Spiramycin/cotrimoxazole versus pyrimethamine/sulfonamide and spiramycin alone for the treatment of toxoplasmosis in pregnancy

Objective - To compare the effectiviness of spyramicin/ cotrimoxazole (Sp/C) versus pyrimethamine/sulphonamide (Pyr/Sul) and spyramicin alone (Spy) on mother-to-child transmission of toxoplasmosis infection in pregnancy. Study Design - Retrospective study of pregnant women evaluated for suspected toxoplasmosis between 1992 and 2011. Results - 120 mothers and their 123 newborns were included.Prenatal treatment consisted of spyramicin in 43 mothers (35%), spyramicin/cotromoxazole in 70 (56.9%),pyrimethamine/ sulphonamide in 10 (8.1%).A trend toward reduction in toxoplasmosis transmission was found when Sp/C was compared with Pyr/Sul and particularly with Spy alone (p= 0.014).In particular, Spy increased the risk of congenital infection when compared with Sp/C (OR 4.368; 95% CI: 1.253–15.219), but there was no significant reduction when Sp/C was compared with Pyr/Sul (OR 1.83; 95% CI: 0.184–18.274). Conclusion - The treatment based on Sp/C has significant efficacy in reducing maternal-fetal transmission of Toxoplasma Gondii when compared to Pyr/Sul and particularly to Spy. Randomized controlled trials would be required.