spiramycin

Summary

Summary: A macrolide antibiotic produced by Streptomyces ambofaciens. The drug is effective against gram-positive aerobic pathogens, N. gonorrhoeae, and staphylococci. It is used to treat infections caused by bacteria and Toxoplasma gondii.

Top Publications

  1. Taniguchi K, Nakamura A, Tsurubuchi K, O Hara K, Sawai T. The role of histidine residues conserved in the putative ATP-binding region of macrolide 2'-phosphotransferase II. FEMS Microbiol Lett. 2004;232:123-6 pubmed
    ..The results suggested that H205 is crucial for maintaining the catalytic activity of MPH(2')II, and Asn can substitute for His at this position. ..
  2. Geyik M, Dikici B, Kokoglu O, Bosnak M, Celen M, Hosoglu S, et al. Therapeutic effect of spiramycin in brucellosis. Pediatr Int. 2003;45:31-4 pubmed
    This study was undertaken to investigate the usefulness of spiramycin in treatment for brucellosis in an animal model. Eighty-four Sprague-Dawley rats were infected by intraperitoneal injection of Brucella melitensis suspension...
  3. Tian X, Li J, Zamek Gliszczynski M, Bridges A, Zhang P, Patel N, et al. Roles of P-glycoprotein, Bcrp, and Mrp2 in biliary excretion of spiramycin in mice. Antimicrob Agents Chemother. 2007;51:3230-4 pubmed
    ..Previous in vitro studies demonstrated that P-gp transported macrolide antibiotics, including spiramycin, which is eliminated primarily by biliary excretion...
  4. Poulet P, Duffaut D, Barthet P, Brumpt I. Concentrations and in vivo antibacterial activity of spiramycin and metronidazole in patients with periodontitis treated with high-dose metronidazole and the spiramycin/metronidazole combination. J Antimicrob Chemother. 2005;55:347-51 pubmed
    Previous studies have shown that metronidazole, alone or in combination with spiramycin (250 mg/1 500 000 units, three times/day), is an effective treatment for active periodontitis, although the dose of metronidazole currently used (750 ..
  5. Pennisi M, De Majo M, Masucci M, Britti D, Vitale F, Del Maso R. Efficacy of the treatment of dogs with leishmaniosis with a combination of metronidazole and spiramycin. Vet Rec. 2005;156:346-9 pubmed
    ..compare the clinical and parasitological efficacy of an oral treatment with a combination of metronidazole and spiramycin (13 dogs) with the efficacy of conventional treatment with meglumine antimonate and allopurinol (14 dogs) as ..
  6. Poulsen S, Kofoed C, Vester B. Inhibition of the ribosomal peptidyl transferase reaction by the mycarose moiety of the antibiotics carbomycin, spiramycin and tylosin. J Mol Biol. 2000;304:471-81 pubmed
    ..The 16-member ring macrolide antibiotics carbomycin, spiramycin, and tylosin inhibit peptidyl transferase...
  7. Bunetel L, Guerin J, Agnani G, Piel S, Pinsard H, Corbel J, et al. In vitro study of the effect of titanium on porphyromonas gingivalis in the presence of metronidazole and spiramycin. Biomaterials. 2001;22:3067-72 pubmed
    ..gingivalis, frequently associated with periodontal diseases, in the presence of titanium and antibiotics (spiramycin and metronidazole alone or in combination). Viability of P...
  8. Grujić J, Djurkovic Djakovic O, Nikolic A, Klun I, Bobic B. Effectiveness of spiramycin in murine models of acute and chronic toxoplasmosis. Int J Antimicrob Agents. 2005;25:226-30 pubmed
    The antitoxoplasmic activity of spiramycin (SPI) was evaluated in murine models of infection using a type-1 (RH) or type-2 (Me49) strain of Toxoplasma gondii...
  9. Nguyen H, Karray F, Lautru S, Gagnat J, Lebrihi A, Huynh T, et al. Glycosylation steps during spiramycin biosynthesis in Streptomyces ambofaciens: involvement of three glycosyltransferases and their interplay with two auxiliary proteins. Antimicrob Agents Chemother. 2010;54:2830-9 pubmed publisher
    Streptomyces ambofaciens synthesizes spiramycin, a 16-membered macrolide antibiotic used in human medicine...

