To the Editor:
—On p. 401 of the March, 1961, Archives of Ophthalmology, an article on "The Treatment of Ocular Toxoplasmosis with Spiramycin" by the Drs. Chodos appeared which deserves some comment. In this article the well known toxicity of high doses of pyrimethamine (Daraprim) was contrasted with the apparent harmlessness of low doses of spiramycin, and this was taken as the rationale for using 2 gm. of spiramycin a day in the treatment of ocular toxoplasmosis. This rationale is open to some question and involves the obvious fact that most drugs are harmless if given in small enough concentrations and are toxic if given in high enough concentrations. The goal, of course, is to obtain therapeutic efficacy—in this case the killing of Toxoplasmas—without toxicity.Spiramycin is an antibiotic discovered in 1954 and is somewhat similar to erythromycin and oleandomycin in its properties. Its spectrum and margin of safety are
Kaufman HE. SPIRAMYCIN. Arch Ophthalmol. 1961;66(4):609–610. doi:https://doi.org/10.1001/archopht.1961.00960010611029
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