well into the chronically inflammed prostate tissue. At the present time, the preferred agents in treating chronic prostatitis are trimethoprim or doxycycline. Doxycycline has the advantage of being active against chlamydia as well as the usual organisms that are responsible for chronic prostatitis. Therapy should be continued for two to three months.

A comparative study of spiramycin and erythromycin in acute tonsillo-pharyngitis.

In a clinical and bacteriological study of 42 patients with acute tonsillo-pharyngitis or chronic tonsillo-pharyngitis with acute exacerbation, patients were allocated at random to receive either a 3-day course of spiramycin or a 5-day course of erythromycin, both antibiotics being given in a dosage of 500 mg 3-times daily. The median time to disappearance of patient complaints such as fever, difficulty in swallowing, sore throat, cough and mucus was 3 days in each group and there was a significant reduction from pre-treatment to normal levels in total white cell count and erythrocyte sedimentation rate after treatment. Although more patients were considered to have shown a good clinical response to spiramycin, the difference was not statistically significant. From a bacteriological point of view, however, treatment with the regimen used was considered a failure in all cases in that neither antibiotic completely eradicated the pathogens identified at the start of treatment even though, with 3 exceptions, all of the micro-organisms were shown to be sensitive to the antibiotics before and after treatment. Few side-effects were reported in either group.

Treatment of acute tonsillo-pharyngitis: a comparative study of spiramycin and erythromycin.

A comparative study was carried out to determine the clinical efficacy of spiramycin and erythromycin in the treatment of acute tonsillo-pharyngitis. Patients were allocated at random to receive either 500 mg spiramycin 3-times daily for 3 days or 500 mg erythromycin 3-times daily for 5 days. Details were recorded daily by patients of subjective complaints such as fever, sore throat and difficulty in swallowing, and objective signs and symptoms of inflammation were assessed by the physician before and after treatment. Results were analyzed for 32 patients in each group and showed both treatments resulted in a rapid relief of their clinical condition in over 90% of patients. Although all patients showed marked improvements, a few still complained of symptoms at the end of the treatment period. Neither treatment regimen proved adequate for the eradication of the initial pathogen identified from throat swab cultures and leucocytosis persisted in at least 1 patient in each group. Seven patients on erythromycin complained of nausea and/or epigastric pain and 1 patient on spiramycin had urticaria.

Spiramycin and erythromycin in the treatment of acute tonsillo-pharyngitis: a comparative study.

A randomized study was carried out in 100 patients with acute tonsillo-pharyngitis to compare the effectiveness and tolerance of treatment with 500 mg spiramycin 3-times daily for 3 days and 500 mg erythromycin 3-times daily for 5 days. Details were recorded on entry of fever, sore throat, difficulty in swallowing, inflammation of the tonsils and/or pharynx, and oedema. Patients in the two groups were re-examined on Days 4 and 6, respectively. Throat swab cultures and blood determinations of haemoglobin, leucocytes and erythrocyte sedimentation rate were made before and after treatment. The results, analyzed in the 95 patients (48 on spiramycin, 47 on erythromycin) who attended for follow-up, indicated that whilst both antibiotics were effective, only 1 patient receiving spiramycin was classified as failing to respond to treatment compared with 8 of those receiving erythromycin. Moreover, significantly fewer patients on erythromycin had complete disappearance of all the signs and symptoms at the end of the treatment period. These findings were supported by the results of the bacteriological cultures. Both treatments reduced leucocyte levels in those patients with high counts initially, but there was no apparent effect on haemoglobin or erythrocyte sedimentation rate. Two patients on spiramycin complained of dry mouth. In the erythromycin group, 2 patients reported dizziness and 5 nausea.

Spiramycin in the treatment of cryptosporidiosis.

Spiramycin, a macrolide antibiotic, has been advocated for the treatment of cryptosporidiosis. The disease most commonly occurs in patients with AIDS and can be debilitating, as diarrhea and malnutrition may be contributing factors in the death of these patients. Until recently, treatment for cryptosporidiosis has been largely symptomatic. Response rates with drug therapy such as metronidazole, quinidine-clindamycin, and pentamidine have been extremely poor. Although response to spiramycin has appeared promising, there have been several reported cases of treatment failure. Further investigation with the agent is advocated to determine its role in the treatment of cryptosporidiosis.

A demonstration of the intrinsic importance of stabilizing hydrophobic binding and non-covalent van der Waals contacts dominant in the non-covalent CC-1065/B-DNA binding.

The comparative DNA binding properties and cytotoxic activity of CDPIn methyl esters (n = 1-5) vs. PDE-In methyl esters (n = 1-3) are detailed in studies which provide experimental evidence for the intrinsic importance of stabilizing hydrophobic binding and non-covalent van der Waals contacts dominant in the CC-1065/B-DNA minor groove binding. High affinity minor groove binding to DNA was established through: (1) the observation of CDPI3 binding (UV) but not unwinding of supercoiled DNA (phi 174 RFI DNA) thus excluding intercalative binding; (2) the observation of CDPI3 binding to T4 phage DNA (UV, delta Tm) in which the major groove is occluded by glycosylation thus excluding major groove binding; (3) the observation of salt (Na+) concentration independent high affinity CDPI3 binding to poly(dA . poly(dT) thus excluding simple electrostatic binding to the DNA phosphate backbone; and further inferred through (4) the observation of an intense induced dichroism (ICD, poly(dA) . poly(dT) and poly(dG) . poly(dC) [phi]23(358) = 24,000 and 23,500). This high affinity minor groove binding is sufficient to produce a potent cytotoxic effect.(ABSTRACT TRUNCATED AT 400 WORDS)

The role of adjunctive Rodogyl therapy in the treatment of advanced periodontal disease. A longitudinal clinical and microbiologic study.

Several studies have indicated that the combination of metronidazole and spiramycin is synergistic against anaerobic bacteria and may be effective against oral infections. The present study sought to determine the efficacy and safety of a commercial preparation of these two antibiotics (Rodogyl) when used adjunctively in the treatment of advanced periodontal disease. In a double-blind parallel randomized trial, 56 patients (mean age = 44 years) with advanced periodontitis (50 of whom completed the study) were assigned to either the Rodogyl or placebo group. Both groups were thoroughly scaled and root planned for approximately 6 hours, with one group receiving Rodogyl for 2 weeks and the other a placebo. No other therapy was received during the study period. Two sites in each patient with probing depths of at least 7 mm were selected for study. Plaque level (P1I), gingival inflammation (GI), probing depth (PD), and attachment level (AL) were measured at baseline, 14 days, 1 month, and then at monthly intervals up to 6 months. Subgingival bacteria were monitored with dark-field microscopy. The development of resistant bacteria, as well as side effects to the medications, was also monitored. The Rodogyl group exhibited a greater gain in AL (0.67 mm) from the 2-month interval until the end of the study. Although this difference was statistically significant (P less than 0.05), it was not necessarily of biologic significance. There was a significantly greater decline in the proportion of spirochetes in the Rodogyl group at the 14-day interval, and this difference remained significant (P less than 0.05) at all study intervals. No difference in the proportion of motile organisms was observed.(ABSTRACT TRUNCATED AT 250 WORDS)