Batumi, Georgia from a mountaintop perspective, looking toward the Black Sea.

Batumi, Georgia from a mountaintop perspective, looking toward the Black Sea. A major port and resort destination, Batumi is Georgia's third largest city.

Uses and Applications

The proven effectiveness of phage therapy is matched only by the versatility of phages themselves as a potential solution for any problem which a bacterial pathogen creates. The section which begins immediately below provides a survey regarding the status of phage therapy as potential alternative for antibiotics across six diverse industries: Agriculture, Aquaculture, Environmental Protection, Food Safety, Health Care, and Veterinary Medicine. The second section below then presents a more in-depth exploration of several applications for phage therapy which relate to human health.

Industry Case Studies

Agriculture

As concerns continue to rise about the toxic effects of copper and other chemicals used to kill bacterial pathogens in agricultural settings, such as citrus groves,1 opportunities for phage therapy as a safe and natural alternative appear poised to grow significantly. Indeed, a phage therapy product which the U.S. Food and Drug Administration approved for use as a food safety additive "is considered organic, suggesting that organic growers could be a valuable market for phage biocontrol products."2

Aquaculture

According to a 2014 paper which evaluated phage therapy potential replacement for antibiotics in efforts to stem the death of fish larvae due to disease caused by Vibrio bacteria, "[p]hage therapy is a proven eco-friendly alternative approach to prevent and control pathogenic bacteria in aquaculture."1 Based on extensive testing which included an assessment of phage viability in a marine environment, this study concluded that "phage therapy is a suitable alternative approach
against vibriosis in aquaculture, with phage administration directly to the culture water as a promising method for treatment of fish larvae."2

Environmental Protection

In addition to the generally positive effects of replacing antibiotics with an all natural, non-toxic substitute like phages to achieve bacterial control, phage therapy is also playing specific roles in cleaning up our environment. According to a 2013 article in Environmental Health Perspectives, phage therapy has emerged as a potential alternative method for "drinking and wastewater treatment."1 Phages have proven particularly effective in destroying P. aeroginosa biofilms at drinking water treatment facilities; besting the performance of traditional chlorine treatment by a margin of 89% to 40% (the percentages representing the number of P. aeroginosa pathogens killed via each method).2

Food Safety

Beyond the phage-based food additive which the U.S. Food and Drug Administration has approved to combat "Listeria bacteria, a common source of food poisoning,"1 efforts to develop phage therapy preparations which address "Salmonella and a particularly virulent type of E.coli" are also underway.2

Health Care

    Phage therapy has routinely excelled in tests for efficacy to which it has fairly been subjected:
  • A 1963 study conducted "in Tbilisi, Georgia enlisted more than 30,000 children in a blind study and reported that incidences of dysentery were significantly lower amongst those who prophylactically received a weekly phage pill (1.8 cases per 1000) rather than a placebo (6.7 cases per 1000)."1. This test "fulfills the quality requirements of modern placebo-controlled randomized clinical trials" but "is to date only documented by a single table in an abstract," as reportedly, "the original data were irretrievably lost in the archives of the KGB."2
  • In a 1983 Polish trial which encompassed "several hundred patients with suppurative bacterial infections, most of which were drug-resistant, phage therapy achieved a 92.4% overall success rate."3
  • Finally, "in 2009, a double-blind Phase II clinical study showed phages to be safe and effective at treating chronic drug-resistant ear infections."4

Veterinary Medicine

As "approximately 80% of all antibiotics used in the U.S. are fed to farm animals,"1 the search for an alternative presents implications for both food safety and environmental protection. According to a report in Environmental Health Perspectives, the application of antibiotics contributes to the growth of antibiotic resistance: "Antibiotics . . . are given to farm animals to speed growth and prevent illness. They end up being flushed down drains and leach into soil and groundwater, where they contribute to environmental hot spots of antibiotic resistance."2 Further, "it is estimated that approximately 75 % of all antibiotics given to animals are not fully digested and eventually pass through the body and enter the environment, where they can encounter new bacteria and create additional resistant strains."3 Studies in chickens have shown phagey therapy's significant efficacy in remediating E.coli infections, while "[c]onvincing evidence for the efficacy of phage therapy" in addressing E.coli infections in calves "was obtained in an extremely carefully documented series of experiments."4

Health Care Applications

Phage Therapy as Preventative Medicine

When phage therapy products are used as directed, they can prevent infection by a specific array of bacterial pathogens (i.e., the strains of bacteria which the phages included in the product naturally attack). Accordingly, even if a particular phage therapy product does not work for a specific infection, taking this product can still offer protection from an additional (secondary or otherwise) infection by several potentially dangerous bacterial pathogens.

As the antibiotic resistance crisis has grown in the West due to overuse, medical practitioners have significantly restricted the instances in which they prescribe antibiotics - often assuming that a particular infection is "viral" until it persists long enough to be unmistakably bacterial in character. At the very least, medical practitioners wait to prescribe antibiotics until they have specifically identified the bacterial pathogen causing the infection; thereby at least partially undoing the putative benefit of a "broad spectrum antibiotic" (before medical science understood the harm associated with antibiotic overuse, the common practice was to prescribe an certain class of antibiotic based upon a range of symptoms alone, which enabled patients to obtain the relief of antibacterial treatment without waiting for proof of a specific bacterial infection).

