Spiramycin (Injection, Oral, Rectal)

Spiramycin is an antibiotic used to treat a wide variety of bacterial infections. It is especially effective against infections of the skin, mouth and respiratory tract.


Spiramycin is an effective antibiotic for soft tissue bacterial infections. It is also frequently prescribed to treat toxoplasmosis. This is a parasitic infection, which can be caught through various means, including undercooked meat and water contamination.

Spiramycin is particularly favored in the treatment of toxoplasmosis during pregnancy since it prevents the transference of the disease to the fetus. It should be noted that it is not effective to treat a fetus with toxoplasmosis but does prevent transference from the mother via the placenta.

This does not mean that Spiramycin is completely safe to use during pregnancy. If you have been prescribed Spiramycin for a standard infection, you should not take the drug during pregnancy, unless you have consulted and received approval from your doctor.

Spiramycin can also be prescribed to treat gonorrhea for patients with allergies to penicillin.

This drug is part of the macrolide family of antibiotics. These are naturally occurring and derived from Saccharopolysprora erythraea: a kind of bacteria found in soil. Antibacterial macrolides are protein synthesis inhibitors. This means Spiramycin treats infection by inhibiting bacterial protein biosynthesis in the body. They perform this task by binding to the P site of the 50S unit of the ribosome.

Spiramycin has a lower absorption rate than some other macrolides, such as Erythromycin. It is also less well metabolized. It does have the advantage of good tissue distribution, particularly for the lungs.

Spiramycin can be taken orally, rectally or via injection.

Currently, the Spiramycin drug is still considered experimental in the USA. It is readily commercially available in the EU and many other countries.

Conditions treated

  • Various infections, especially respiratory infections
  • Gonorrhea
  • Toxoplasmosis
  • Toxoplasmosis in pregnancy (prevention of the passing of infection from mother to fetus)

Type of medicine

  • Macrolide antibiotic

Side Effects

When taking any medication, it is not uncommon to experience unwanted side effects that are not the main purpose of the drug. This is especially common if you are taking this kind of medication for the first time.

In the vast majority of cases, these side effects are not harmful. Your doctor will have carefully considered and weighed the appropriate risks before prescribing Spiramycin.

While unwanted side effects can sometimes be unpleasant, this is not a good reason to stop taking your medication.

You should continue taking the prescribed dose of Spiramycin as instructed until your treatment is complete or your doctor advises you otherwise.

It is not uncommon with many antibiotics for patients to experience some digestive discomfort.

There are also a number of other potential side effects associated with Spiramycin, including:

If Spiramycin is being administered intravenously, there is occasionally the side effect of pain at the injection site, although this is rare.

Other rare side effects that you may experience when taking Spiramycin are:

  • bloody stools
  • chest pain
  • fever
  • heartburn
  • irregular heartbeat
  • nausea
  • recurrent fainting
  • stomach pain
  • vomiting
  • yellowing of the eyes and/or skin

If you experience any of the above side effects severely and consistently, you should inform your doctor immediately, but do not stop taking your medication unless instructed.

If you experience any side effects that are not listed above or that resemble an allergic reaction, consult your physician straight away.


It is imperative that patients always take Spiramycin and any medication as instructed by their doctor.

Your required dosage may be different from the norm and if your doctor prescribes a dosage different from the manufacturer this will be based on your medical history and personal circumstances or condition.

If the dosage instruction on your medication bottle differs from your doctor's instructions, you should clarify this with your doctor straight away.

Do not stop taking your medication unless instructed to by your physician. You should never increase or decrease your dose unless instructed by your doctor. If you experience adverse side effects as a result of the medication, consult your doctor but do not alter or stop your dose unless instructed.

Spiramycin doses are administered in different amounts depending on whether you take the medication orally, intravenously or rectally.

While your dose may be different, a standard adult dose for oral use is usually a capsule tablet of 1-2 grams to be taken twice daily. It is also common to spread the dose further throughout the day with a 500mg - 1-gram tablet taken three times a day.

For a more severe infection, the dose can be increased to a 2 - 2.5-gram tablet two times a day.

Children with a body weight of 20kg and over may take 25mg per kg of body weight two times a day or 16.7mg per kg of body weight three times a day.

If you are taking Spiramycin orally, it should be taken on an empty stomach. Taking Spiramycin with food can reduce its absorption and make your medication less effective.

