Bacteriophage Therapy: Alternatives to Antibiotics

[micromass]

Antibiotics have come a long way since their discovery. But I think it will happen quite soon that they'll be ineffective. So what are the alternatives? I've read a bit about bacteriophage therapies which could possibly form an effective alternative to antibiotics. On the other hand, the government currently do not allow any bacteriophage therapy on humans. So why is this? Why isn't this alternative taken seriously?

 

[DiracPool]

On the other hand, the government currently do not allow any bacteriophage therapy on humans

What government?

https://en.wikipedia.org/wiki/Phage_therapy

"Washington and Oregon law allows naturopathic physicians to use any therapy that is legal any place in the world on an experimental basis.[49]

In Texas phages are considered natural substances and can be used in addition to (but not as a replacement for) traditional therapy; they've been used routinely in a wound care clinic in Lubbock, TX, since 2006.[50]"

 

[Ygggdrasil]

On the other hand, the government currently do not allow any bacteriophage therapy on humans. So why is this? Why isn't this alternative taken seriously?

The FDA approves therapies for clinical use only after therapies have been proven safe and effective in clinical trials. No bacteriophage therapy has passed this bar yet.

One challenge with bacteriophage therapy is that bacteriophages are very species specific whereas antibiotics typically act on a more broad spectrum of bacteria. Bacteriophage therapy may require advances in rapid diagnosis to identify the exact bacteria involved before phage therapy becomes practical.

 

[Fervent Freyja]

The largest challenge here is that the pharmaceutical and biotechnology industries need a big incentive (funding, of course) for developing and testing so many specific phage therapies/alternatives than can realistically be supported. Also, antibiotics are cheap and have set the bar low for treatment costs, that is a large-scale change for many different entities involved. I think the alternative isn't being taken so seriously because humans wait until it's a full-blow crisis before doing anything.

As far as diagnosis, in my area, I've sensed a large communication barrier in the healthcare field and research. Many diagnoses are now being left to nurse practitioners and nurses are making more decisions than ever before, my fear is that they aren't exactly obligated to remain so relevant or may not even have the initial training... Very young children are constantly being prescribed antibiotics for common infections that are not supported by clinical trials to be beneficial. I have had at least 2 ER nurses 'diagnose' my daughter with a middle ear infection before checking her! We can assume if there are so many issues in making a diagnosis at those levels already, where many infections are diagnosed with symptoms, not lab reports, and not always by doctors, then there will be as many in using phage therapy. That could be a good thing though, it would force the diagnosis to be proved first?

 

[Fervent Freyja]

The FDA approves therapies for clinical use only after therapies have been proven safe and effective in clinical trials. No bacteriophage therapy has passed this bar yet.

One challenge with bacteriophage therapy is that bacteriophages are very species specific whereas antibiotics typically act on a more broad spectrum of bacteria. Bacteriophage therapy may require advances in rapid diagnosis to identify the exact bacteria involved before phage therapy becomes practical.

What is going on here? Did you have the letter y in your username capitalized? I swear it was a lower-case y not long ago! Please tell me, it's driving me bonkers looking at it! I need to know. I do like it much better this way though.

 

[Ygggdrasil]

What is going on here? Did you have the letter y in your username capitalized? I swear it was a lower-case y not long ago! Please tell me, it's driving me bonkers looking at it! I need to know. I do like it much better this way though.

I haven't changed anything recently, and as far as I know, it's always been capitalized. Maybe the font somehow changed?

 

[Fervent Freyja]

I haven't changed anything recently, and as far as I know, it's always been capitalized. Maybe the font somehow changed?

Huh, then I really did write it incorrectly in a prior post. It's one thing to know when you are wrong and let the mistake slide, but another when you don't realize it until way later, if ever. Thanks.

 

[epenguin]

Funny name.

 

[Ryan_m_b]

It's worth noting that phage therapy is still used in Russia and other former Soviet Union nations:
http://www.nature.com/news/phage-therapy-gets-revitalized-1.15348

I started typing out a longer answer but in the course of looking up a few facts found this article which seems pretty comprehensive on the matter:

What are the limitations on the wider use of phage therapy?
Alexandra Henein, 2013
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3821673/

Bacterial resistance to antibiotics poses a serious health threat. Since research into new antibiotics is not progressing at the same rate as the development of bacterial resistance, widespread calls for alternatives to antibiotics have been made. Phage therapy is an ideal alternative candidate to be investigated. However the success of phage therapy may be hampered by a lack of investment support from large pharmaceutical companies, due to their narrow spectrum of activity in antibiotics, very large costs associated with clinical trials of the variety of phages needed, and regulatory requirements remaining unclear. Intellectual property is difficult to secure for therapeutic phage products for a variety of reasons, and patenting procedures vary widely between the US and the EU. Consequently, companies are more likely to invest in phage products for decontamination or veterinary use, rather than clinical use in humans. Some still raise questions as to the safety of phage therapy overall, suggesting the possibility of cytotoxicity and immunogenicity, depending on the phage preparation and route. On the other hand, with patients dying because of infections untreatable with conventional antibiotics, the question arises as to whether it is ethical not to pursue phage therapy more diligently. A paradigm shift about how phage therapy is perceived is required, as well as more rigorous proof of efficacy in the form of clinical trials of existing medicinal phage products. Phage therapy potential may be fulfilled in the meantime by allowing individual preparations to be used on a named-patient basis, with extensive monitoring and multidisciplinary team input. The National Health Service and academia have a role in carrying out clinical phage research, which would be beneficial to public health, but not necessarily financially rewarding.

 

[Laroxe]

Its not that "Big Pharm" whoever that is, is disinterested, there has been quite a lot of work done on using phages and indeed Russian has the largest collection of phages on the planet. The problem is that bacteriophages are viruses that attack bacteria, treatment would involve injecting large doses of these live viruses into the body to destroy the invading organisms, so far no one has worked out a way of telling our own immune system that these phages are on our side, they see this as a further challenge and react accordingly. Even using phages to treat local wounds can only be done for a short period before causing a reaction.
I've read somewhere that it might be possible to use some of the new genetic technology to get around this, but nothing recently.
Antibiotic resistance is interesting in that its not just about antibiotic use, bugs are capable of sharing resistance by exchanging genetic code, with good antibiotic control, particularly if some can be taken off the market, these pieces of code will have no function and will probably be exchanged for something more useful. There is also the possibility because many antibiotics are natural products, the organisms that produce them may be pushed into making changes themselves, this is the very essence of natural selection. Though I don't suppose we should hold our breath.