More Information

Publications62

  1. Meroni V, Genco F, Tinelli C, Lanzarini P, Bollani L, Stronati M, et al. Spiramycin treatment of Toxoplasma gondii infection in pregnant women impairs the production and the avidity maturation of T. gondii-specific immunoglobulin G antibodies. Clin Vaccine Immunol. 2009;16:1517-20 pubmed publisher
    The aim of the study was to evaluate the influence of treatment with spiramycin on the increase of immunoglobulin G (IgG) titers and IgG avidity indexes (AI) in pregnant women with seroconversion from the beginning of therapy until ..
  2. Furusawa N. Binding profile of spiramycin to oviducal proteins of laying hens. J Vet Med A Physiol Pathol Clin Med. 2000;47:585-91 pubmed
    In vitro protein binding of spiramycin (SP) in the plasma and oviducts of laying hens was studied...
  3. Petropoulos A, Xaplanteri M, Dinos G, Wilson D, Kalpaxis D. Polyamines affect diversely the antibiotic potency: insight gained from kinetic studies of the blasticidin S AND spiramycin interactions with functional ribosomes. J Biol Chem. 2004;279:26518-25 pubmed
    ..on peptidyltransferase inhibition by an aminohexosylcytosine nucleoside, blasticidin S, and by a macrolide, spiramycin, were investigated in a model system derived from Escherichia coli, in which a peptide bond is formed between ..
  4. Rams T, Dujardin S, Sautter J, Degener J, van Winkelhoff A. Spiramycin resistance in human periodontitis microbiota. Anaerobe. 2011;17:201-5 pubmed publisher
    The occurrence of in vitro resistance to therapeutic concentrations of spiramycin, amoxicillin, and metronidazole was determined for putative periodontal pathogens isolated in the United States...
  5. Franco P, Gomes A, Barbosa B, Angeloni M, Silva N, Teixeira Carvalho A, et al. Azithromycin and spiramycin induce anti-inflammatory response in human trophoblastic (BeWo) cells infected by Toxoplasma gondii but are able to control infection. Placenta. 2011;32:838-44 pubmed publisher
    ..This study aimed to examine the effects of azithromycin and spiramycin against T. gondii infection in BeWo cells...
  6. Karray F, Darbon E, Oestreicher N, Dominguez H, Tuphile K, Gagnat J, et al. Organization of the biosynthetic gene cluster for the macrolide antibiotic spiramycin in Streptomyces ambofaciens. Microbiology. 2007;153:4111-22 pubmed
    b>Spiramycin, a 16-membered macrolide antibiotic used in human medicine, is produced by Streptomyces ambofaciens; it comprises a polyketide lactone, platenolide, to which three deoxyhexose sugars are attached...
  7. Loria G, Sammartino C, Nicholas R, Ayling R. In vitro susceptibilities of field isolates of Mycoplasma agalactiae to oxytetracycline, tylosin, enrofloxacin, spiramycin and lincomycin-spectinomycin. Res Vet Sci. 2003;75:3-7 pubmed
    The minimum inhibitory concentrations (MICs) of tetracycline, enrofloxacin, tylosin, spiramycin and a lincomycin:spectinomycin 1:2 combination, against 24 Sicilian isolates of Mycoplasma agalactiae, the causative organism of contagious ..
  8. Todros T, Verdiglione P, Ogge G, Paladini D, Vergani P, Cardaropoli S. Low incidence of hypertensive disorders of pregnancy in women treated with spiramycin for toxoplasma infection. Br J Clin Pharmacol. 2006;61:336-40 pubmed
    Toxoplasma infection in pregnancy is usually treated with long-term administration of the macrolide spiramycin to prevent fetal malformations...
  9. Chew W, Segarra I, Ambu S, Mak J. Significant reduction of brain cysts caused by Toxoplasma gondii after treatment with spiramycin coadministered with metronidazole in a mouse model of chronic toxoplasmosis. Antimicrob Agents Chemother. 2012;56:1762-8 pubmed publisher
    ..We assessed spiramycin pharmacokinetics coadministered with metronidazole, the eradication of brain cysts and the in vitro reactivation...
  10. Julliac B, Théophile H, Begorre M, Richez B, Haramburu F. Side effects of spiramycin masquerading as local anesthetic toxicity during labor epidural analgesia. Int J Obstet Anesth. 2010;19:331-2 pubmed publisher
    ..The most likely source of the maternal symptoms was spiramycin, which was being administered for treatment of toxoplasmosis.