In the case of Spiramycin being given via injection, a standard adult dose is usually 500mg every eight hours. However, for more severe infections, this is often increased to 1 gram every eight hours.

When administering Spiramycin intravenously it is standard practice to dilute the drug with 4ml of sterile water. Sometimes the formula is further diluted with a minimum of 100ml of 5% dextrose to aid slow intravenous infusion.

A child's dose is more often given orally or rectally but an injected dose should be decided by the child's physician.

When administering Spiramycin rectally, a standard adult dose is usually two to three 750mg suppositories every 24 hours.

Children over 12 can take the same dose as adults unless your healthcare provider decides otherwise.

Children under 12 are usually given two to three 500mg suppositories every 24 hours.

Newborns can be given one 250mg suppository per 5kg of body weight every 24 hours.

If you are taking Spiramycin as a suppository, first remove it from the wrapper and moisten with cold water before insertion. Ensure to insert deeply but naturally into the rectum.

When using Spiramycin to treat toxoplasmosis during pregnancy the oral route is most common. The dosage should change depending on the duration of the pregnancy. For the first trimester, 3 grams per day in three or four doses are standard. In the second and third trimesters, it is usual to take 25 - 50mg of pyrimethamine per day combined with 2 - 3 grams of sulfadiazine per day and folinic acid at 5mg per day for three weeks, alternating with 3 grams of Spiramycin divided into three or four doses per day for three weeks.

In the event that you accidentally miss your dose, take it as soon as you remember, unless it is nearly time for your next dose. If this is the case, then skip the missed dose.

It can be hazardous to double-up on doses. Try to take your medication at the same times each day, as Spiramycin works optimally with a constant amount in your blood to fight the infection.

Major drug interactions

There are often negative drug interactions associated with every type of medication. Drug interactions can vary from mild, such as limiting the effectiveness of your medication, to severe, which may cause harm to your health.

While there may be some negative drug interactions associated with combining other medications and Spiramycin, your doctor may still prescribe them together. In these cases, they will have weighed the risk and deemed it necessary.

If you are taking other medications or recreational drugs, vitamins, supplements etc. in addition to Spiramycin, it is essential that you inform your medical provider immediately.

If you are taking multiple medications with Spiramycin, which are associated with negative interactions, it may be that your doctor will change your dosage rather than stop your treatment, in order to best match your needs.

Never lower or increase the dose of any medications yourself to avoid drug interactions, always ask your healthcare provider for direction.

While there is a wide range of medications that may interact with Spiramycin, the following is a non-exhaustive list of drugs that are well known to produce adverse reactions specifically with Spiramycin.

If you are taking any of the following you should tell your doctor before taking Spiramycin:

  • Dihydroergotamine
  • Ergoloid Mesylates
  • Ergonovine
  • Ergotamine
  • Levomethadyl
  • Methylergonovine
  • Methysergide

In addition to those listed above, there may be other medications which are dangerous to take in combination with Spiramycin, hence you should always inform your doctor of any drugs you are taking.

The following drugs are also associated with negative drug interactions for Spiramycin, however, your doctor may deem these combinations necessary for your health and may merely alter your dose to accommodate treatment:

  • Acecainide
  • Ajmaline
  • Amiodarone
  • Amitriptyline
  • Amoxapine
  • Aprindine
  • Arsenic Trioxide
  • Astemizole
  • Azimilide
  • Bretylium
  • Chloral Hydrate
  • Chloroquine
  • Cholera Vaccine, Live
  • Clarithromycin
  • Desipramine
  • Dibenzepin
  • Disopyramide
  • Dofetilide
  • Dolasetron
  • Doxepin
  • Droperidol
  • Enflurane
  • Erythromycin
  • Flecainide
  • Fluconazole
  • Fluoxetine
  • Foscarnet
  • Gemifloxacin
  • Halofantrine
  • Haloperidol
  • Halothane
  • Hydroquinidine
  • Ibutilide
  • Imipramine
  • Isoflurane
  • Isradipine
  • Lidoflazine
  • Lorcainide
  • Mefloquine
  • Nortriptyline
  • Octreotide
  • Pentamidine
  • Pirmenol
  • Prajmaline
  • Probucol
  • Procainamide
  • Prochlorperazine
  • Propafenone
  • Quinidine
  • Risperidone
  • Sematilide
  • Sertindole
  • Sotalol
  • Sulfamethoxazole
  • Sultopride
  • Tedisamil
  • Telithromycin
  • Trifluoperazine
  • Trimethoprim
  • Trimipramine
  • Vasopressin
  • Zolmitriptan
  • Zotepine

The following medications are also known to have drug interactions with Spiramycin. These may exacerbate or increase the risk of side effects, but this may still be essential for your treatment. Patients on the following drugs, along with Spiramycin may experience additional or more intense side effects to their treatment.

