Phage therapy came to a standstill after antibiotics was introduced. However, based on various studies done recently: [1] phages will not harm human cells except for the target bacterial cells, [2] phage therapy has fewer side effects than antibiotics, [3] phages can prevent the bacteria from sharing antibiotic-resistance genes, [4] fewer units of phages are required per treatment, and [4] can be used (in combination with antibiotics) to make antibiotics that previously lost their antibacterial effect against drug-resistant bacteria regain their initial role.
Is it not better to make use of phage therapy to further improve/develop antibiotics we know are already effective, rather than making entirely novel drugs with the same effect? Are there more risks in using phage therapy as opposed to novel drugs used for drug-resistant bacteria?
It is not so much risks as that it is more difficult to use phage therapeutically. Phage are in general highly specific, unlike most antibiotics. So if someone has an infection you can treat the infection without knowing much about what strain of bacteria is causing it. However since phage are quite specific, you need to have accurately characterized the causative agent of the infection before you could select a phage. And we don't yet have approved phage for many infectious bacteria.
So I don't think there are more risks, but it's just not so simple.
Phage therapy is one of the best approaches against drug-resistant microorganisms, the specificity, and selectivity of phages match better than even the best chemical antibiotics.
Dear Hannah,
While I agree with the answers given above, I feel that the proponents of phage therapy over antibiotics avoid the obvious: phage and their bacterial hosts are engaged in a constant evolutionary battle. The persistent use of particular phage will result in the co-evolution of the target bacteria and 'escapes' will present a particular problem for infection control (this is similar to the issue of mutations causing antibiotic resistance in bacteria).
Further, the possibility of developing an immune reaction to phage is not well considered, and a common phage body coupled with varied tail fibres (thus giving the same phage the ability to infect a range of host strains/species) may limit repeat treatments (there is no parallel here with antibiotic treatment, though some people are more sensitive to toxic intermediates than others).
Andrew
It would really be useful to hear from our colleagues in Georgia what their experience with phage therapy has been over the last 8 decades... Indeed, while the advent of antibiotics brought about the end of phage therapy in western countries right about the time of the Second World War, various institutes in Eastern block countries, and particularly in Georgia, continued (smartly, it turns out) to use it routinely afterwards. So, they basically have more than 80 years of clinical evidence that could be very useful to tap into to answer questions about adaptation of bacteria, and any side effect to humans. Some answers about the co-evolution of bacteria and phages may also come in the future from the research that is now intensifying on the topic in soils, but we have to be realistic: Because of the inherent complexity of the topic, and the fact that, in that context, we start almost from ground zero, that research is likely to be very slow to yield practical results.
I fully agree with Philippe, I remember reading a wonderful photo reportage about the Eliava Institute in a German science magazine back in 2013, I think their work has been acknowledged more and more since then.
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