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Latest news on the strange story of Phage

You may remember the section in The Solutions Focus book about the strange story of phage - the virus that eats bacteria. An evolving alternative to antibiotics, phage evolve along with bacteria and so offer a possible way to deal with bacteria which develop resistance to antibiotics. The parallel is with 'every case is different' (phage) vs 'every case is the same' (antibiotics).

I thought you might be interested to know that the development of phage treatments is continuing, with the first set of clinical trials carried out in the west (as opposed to the former eastern bloc, where these things have been used for ages).

This appeared in New Scientist last week:

Viruses could kill superbugs that antibiotics can't
23 April 2009 by Catherine de Lange

A VIRUS that gobbles up the bacteria that cause debilitating ear infections could become the next weapon against antibiotic-resistant bacteria, after the first clinical trial of a bacteriophage treatment proved successful.

The trouble with bacteria is that they can evolve to outsmart antibiotics, secreting enzymes that break them down, or developing extra pumps to force drugs out of their cells. Because antibiotic resistance hampers treatment for common diseases including pneumonia, salmonella and tuberculosis, it is a growing public health problem.

Pseudomonas aeruginosa, which can cause ear infections, is particularly hard to treat because it wraps itself in a biofilm - a layer of sugars and proteins that make it up to 1000 times as resistant to antibiotics as a non-biofilm from the same species.

Now a single dose of Biophage-PA, which contains a virus that selectively attacks P. aeruginosa, has successfully treated long-term sufferers of antibiotic-resistant ear infections.

The therapy's key ingredients are viruses called bacteriophages. These "eaters of bacteria" break down the biofilm and destroy target cells, without harming other useful bacteria in the body.

Phages break down the biofilm to destroy target cells, without harming useful bacteria
Andrew Wright from University College London Ear Institute and colleagues studied 24 people with severe ear infections (Clinical Otolaryngology, accepted for publication). Half the volunteers were given Biophage-PA and the rest received a placebo.

Pain, pus secretion and inflammation were reduced in both groups, but the change was twice as noticeable in the group on the treatment. The number of target bacteria in the ear was significantly reduced in this group, while there was no significant reduction in the placebo group. By the end of the six-week trial, three patients on the phage were clear of infection.

Phages are routinely used to treat infections in eastern Europe but in an unregulated way, says David Harper, who worked on the trial. "There is a lot of anecdotal evidence," he says, "but this is the first time it has been tested in a clinical trial to see if it really works."

There are other advantages too, says Harper. You only need to give one dose, unlike regular courses of antibiotics which people sometimes forget to finish, making resistance more likely. Standard antibiotics can also damage hearing by destroying delicate hairs in the ears needed to transmit sound.

"This trial is an important step forward," says Lucinda Hall, a microbiologist from Barts and The London School of Medicine, but warns there are challenges ahead, notably the possibility that bacteria might evolve resistance to this treatment too.

Harper is now working with the US army to see if similar phages could treat wound infections, and is developing an aerosol treatment for lung infection in patients with cystic fibrosis.

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