Accordingly, in a strictly practical sense, the capacity of phage therapy to serve as preventative medicine could be its most powerful benefit for daily life. For example, parents who learn that students at their child's school have been suffering from strep throat can administer regular doses of Pyophage - a trademarked product of ABTI's exclusive partner, BiopharmL, LLC, which kills strains of Streptoccocus bacteria - in an effort to protect their child from that infection. It is not possible to "overdose" a phage therapy product, as phages are "natural viral predators which target bacteria but leave mammalian and plant cells unscathed."1 Expanding upon the example set forth above, if a parent administered Pyophage to a child as a preventative measure against a potential strep infection, the child would not be harmed if the strep phages in Pyophage did not, in fact, match the target strep causing the infection. The child would not receive the desired protection against that strain of strep, but would not have "lost anything" in trying this option. Finding no matching bacterial strains, the Pyophage would simply be eliminated from the child's body without any effects at all.2

If, however, the strain at issue did match a phage included in Pyophage, the child might avoid an extended absence from school and perhaps weeks of suffering (a portion of which would be due to the delayed availability of antibiotics, as described above) - not to mention multiple trips to receive medical attention and the costs associated therewith.

Phages as Antibacterial Probiotics

In addition to phage therapy's qualities as a preventative medicine, one group of scientists has suggested that phages could be accurately classified as probiotics, as phages "actually fit well the definition by the Food and Agriculture Organization (FAO) of the United Nations (UN) and World Health Organization (WHO) of probiotics: 'live microorganisms which, when administered in adequate amounts, confer a health benefit on the host.'”1 They explain that phages achieve a probiotic effect in the human gastro-intestinal tract by eradicating harmful bacterial pathogens without harming beneficial bacteria; potentially offering a "much more specific way" of restoring microflora balance than bacteria-based probiotics, which "introduce nonpathogenic bacteria to interfere with the ability of pathogenic bacteria to colonize the GI tract."2 The authors conclude that:

Phage-based probiotics would be used prophylactically rather than therapeutically, although it is clear that prophylactically supplied phages also could act therapeutically if administered early in bacterial infections. [Phage-based probiotics] are likely to be most successful for managing pathogens such as Salmonella spp., Clostridium difficile, diarrheagenic E. coli and other bacteria that have an oral portal of entry and require short- or long-term colonization of the GI tract in order to cause disease.

Phage Therapy and MRSA

The prospect of a Methicillin-Resistant Staphylococcus aureus (MRSA) infection continues to strike terror into the minds of hospital patients throughout the West. Reports have also emerged that MRSA has become "endemic in [U.S.] households," as well.1

Yet, "so far as phages are concerned," this potentially deadly antibiotic-resistant bacterial pathogen "is simply another strain of Staphylococcus. These pathogens are targeted by the anti-S. aureus activity of phage preparations such as Pyophage" 2 (NOTE: Pyophage, a trademarked product of ABTI's exclusive partner, BiopharmL, LLC, is a phage therapy preparation which treats or prevents MRSA).

A 2007 study by Dr. Leila Kalandarishvili (Director General of BiopharmL, LLC) found an efficacy rate in the high 90-percentile range among 2,500 patients who received Pyophage to treat a variety of infections. 40% of those patients suffered from MRSA. Phage therapy has also proven exceptionally effective as a means of preventing MRSA. "[E]xperimental hand washing with a phage-containing Ringers solution" achieved "[a]pproximately 100-fold reductions in bacterial densities," while "oral phage therapy" achieved "complete elimination of culturable MRSA" when applied to a nurse who had become a "carrier" of the disease.3

Phages as an Antiseptic for Wound Care

Wound care offers a particularly illustrative example of the power of phage therapy as preventative medicine. The Red Army used phage therapy preparations to significantly increase the survival rates of soldiers during World War II; while "Pyophage spraying of wounds has been employed by Georgian soldiers on the battlefield, reducing infection, prolonging the time over which treatment is optimally performed, and increasing rates of recovery."1

Accordingly, phage therapy products offer a safe, natural, and non-toxic alternative for the antibiotic creams and sprays which parents often use to treat the frequent and superficial cuts, burns, and scrapes which children receive on a regular basis.

NOTE: Parents and other consumers must not rely upon packaged commercial phage therapy products to treat advanced infections or deep wounds, as these products may not work due to a) a mismatch between the bacteria causing the infection and the phages included in the particular phage therapy product or b) the inability of phages to penetrate infected areas. Please refer to the Indications and Instructions which are downloadable from each product page for further guidance and limitations.

Phages as an Alternative to Toxic Disinfectants

As a broadening array of health problems are linked to the harsh and frequently toxic chemicals which serve as bacterial disinfectants in homes, businesses, and hospitals, phage-based solutions have become a viable "green" alternative. In Georgia, for example, "[u]se of phages for disinfection has been carried out . . . to sanitize operating rooms and medical equipment and [to] prevent nosocomial infections."1 Indeed, a policy paper on phages published by the Center for Disease Dynamics, Economics & Policy predicted that "with the ever-increasing problem of drug resistance, and the current positive momentum toward development of new, natural ("green"), and safe alternatives to antibiotics and chemical disinfectants, phage-based products seem poised for increased recognition and growth in the years ahead. 2