Spiramycin/cotrimoxazole Versus Pyrimethamine/sulfonamide and Spiramycin Alone for the Treatment of Toxoplasmosis in Pregnancy

Overview

Journal J Perinatol

Specialty Gynecology & Obstetrics

Date 2014 Sep 12

PMID 25211284

Citations 15

Authors

P Valentini

D Buonsenso

G Barone

D Serranti

R Calzedda

M Ceccarelli

D Speziale

R Ricci

L Masini

Affiliations

Soon will be listed here.

Abstract

Objective: To compare the effectiviness of spiramycin/cotrimoxazole (Sp/C) versus pyrimethamine/sulfonamide (Pyr/Sul) and spiramycin 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.

Result: A total of 120 mothers and their 123 newborns were included. Prenatal treatment consisted of spiramycin in 43 mothers (35%), spiramycin/cotrimoxazole in 70 (56.9%) and pyrimethamine/sulfonamide 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 (odds ratio (OR) 4.368; 95% CI: 1.253 to 15.219), but there was no significant reduction when Sp/C was compared with Pyr/Sul (OR 1.83; 95% CI: 0.184 to 18.274).

Conclusion: The treatment based on Sp/C has significant efficacy in reducing maternal-fetal transmission of Toxoplasma gondii when compared with Pyr/Sul and particularly to Spy. Randomized controlled trials would be required.

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References

Neto E, Anele E, Rubim R, Brites A, Schulte J, Becker D . High prevalence of congenital toxoplasmosis in Brazil estimated in a 3-year prospective neonatal screening study. Int J Epidemiol. 2000; 29(5):941-7. DOI: 10.1093/ije/29.5.941. View

Czeizel A, Rockenbauer M, Sorensen H, Olsen J . The teratogenic risk of trimethoprim-sulfonamides: a population based case-control study. Reprod Toxicol. 2001; 15(6):637-46. DOI: 10.1016/s0890-6238(01)00178-2. View

Guerina N, Hsu H, Meissner H, Maguire J, Lynfield R, Stechenberg B . Neonatal serologic screening and early treatment for congenital Toxoplasma gondii infection. The New England Regional Toxoplasma Working Group. N Engl J Med. 1994; 330(26):1858-63. DOI: 10.1056/NEJM199406303302604. View

Eskild A, Oxman A, Magnus P, Bjorndal A, Bakketeig L . Screening for toxoplasmosis in pregnancy: what is the evidence of reducing a health problem?. J Med Screen. 1996; 3(4):188-94. DOI: 10.1177/096914139600300406. View

Wallon M, Liou C, Garner P, Peyron F . Congenital toxoplasmosis: systematic review of evidence of efficacy of treatment in pregnancy. BMJ. 1999; 318(7197):1511-4. PMC: 27891. DOI: 10.1136/bmj.318.7197.1511. View

da Fonseca Ferreira-da-Silva M, Takacs A, Barbosa H, Gross U, Luder C . Primary skeletal muscle cells trigger spontaneous Toxoplasma gondii tachyzoite-to-bradyzoite conversion at higher rates than fibroblasts. Int J Med Microbiol. 2008; 299(5):381-8. DOI: 10.1016/j.ijmm.2008.10.002. View

Serranti D, Buonsenso D, Valentini P . [Congenital toxoplasmosis treatment]. Eur Rev Med Pharmacol Sci. 2011; 15(2):193-8. View

Leeming R . Co-trimoxazole and phenylalanine metabolism. Lancet. 1980; 1(8162):255-6. DOI: 10.1016/s0140-6736(80)90739-4. View

Evengard B, Petersson K, Engman M, Wiklund S, Ivarsson S, Forsgren M . Low incidence of toxoplasma infection during pregnancy and in newborns in Sweden. Epidemiol Infect. 2001; 127(1):121-7. PMC: 2869718. DOI: 10.1017/s0950268801005775. View

10.

Wise R . Antibiotics. Br Med J (Clin Res Ed). 1987; 294(6563):42-6. PMC: 1245050. DOI: 10.1136/bmj.294.6563.42. View

11.

Gras L, Gilbert R, Ades A, Dunn D . Effect of prenatal treatment on the risk of intracranial and ocular lesions in children with congenital toxoplasmosis. Int J Epidemiol. 2002; 30(6):1309-13. DOI: 10.1093/ije/30.6.1309. View

12.

Raeber P, Biedermann K, Just M, Zuber P . [Prevention of congenital toxoplasmosis in Europe]. Schweiz Med Wochenschr Suppl. 1995; 65:96S-102S. View

13.

Foulon W, Villena I, Stray-Pedersen B, Decoster A, Lappalainen M, Pinon J . Treatment of toxoplasmosis during pregnancy: a multicenter study of impact on fetal transmission and children's sequelae at age 1 year. Am J Obstet Gynecol. 1999; 180(2 Pt 1):410-5. DOI: 10.1016/s0002-9378(99)70224-3. View

14.

Arens J, Barnes K, Crowley N, Maartens G . Treating AIDS-associated cerebral toxoplasmosis - pyrimethamine plus sulfadiazine compared with cotrimoxazole, and outcome with adjunctive glucocorticoids. S Afr Med J. 2007; 97(10):956-8. View

15.

Gilbert R, Gras L . Effect of timing and type of treatment on the risk of mother to child transmission of Toxoplasma gondii. BJOG. 2003; 110(2):112-20. DOI: 10.1016/s1470-0328(02)02325-x. View

16.

Lim W, Macfarlane J, Colthorpe C . Treatment of community-acquired lower respiratory tract infections during pregnancy. Am J Respir Med. 2004; 2(3):221-33. PMC: 7100023. DOI: 10.1007/BF03256651. View

17.

Silveira C, Belfort Jr R, Muccioli C, Holland G, Victora C, Horta B . The effect of long-term intermittent trimethoprim/sulfamethoxazole treatment on recurrences of toxoplasmic retinochoroiditis. Am J Ophthalmol. 2002; 134(1):41-6. DOI: 10.1016/s0002-9394(02)01527-1. View

18.

Opremcak E, Scales D, Sharpe M . Trimethoprim-sulfamethoxazole therapy for ocular toxoplasmosis. Ophthalmology. 1992; 99(6):920-5. DOI: 10.1016/s0161-6420(92)31873-1. View

19.

Valentini P, Annunziata M, Angelone D, Masini L, De Santis M, Testa A . Role of spiramycin/cotrimoxazole association in the mother-to-child transmission of toxoplasmosis infection in pregnancy. Eur J Clin Microbiol Infect Dis. 2008; 28(3):297-300. DOI: 10.1007/s10096-008-0612-5. View

20.

Rothova A, Meenken C, Buitenhuis H, Brinkman C, Baarsma G, de Jong P . Therapy for ocular toxoplasmosis. Am J Ophthalmol. 1993; 115(4):517-23. DOI: 10.1016/s0002-9394(14)74456-3. View