Spiramycin is a macrolide antibiotic which is capable of killing free and intracellular parasites by interfering with protein synthesis. It concentrates markedly in tissues, but the penetration to the cerebrospinal fluid (CSF) is poor, so it has no logical role in the treatment of cerebral toxoplasmosis. It does accumulate in the placenta, and the concentration is up to five times greater than that of the corresponding maternal serum. Spiramycin crosses the placental barrier, but the foetal blood level is only half of the corresponding maternal serum levels (Forestier et al. 1987). A dose of 3g/day (9 MIU) is recommended during pregnancy. The main advantage of spiramycin lies in the complete safety of the foetus. It has no teratogenic effect whatsoever, and is well tolerated.

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