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by Zemphira Alavidze, PhD Phage therapy can be very effective
in certain conditions and has some unique advantages over antibiotics. Bacteria also
develop resistance to phages, but it is incomparably easier to develop new phage than new
antibiotic. A few weeks versus years are needed to obtain new phage for new strain of
resistant bacteria. As bacteria evolve resistance, the relevant phages naturally evolve
alongside. When super bacterium appears, the super phage already attacks it. We just need
to derive it from the same environment. Phages have special advantage for localized use,
because they penetrate deeper as long as the infection is present, rather than decrease
rapidly in concentration below the surface like antibiotics. The phages stop reproducing
as long as the specific bacteria they target are dead. Phages do not develop secondary
resistance, which is quite often in antibiotics. With the increasing incidence of
antibiotic resistant bacteria and a deficit in the development of new classes of
antibiotics to counteract them, there is a need to apply phages in a range of infections.
Lytic phages are similar to antibiotics in that they have remarkable antibacterial
activity. However, therapeutic phages have some at least theoretical advantages over
antibiotics, and phages have been reported to be more effective than antibiotics in
treating certain infections in humans and experimentally infected animals. For example, in
one study, Staphylococcus aureus phages were used to treat patients having
purulent disease of the lungs and pleura. The patients were divided into two groups; the
patients in group A (223 individuals) received phages, and the patients in group B
(117 individuals) received antibiotics. Also, this clinical trial is one of the few
studies using i.v. phage administration (48 patients in group A received phages by
i.v. injection). The results were evaluated based on the following criteria: general
condition of the patients, X-ray examination, reduction of purulence, and microbiological
analysis of blood and sputum. No side effects were observed in any of the patients,
including those who received phages intravenously. Overall, complete recovery was observed
in 82% of the patients in the phage-treated group as opposed to 64% of the patients in the
antibiotic-treated group. Interestingly, the percent recovery in the group receiving
phages intravenously was even higher (95%) than the 82% recovery rate observed with all
223 phage-treated patients.
Comparison of the prophylactic and/or therapeutic use of phages
and antibiotics
| Bacteriophages |
Antibiotics |
Comments |
| Very specific (i.e., usually affect only the targeted
bacterial species); therefore, dysbiosis and chances of developing secondary infections
are avoided (15). |
Antibiotics target both pathogenic microorganisms and normal
microflora. This affects the microbial balance in the patient, which may lead to serious
secondary infections. |
High specificity may be considered to be a disadvantage of
phages because the disease-causing bacterium must be identified before phage therapy can
be successfully initiated. Antibiotics have a higher probability of being effective than
phages when the identity of the etiologic agent has not been determined. |
| Replicate at the site of infection and are thus available
where they are most needed (59). |
They are metabolized and eliminated from the body and do not
necessarily concentrate at the site of infection. |
The "exponential growth" of phages at the site of
infection may require less frequent phage administration in order to achieve the optimal
therapeutic effect. |
| No serious side effects have been described. |
Multiple side effects, including intestinal disorders,
allergies, and secondary infections (e.g., yeast infections) have been reported (76). |
A few minor side effects reported (17, 58) for
therapeutic phages may have been due to the liberation of endotoxins from bacteria lysed
in vivo by the phages. Such effects also may be observed when antibiotics are used (42). |
| Phage-resistant bacteria remain susceptible to other phages
having a similar target range. |
Resistance to antibiotics is not limited to targeted
bacteria. |
Because of their more broad-spectrum activity, antibiotics
select for many resistant bacterial species, not just for resistant mutants of the
targeted bacteria (47). |
| Selecting new phages (e.g., against phage-resistant
bacteria) is a relatively rapid process that can frequently be accomplished in days or
weeks. |
Developing a new antibiotic (e.g., against
antibiotic-resistant bacteria) is a time-consuming process and may take several years
(16, 51). |
Evolutionary arguments support the idea that active phages
can be selected against every antibiotic-resistant or phage-resistant bacterium by the
ever-ongoing process of natural selection. |
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