First-lineRovamycine
Spiramycin
Macrolide antiprotozoal
First-line for maternal Toxoplasma seroconversion (T1) — prevents vertical transmission.
Oral
First-line for
- Maternal primary Toxoplasma infection (any trimester until amnio result)
- Continued prophylaxis if amnio PCR negative
Mechanism
Binds 50S ribosomal subunit; concentrates in placental tissue → reduces transplacental transmission. Does NOT treat established fetal infection.
“Spiramycin protects placenta — pyr+sulfa treats fetus”
- Maternal seroconversion → spiramycin immediately
- Amnio +ve at ≥18/40 → switch to pyrimethamine + sulfadiazine + folinic
Dosing
- Adult
- 3 g (9 MIU) PO daily in 3 divided doses until delivery or amnio result
Contraindications
- AbsoluteMacrolide hypersensitivity
- CautionLong QT
Side effects
- GI upset
- Allergic reaction
- QT prolongation (rare)
Fetal & maternal notes
- • Does not cross placenta well — concentrates IN placenta, blocking transmission
- • Safe in all trimesters (extensive European data)
Key interactions
QT-prolonging drugs
CautionTorsades
Levodopa
Caution↓ levodopa
Clinical pearls
- 💡 Available in UK/Europe; US via FDA IND/compassionate use
- 💡 Continue until delivery if amnio not performed or negative
Content last reviewed: REPLACE_ME (e.g. 2026-07)
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