  11. Dellestable P, Weber Muller F, Trechot P, Vernassiere C, Schmutz J, Barbaud A. [Co-sensitization to drugs belonging to different chemical classes during the same episode of cutaneous adverse drug reaction: two cases]. Ann Dermatol Venereol. 2007;134:655-8 pubmed
    ..The oral challenge with ceftriaxon was positive. A woman taking spiramycin developed a maculopapular rash which was slowly regressive despite substitution with cefixim and corticotherapy...
  12. Asensio Sánchez T, Davila I, Moreno E, Laffond E, Macias E, Ruiz A, et al. Anaphylaxis due to metronidazole with positive skin prick test. J Investig Allergol Clin Immunol. 2008;18:138-9 pubmed
  13. Pendela M, Govaerts C, Diana J, Hoogmartens J, Van Schepdael A, Adams E. Characterization of impurities in spiramycin by liquid chromatography/ion trap mass spectrometry. Rapid Commun Mass Spectrom. 2007;21:599-613 pubmed
    A reversed-phase liquid chromatography/tandem mass spectrometry method is described for the investigation of spiramycin and related substances. The method uses an XTerra C18 column (250 x 4.6 mm i.d...
  14. Nicolas P, Cavallo J, Fabre R, Martet G. [Standardization of the Neisseria meningitidis antibiogram. Detection of strains relatively resistant to penicillin]. Bull World Health Organ. 1998;76:393-400 pubmed
    ..Based on our results and literature data on pharmacokinetics, we propose critical concentrations for these various antibiotics as well as critical diameters for chloramphenicol and rifampicin discs. ..
  15. Carletti M, Gusson F, Zaghini A, Dacasto M, Marvasi L, Nebbia C. In vitro formation of metabolic-intermediate cytochrome P450 complexes in rabbit liver microsomes by tiamulin and various macrolides. Vet Res. 2003;34:405-11 pubmed
    ..gt; TAO approximately roxithromycin approximately tylosin and did not take place with tilmicosin and spiramycin. Most of the tested compounds underwent an oxidative N-dealkylation and a good relationship could be found ..
  16. Guangdong S, Jianlu D, Yiguang W. Construction and physiological studies on a stable bioengineered strain of shengjimycin. J Antibiot (Tokyo). 2001;54:66-73 pubmed
    ..by integrating the 4"-O-acyltransferase gene (ist) by homologous recombination into the chromosome of the spiramycin-producing strain S. spiramyceticus F21. In this construction, a Streptomyces/E...
  17. Briand P, Gangneux J, Favaretto G, Ly Sunnaram B, Godard M, Robert Gangneux F, et al. [Hemophagocytic syndrome and toxoplasmic primo-infection]. Ann Biol Clin (Paris). 2008;66:199-205 pubmed publisher
    ..The objective of this work is to present the step of the biological diagnosis of HPS. Moreover, this observation allows the study of a very rare clinical presentation of toxoplasmic primo-infection, in an immunocompetant patient. ..
  18. Berrebi A, Assouline C, Bessières M, Lathière M, Cassaing S, Minville V, et al. Long-term outcome of children with congenital toxoplasmosis. Am J Obstet Gynecol. 2010;203:552.e1-6 pubmed publisher
    ..This was a 20 year prospective study (1985-2005). All mothers received spiramycin, alone or associated with pyrimethamine-sulfadoxine, and underwent amniocentesis and monthly ultrasound ..
  19. Radoi M, Bobescu E, Agache I. Rovamycine as add-on treatment in unstable angina and 4 year evolution with major cardiovascular events. Rom J Intern Med. 2003;41:237-46 pubmed
    ..The beneficial effect of Rovamycine was parallel to the decrease in serum inflammations markers concentration. ..
  20. Cester C, Beguin J, Toutain P. The use of an experimental metritis model to study antibiotic distribution in genital tract secretions in the ewe. Vet Res. 1996;27:479-89 pubmed
    The influence of experimentally-induced metritis on spiramycin disposition in genital secretions was investigated in six ovariectomized ewes. A crossover study design was selected to compare control with metritis pharmacokinetics...
  21. Pergola G, Cascone A, Russo M. Acute pericarditis and myocarditis by Toxoplasma gondii in an immunocompetent young man: a case report. Infez Med. 2010;18:48-52 pubmed
    ..by serological tests positive for toxoplasmosis, recommended an antibiotic therapy as additional treatment (spiramycin 9MU/day for one month)...