  • Carbidopa
  • Fentanyl
  • Levodopa

Again, it is vital to note that these are non-exhaustive lists and there may be other drugs that interact severely with Spiramycin or reduce its effectiveness or increase the risk of side effects.


If you have any allergies to Spiramycin or similar antibiotics, you should inform your doctor before commencing with treatment. If you are unaware of any allergies to this medication but experience allergy-like symptoms while taking Spiramycin, inform your doctor or a healthcare provider.

Spiramycin is prescribed to treat various infections but it is not a suitable treatment for meningitis.

Avoid drinking alcohol and smoking when taking Spiramycin. The consumption of certain drugs, chemicals and food can decrease the effectiveness of your treatment or increase the risk of side effects. Spiramycin is intended to be taken on an empty stomach. This usually means at least an hour before eating or at least two hours after eating.

Liver disease and reduced liver function have been known to affect Spiramycin. Your doctor may have to adjust your dosage, therefore, be sure to inform your doctor if you have reduced liver function, liver disease or obstruction of the bile ducts.

There may be several food types that react negatively with Spiramycin, but grapefruit juice, in particular, is known to increase the severity of side effects. For this reason, you should avoid the consumption of grapefruits or grapefruit juice while taking Spiramycin.

Another health issue that can be exacerbated by Spiramycin is abnormal heart rhythms. QT prolongation can be increased when taking Spiramycin, especially when taken with other drug combinations. Combinations such as quinidine, thioridazine, chlorpromazine, mefloquine and many others, combined with Spiramycin have been known to worsen this abnormal heart rhythm problem.

Patients suffering from QT prolongation or other abnormal heart rhythms should discuss the issue with their doctor. An adjustment of dosage and additional monitoring may be required.

Since Spiramycin is an antibiotic, there is a risk that extended use can result in other bacteria growing in your body. It is important that you inform your doctor if symptoms do not improve or if they worsen.

Spiramycin is often prescribed as a treatment for toxoplasmosis during pregnancy. However, unless you have been prescribed Spiramycin, for this reason, it is inadvisable to take this medication while pregnant. If you think you might be pregnant, inform your doctor before commencing the medication.

You should also not take Spiramycin while breastfeeding unless told to by your doctor.


It is always important to store your medications in a suitable environment to prevent contamination or accidental ingestion by others.

Ensure that you store Spiramycin in a safe location, away from the reach of any children and if possible, keep it in its original medical bottle with the cap tightly sealed.

Keep your medication away from heat and moisture. Storing medication in damp environments or areas with radical heat change, such as kitchens or bathrooms, is not advisable.

You should also keep Spiramycin away from freezing temperatures. Ideally, this drug should be stored below 40 degrees Celsius or 104 degrees Fahrenheit and between 15 and 30 degrees Celsius or 59 and 86 degrees Fahrenheit.

You should refrain from storing Spiramycin on open shelves, as it must be kept away from direct sunlight.

You should never keep any medicine that is past its expiration date or no longer needed.

While you should not stop taking this medication, unless you have finished your dosage or your doctor instructs you otherwise, if you do have medicine that you no longer require or that is expired, then do not throw it down the drain or toilet. Instead, contact your doctor or medical supplier for instructions on how to correctly dispose of the remaining medicine.


Spiramycin has been proven effective in the treatment of a range of bacterial infections and treatment of toxoplasmosis and prevention of transference of toxoplasmosis from mother to fetus.

Spiramycin is not suitable for treating viruses, nonbacterial infections or cold and flu symptoms. It is also not recommended for the treatment of meningitis.

If your symptoms fail to improve within a few days of taking Spiramycin or if they worsen, consult your doctor.

Doctors in the USA should consult the FDA if they wish to prescribe Spiramycin, as it is currently still classed as experimental in this country.

Last Reviewed:
December 24, 2017
Last Updated:
April 05, 2018
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