2023-06-29 16:00:00
Antibiotic resistance is an important public health problem. And the solution might come from bacteria-eating viruses, harmless to humans, called phages (or bacteriophages). Swiss doctors came up with the idea of using them to treat a patient with a recurrent antibiotic-resistant lung infection. This practice, known as phage therapy, is not really new. Although it had been neglected by most Western doctors in the 1960s, it is still used in Eastern European countries, and might be a response to antibiotic resistance.
Phages: a last chance treatment
José-Maria Vidal has Kartagener syndrome. This genetic disease which affects the respiratory tract and prevents the expulsion of mucus by the hair cells, promotes the development of recurrent pulmonary infections. Superinfections became more numerous in the patient when a mountain bike accident made him quadriplegic at 36 years old. This is how pneumonia led him to be hospitalized between December 2019 and May 2020 at the University Hospitals of Geneva.
Despite continuous intravenous antibiotic treatment, no improvement was observed. Faced with this desperate situation, the doctors suggested that the 40-year-old try phage therapy.
“When we tried to stop the antibiotic therapy, I had fever peaks at 40 which did not go down, my lungs became engorged with mucus which I might not expectorate, I was suffocated. We tested this protocol (antibiotics, administered intravenously continuously, 24 hours a day, 7 days a week, editor’s note) for one or two months, but nothing worked… I no longer had the strength to fight. That’s when I was offered to try phage therapy.”recalled the now 45-year-old patient, in the pages of the Swiss newspaper The weather.
Antiresistant infection: the search for the most suitable phage
For phage therapy to be effective, it is essential to determine which phage has the capacity to destroy the bacterium responsible for the recurrent infection. In the case of José-Maria Vidal, the bacteria responsible was Pseudomonas aeruginosa. Doctors therefore set out to search for the most suitable bacteriophage in the phage banks of scientific laboratories around the world. Eventually he was identified and found at Yale University in the United States.
“The American team made this phage available to us for free and we were therefore able to start the treatment by administering it by aerosol, while continuing the antibiotics. To be honest, I was not completely reassured at the beginning, but following three days the patient was already breathing significantly better, following four he was no longer producing mucus.The result was impressive, and apart from a small fever on the first day, no other side effects were reported and we were quickly able to reduce the intake of intravenous antibiotics every other day”explained Professor Christian Van Delden, associate assistant physician in the infectious diseases department of the HUG and author of the research in the newspaper Le Temps.
A second cycle of phage treatment was carried out a year and a half later when the infection returned. It allowed the patient to continue taking antibiotics only in the form of aerosols at home.
Phage therapy: a long journey before the green light from regulatory agencies
Although the results of this case study published in the journal Nature Communications show promise, phage therapy still has many steps to take before it becomes a routine treatment offered in Western hospitals. The European and American regulatory agencies are indeed slow to grant the necessary authorizations for the use of this method. The reason ? To be effective, this type of treatment must be individualized for each patient, which complicates the implementation of randomized trials.
“We hope that our publication reassures health agencies regarding the efficacy and safety of phage therapy, thus facilitating the development of this strategy on a larger scale”told Professor Christian Van Delden to the Swiss magazine.
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