  22. Kusano T, Kanda M, Kamata K, Miyazaki T. [Microbiological method for the detection of antibiotic residues in meat using mixed-mode, reverse-phase and cation-exchange cartridge]. Shokuhin Eiseigaku Zasshi. 2004;45:191-6 pubmed
    A microbiological method for screening of residual benzylpenicillin (PCG), oxytetracycline (OTC) and spiramycin (SPM) in meat using a single mixed mode, reversed-phase and cation-exchange cartridge was developed...
  23. Maeda T. [Toxoplasmosis]. Nihon Rinsho. 2003;61 Suppl 2:603-7 pubmed
  24. Wallon M, Gaucherand P, Al Kurdi M, Peyron F. [Toxoplasma infections in early pregnancy: consequences and management]. J Gynecol Obstet Biol Reprod (Paris). 2002;31:478-84 pubmed
    ..For these early maternal infections as for those acquired later, we recommend immediate treatment with spiramycin, monthly ultrasound surveillance, amniocentesis and treatment with pyrimethamine and sulphamides if the PCR is ..
  25. Ribeiro M, Franco P, Lopes Maria J, Angeloni M, Barbosa B, Gomes A, et al. Azithromycin treatment is able to control the infection by two genotypes of Toxoplasma gondii in human trophoblast BeWo cells. Exp Parasitol. 2017;181:111-118 pubmed publisher
    ..Here, we investigate whether the antibiotic therapy with azithromycin, spiramycin and sulfadiazine/pyrimethamine are effective to control trophoblast infection by two Brazilian T...
  26. Pol Hofstad I, Driessen Van Lankveld W, Tomassen M, De Jong J, van Egmond H. Collaborative study of a microbiological screening method (three-plate) for the banned antimicrobial growth promotors tylosin, virginiamycin, spiramycin, zinc bacitracin and avoparcin in animal feed. Food Addit Contam Part A Chem Anal Control Expo Risk Assess. 2008;25:1465-74 pubmed publisher
    A microbiological screening method (three-plate) for the detection of the antimicrobial growth promoters tylosin, spiramycin, virginiamycin, zinc bacitracin, and avoparcin in animal feed has been developed and validated successfully...
  27. de Górgolas Hernández Mora M, Verdejo Morcillo C, Fernández Guerrero M. [Therapeutic approaches to cryptosporidiosis. A review of the literature]. Rev Clin Esp. 1993;193:322-8 pubmed
    ..Symptomatic and nutritional support are the unique treatment we have so far. ..
  28. Liu X, Li P, Zhao X, Wang Y, Zhang S. [Rational screen of high kelimycin-producing strain by combined conventional mutagenesis and high-throughput screen method]. Wei Sheng Wu Xue Bao. 2013;53:758-65 pubmed
    ..The potency in 500 L pilot fermenter increased by 61%. This study shows that the screening industrial production strains can be enhanced effectively by combining multiple conventional mutagenesis and high-throughput screen methods. ..
  29. Tang H, Xiong X, Qin Z. [Clinical experience on treating Toxoplasma gondii infection during pregnancy by using acetyl spiramycin combined with azithromycin]. Zhongguo Xue Xi Chong Bing Fang Zhi Za Zhi. 2013;25:555-6 pubmed
    To explore an effective therapy for pregnant Toxoplasma gondii infection by using acetyl spiramycin combined with azithromycin. ELISA and PCR were used to diagnose and evaluate the therapy efficiency to toxoplasmosis in pregnant women...
  30. Xie W, Ding H, Xi J, Qian Y, Huang L. [Determination of five macrolide antibiotic residues in royal jelly samples by using high performance liquid chromatography tandem mass spectrometry]. Se Pu. 2007;25:404-7 pubmed
    ..tandem mass spectrometry (HPLC-MS/MS) was developed for the confirmation of five macrolide antibiotic residues (spiramycin, oleandomycin, tylosin, roxithromycin, josamycin) in royal jelly samples...
  31. Hadi U, Rameh C. Intraglandular toxoplasmosis of the parotid gland pre- or postoperative diagnosis?. Am J Otolaryngol. 2007;28:201-4 pubmed
    ..In this article, we present 2 cases of intraglandular parotid toxoplasmosis, one diagnosed postoperatively and the other preoperatively. We also review the relevant literature concerning Toxoplasma infection of the parotid gland. ..
  32. Gilbert R, Gras L. Effect of timing and type of treatment on the risk of mother to child transmission of Toxoplasma gondii. BJOG. 2003;110:112-20 pubmed
    ..Of 1208 women analysed, 72% were first prescribed spiramycin, 19% pyrimethamine-sulphonamide and 9% (mostly infected during the last trimester) were untreated...
