Treatment of toxoplasmosis in the pregnant mother and newborn child

Abstract

The paper presents a review of different treatment regimens employed for 25 years to prevent and treat congenital toxoplasmosis. Unfortunately, no well-controlled, randomized trials have been performed to evaluate the efficacy of different therapies of pregnant women or infected neonates. Treatment in pregnancy may be effective since transplacental passage of parasites is delayed. Spiramycin, a complete safe drug which concentrates in the placenta, may reduce the risk of materno-fetal transmission by 60%, but is in the present doses without influence on an already infected fetus. Pyrimethamine in combination with sulfonamides erradicates more effectively parasites in the placenta, and also in the fetus. Today a combination of both regimens is recommended in pregnancy. As for the infected neonates, intensive treatment of pyrimethamine/sulfonamides alternating with spiramycin until one year of age seems to prevent development of late appearing sequelae. There is obviously a need for international multicenter studies to settle the optimal schedules and duration of therapy which again is highly dependent on the performance of an appropriate serological screening during pregnancy.