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result The combined search strategies led to the retrieval of 224 studies. After applying the eligibility criteria, based on titles and abstracts, 9 studies1-9 were selected for critical evaluation of texts. Of the studies, 8 were observational cohorts (7 historical and one prospective) and one systematic review. Patients included in the evidence were pregnant women with acute toxoplasmosis treated prenatally with spiramycin, sulfadiazine, pyrimethamine and folinic acid (PSA), or sulfadiazine and pyrimethamine (SP) combined with spiramycin. The rates of vertical transmission in women infected in the 1st, 2nd and 3rd trimesters of pregnancy were 5, 13 and 32%, respectively. The rates of vertical transmission in those treated only with spiramycin, PSA, or PS combined with spiramycin were 13, 13 and 24% respectively. No studies have compared spiramycin with sulfadiazine, or even used sulfadiazine as an isolated treatment option.

Is sulfadiazine alone equivalent (benefit and harm) to spiramycin to treat acute toxoplasmosis in the first trimester of pregnancy?