  33. Christoph J, Kattner E, Seitz H, Reiter Owona I. [Strategies for the diagnosis and treatment of prenatal toxoplasmosis - a survey]. Z Geburtshilfe Neonatol. 2004;208:10-6 pubmed
    ..outcome - mild or subclinical infection - is considered to be an effect of early maternofetal treatment with spiramycin and pyrimethamine/sulfadiazine (PS)...
  34. Kawakami Y, Hayashi J, Fujisaki T, Tani Y, Kashiwagi S, Yamaga S. [A case of toxoplasmosis with dermatomyositis]. Kansenshogaku Zasshi. 1995;69:1312-5 pubmed
    ..0 (Cut off index 0.7), suggesting acute toxoplasmosis. Treatment with prednisolone for DM and acetylspiramycin for toxoplasmosis was successful. Toxoplasmosis should be considered as a possibility in patients with myositis. ..
  35. Flurer C. Analysis of macrolide antibiotics by capillary electrophoresis. Electrophoresis. 1996;17:359-66 pubmed
    ..e. pharmaceutical glycoconjugates) clarithromycin, erythromycin, oleandomycin, troleandomycin, and spiramycin. In order to assist in analyte solubilization, two buffer systems using acetonitrile were developed...
  36. Wang M, Pendela M, Hu C, Jin S, Hoogmartens J, Van Schepdael A, et al. Impurity profiling of acetylspiramycin by liquid chromatography-ion trap mass spectrometry. J Chromatogr A. 2010;1217:6531-44 pubmed publisher
    ..Most of the major impurities arise from the starting materials and the synthesis process. This work provides very useful information for quality control of ASPM and evaluation of its synthesis process. ..
  37. Gilbert R, Dunn D, Wallon M, Hayde M, Prusa A, Lebech M, et al. Ecological comparison of the risks of mother-to-child transmission and clinical manifestations of congenital toxoplasmosis according to prenatal treatment protocol. Epidemiol Infect. 2001;127:113-20 pubmed
    ..19 (0.04, 0.51); Denmark 0.60 (0.13, 1.08); and The Netherlands 1.46 (0.51, 2.72). There was no clear evidence that the risk of transmission or of clinical manifestations was lowest in centres with the most intensive prenatal treatment. ..
  38. D Offizi G, Topino S, Anzidei G, Frigiotti D, Narciso P. Primary Toxoplasma gondii infection in a pregnant human immunodeficiency virus-infected woman. Pediatr Infect Dis J. 2002;21:981-2 pubmed
    We report a 36-year-old HIV-infected woman who developed primary Toxoplasma gondii infection during pregnancy that was treated with spiramycin and antiretroviral drugs. There was no vertical transmission of toxoplasmosis and HIV.
  39. Oka H, Harada K, Suzuki M, Ito Y. Separation of spiramycin components using high-speed counter-current chromatography. J Chromatogr A. 2000;903:93-8 pubmed
    High-speed counter-current chromatography was successfully applied to the separation of the main components of spiramycin. A 25-mg quantity of sample was separated using a two-phase solvent system composed of n-hexane-ethyl acetate-..
  40. Yang Y, Yang J, Hu M, Hu C. [Determination of the components of bitespiramycin by HPLC]. Yao Xue Xue Bao. 2009;44:1183-6 pubmed
    ..This gradient elution HPLC method reported by this paper is considered to be suitable for the quality control of bitespiramycin. ..
  41. Danielson N, Holeman J, Bristol D, Kirzner D. Simple methods for the qualitative identification and quantitative determination of macrolide antibiotics. J Pharm Biomed Anal. 1993;11:121-30 pubmed
    ..for the qualitative differentiation of the macrolide antibiotics erythromycin, oleandomycin, troleandomycin, spiramycin and tylosin...
  42. Sugamata R, Sugawara A, Nagao T, Suzuki K, Hirose T, Yamamoto K, et al. Leucomycin A3, a 16-membered macrolide antibiotic, inhibits influenza A virus infection and disease progression. J Antibiot (Tokyo). 2014;67:213-22 pubmed publisher
    ..To search for candidate anti-influenza compounds, we screened leucomycin A3 (LM-A3), spiramycin (SPM), an erythromycin derivative (EM900, in which anti-bacterial activity has been eliminated), and ..
