„Beyond antibiotic therapy“ – Zukünftige antiinfektiöse Strategien – Update 2017

115

104

Bacteriophage therapy has recently attracted increased interest, particularly in difficult-to-treat infections. Although it is not a novel concept, standardized treatment guidelines are currently lacking. We present the first steps towards the establishment of a “multidisciplinary phage task force” (MPTF) and a standardized treatment pathway, based on our experience of four patients with severe musculoskeletal infections. After review of their medical history and current clinical status, a multidisciplinary team found four patients with musculoskeletal infections eligible for bacteriophage therapy within the scope of Article 37 of the Declaration of Helsinki. Treatment protocols were set up in collaboration with phage scientists and specialists. Based on the isolated pathogens, phage cocktails were selected and applied intraoperatively. A draining system allowed postoperative administration for a maximum of 10 days, 3 times per day. All patients received concomitant antibiotics and their clinical status was followed daily during phage therapy. No severe side-effects related to the phage application protocol were noted. After a single course of phage therapy with concomitant antibiotics, no recurrence of infection with the causative strains occurred, with follow-up periods ranging from 8 to 16 months. This study presents the successful outcome of bacteriophage therapy using a standardized treatment pathway for patients with severe musculoskeletal infection. A multidisciplinary team approach in the form of an MPTF is paramount in this process.

Section: Discussionmentioning

confidence: 87%

Bacteriophage Application for Difficult-To-Treat Musculoskeletal Infections: Development of a Standardized Multidisciplinary Treatment Protocol

Onsea

Soentjens

Djebara

et al. 2019

115

104

“…The patient received three ampules per day. Finally, his drainage secretion was sterile, and he received a prosthesis [10].…”

Section: Recent Phage Therapy Trialsmentioning

confidence: 99%

Phages Needed against Resistant Bacteria

Moelling

2020

Phages have been known for more than 100 years. They have been applied to numerous infectious diseases and have proved to be effective in many cases. However, they have been neglected due to the era of antibiotics. With the increase of antibiotic-resistant microorganisms, we need additional therapies. Whether or not phages can fulfill this expectation needs to be verified and tested according to the state-of-the-art of international regulations. These regulations fail, however, with respect to GMP production of phages. Phages are biologicals, not chemical compounds, which cannot be produced under GMP regulations. This needs to be urgently changed to allow progress to determine how phages can enter routine clinical settings.

“…A significant reduction of a contamination with pan-resistant P. aeruginosa was achieved by surgeons of the German Military Hospital, Berlin, while treating a war-injured patient with a mixture of phages from the Eliava Institute, antibiotics and other detoxifying agents. The authors stress the importance of combining phages with antibiotics and even discuss antimicrobial peptides or photodynamic therapies in combination with phages [74]. Phages may increase the uptake of antibiotics into bacterial cells.…”

Section: Recent Developments In Phage Therapymentioning

confidence: 99%

“…Phages may increase the uptake of antibiotics into bacterial cells. Therefore, phage therapy is likely most effective when combined with antibiotics [74,75,76,77,78]. In this effort Jean-Paul Pirnay from the Queen Astrid Military Hospital in Brussels, Belgium, also participated, who is an advocate of phage therapy and published a proposal for guidelines on how phage therapy can be implemented today [1].…”

Section: Recent Developments In Phage Therapymentioning

confidence: 99%

A Wake-Up Call: We Need Phage Therapy Now

Moelling

Broecker

Willy³

2018

111

The rise of multidrug-resistant bacteria has resulted in an increased interest in phage therapy, which historically preceded antibiotic treatment against bacterial infections. To date, there have been no reports of serious adverse events caused by phages. They have been successfully used to cure human diseases in Eastern Europe for many decades. More recently, clinical trials and case reports for a variety of indications have shown promising results. However, major hurdles to the introduction of phage therapy in the Western world are the regulatory and legal frameworks. Present regulations may take a decade or longer to be fulfilled. It is of urgent need to speed up the availability of phage therapy.