  43. Wei L, Cheng Y, Si K, Gu N, Li X, Li C, et al. [In vitro effect of (+)-usnic acid on Toxoplasma gondii tachyzoites]. Zhongguo Ji Sheng Chong Xue Yu Ji Sheng Chong Bing Za Zhi. 2008;26:438-41 pubmed
    ..But the cultivated rat cardiofibroblasts were infected to varying degree in acetylspiramycin groups, normal saline group and DMSO group. (+)-Usnic acid has a remarkable effect on T. gondii tachyzoites. ..
  44. Sanders P, Moulin G, Gaudiche C, Delepine B, Mourot D. Comparison of automated liquid chromatographic and bioassay methods for determining spiramycin concentration in bovine plasma. J Assoc Off Anal Chem. 1991;74:912-7 pubmed
    The performance of a liquid chromatographic (LC) method for spiramycin measurement in bovine plasma has been compared with that of a microbiological method. Plasma samples were obtained from cattle administered spiramycin intravenously...
  45. Lefevre Pettazzoni M, Bissery A, Wallon M, Cozon G, Peyron F, Rabilloud M. Impact of spiramycin treatment and gestational age on maturation of Toxoplasma gondii immunoglobulin G avidity in pregnant women. Clin Vaccine Immunol. 2007;14:239-43 pubmed
    ..03-fold increase (P = 0.0003) was observed for each additional week of delay to the onset of spiramycin treatment...
  46. Choi S, Kim M, Ha H, Hwang Y. In vivo functions of the gamma-butyrolactone autoregulator receptor in Streptomyces ambofaciens producing spiramycin. Biotechnol Lett. 2008;30:891-7 pubmed
    ..coli from Streptomyces ambofaciens producing spiramycin, a macrolide antibiotic used in both veterinary medicine and human medicine...
  47. Youssef R, Maher H. Electrochemical study of spiramycin and its determination in pharmaceutical preparation. Drug Test Anal. 2010;2:392-6 pubmed publisher
    b>Spiramycin (SPY) is a medium-spectrum antibiotic with high effectiveness against Gram-positive bacteria. The voltammetric behaviour of spiramycin was studied using differential pulse polarography (DPP) and square wave polarography (SWP)...
  48. Rencuzogullari E, Ila H, Topaktas M, Kayraldiz A, Budak S, Arslan M. No significant increase in chromosome aberrations and sister chromatid exchanges in cultured human lymphocytes treated with spiramycin. Teratog Carcinog Mutagen. 2002;22:51-8 pubmed
    ..aberrations (CAs) and sister chromatid exchanges (SCEs) were investigated in human lymphocytes treated with spiramycin antibiotic (trade name, rovamycin)...
  49. Calza P, Marchisio S, Medana C, Baiocchi C. Fate of antibacterial spiramycin in river waters. Anal Bioanal Chem. 2010;396:1539-50 pubmed publisher
    b>Spiramycin, a widely used veterinary macrolide antibiotic, was found at traceable levels (nanograms per litre range) in Po River water (N-Italy)...
  50. Costa I, Angeloni M, Santana L, Barbosa B, Silva M, Rodrigues A, et al. Azithromycin inhibits vertical transmission of Toxoplasma gondii in Calomys callosus (Rodentia: Cricetidae). Placenta. 2009;30:884-90 pubmed publisher
    ..Current toxoplasmosis treatment for pregnant women is based on the administration of spiramycin or a drug combination as sulphadiazine-pyrimethamine-folinic acid (SPFA) in cases of confirmed fetal infection...
  51. Ma C, Wu L, Dai J, Zhou H, Li J, Sun X, et al. [Acylation specificity of midecamycin 3-O-acyltransferase within Streptomyces spiramyceticus F21]. Sheng Wu Gong Cheng Xue Bao. 2008;24:2086-92 pubmed
    b>Spiramycin and midecamycin are 16-membered macrolide antibiotics with very similar chemical structures. Spiramycin has three components, namely spiramycin I, II and III...
  52. Habib F. Post-treatment assessment of acute Toxoplasma infection during pregnancy. J Obstet Gynaecol. 2008;28:593-5 pubmed publisher
    ..All of them received the recommended dose of Spiramycin. Only 19 returned for follow-up visits and completed their pregnancies to full term...
  53. Greco P, Vimercati A, Angelici M, Carbonara S, Doria G, Nappi L, et al. Toxoplasmosis in pregnancy is still an open subject. J Perinat Med. 2003;31:36-40 pubmed
    ..However, there were some weak points; for example, the high number of invasive procedures and the questionable prevention of mother to child transmission in the second to third trimester. ..