Phage therapy pioneered the use of phages in treating bacterial infections Phages were discovered to be antibacterial agents and were used in the former
Soviet Republic of
Georgia (pioneered there by
Giorgi Eliava with help from the co-discoverer of bacteriophages,
Félix d'Hérelle) during the 1920s and 1930s for treating bacterial infections. D'Herelle "quickly learned that bacteriophages are found wherever bacteria thrive: in sewers, in rivers that catch waste runoff from pipes, and in the stools of convalescent patients." They had widespread use, including treatment of soldiers in the
Red Army. However, they were abandoned for general use in the West for several reasons: • Antibiotics were discovered and marketed widely. They were easier to make, store, and prescribe. • Medical trials of phages were carried out, but a basic lack of understanding of phages raised questions about the validity of these trials. • Publication of research in the Soviet Union was mainly in the
Russian or
Georgian languages and for many years was not followed internationally. • The Soviet technology was widely discouraged and in some cases illegal due to the
red scare. The use of phages has continued since the end of the
Cold War in Russia, Georgia, and elsewhere in Central and Eastern Europe. The first regulated, randomized, double-blind
clinical trial was reported in the
Journal of Wound Care in June 2009, which evaluated the safety and efficacy of a bacteriophage cocktail to treat infected venous ulcers of the leg in human patients. The FDA approved the study as a Phase I clinical trial. The study's results demonstrated the safety of therapeutic application of bacteriophages, but did not show efficacy. The authors explained that the use of certain chemicals that are part of standard wound care (e.g.
lactoferrin or silver) may have interfered with bacteriophage viability. The study concludes that bacteriophage preparations were safe and effective for treatment of chronic ear infections in humans. Additionally, there have been numerous animal and other experimental clinical trials evaluating the efficacy of bacteriophages for various diseases, such as infected burns and wounds, and cystic fibrosis-associated lung infections, among others. Meanwhile, bacteriophage researchers have been developing engineered viruses to overcome
antibiotic resistance, and engineering the phage genes responsible for coding enzymes that degrade the biofilm matrix, phage structural proteins, and the enzymes responsible for
lysis of the bacterial cell wall. Therapeutic efficacy of a phage cocktail was evaluated in a mouse model with nasal infection of multi-drug-resistant (MDR)
A. baumannii. Mice treated with the phage cocktail showed a 2.3-fold higher survival rate compared to those untreated at seven days post-infection. In 2017, a 68-year-old diabetic patient with necrotizing pancreatitis complicated by a pseudocyst infected with MDR
A. baumannii strains was being treated with a cocktail of Azithromycin, Rifampicin, and Colistin for 4 months without results and overall rapidly declining health. Because discussion had begun of the clinical futility of further treatment, an Emergency Investigational New Drug (eIND) was filed as a last effort to at the very least gain valuable medical data from the situation, and approved, so he was subjected to phage therapy using a percutaneously (PC) injected cocktail containing nine different phages that had been identified as effective against the primary infection strain by rapid isolation and testing techniques (a process which took under a day). This proved effective for a very brief period, although the patient remained unresponsive and his health continued to worsen; soon isolates of a strain of
A. baumannii were being collected from drainage of the cyst that showed resistance to this cocktail, and a second cocktail which was tested to be effective against this new strain was added, this time by intravenous (IV) injection as it had become clear that the infection was more pervasive than originally thought.
Other Food industry Phages have increasingly been used to safen food products and to forestall
spoilage bacteria. Since 2006, the
United States Food and Drug Administration (FDA) and
United States Department of Agriculture (USDA) have approved several bacteriophage products. LMP-102 (Intralytix) was approved for treating ready-to-eat (RTE) poultry and meat products. In that same year, the FDA approved LISTEX (developed and produced by
Micreos) using bacteriophages on cheese to kill
Listeria monocytogenes bacteria, in order to give them
generally recognized as safe (GRAS) status. In July 2007, the same bacteriophage were approved for use on all food products. In 2011 USDA confirmed that LISTEX is a clean label processing aid and is included in USDA. Research in the field of food safety is continuing to see if lytic phages are a viable option to control other food-borne pathogens in various food products. Switzerland authorized a phage for use in cheese production in 2016. The European Union has not yet (2025) authorized any.
Water indicators Bacteriophages, including those specific to
Escherichia coli, have been employed as indicators of fecal contamination in water sources. Due to their shared structural and biological characteristics, coliphages can serve as proxies for viral fecal contamination and the presence of pathogenic viruses such as rotavirus, norovirus, and HAV. Research conducted on wastewater treatment systems has revealed significant disparities in the behavior of coliphages compared to fecal coliforms, demonstrating a distinct correlation with the recovery of pathogenic viruses at the treatment's conclusion. Establishing a secure discharge threshold, studies have determined that discharges below 3000 PFU/100 mL are considered safe in terms of limiting the release of pathogenic viruses.
Diagnostics In 2011, the FDA cleared the first bacteriophage-based product for in vitro diagnostic use. The KeyPath MRSA/MSSA Blood Culture Test uses a cocktail of bacteriophage to detect
Staphylococcus aureus in positive blood cultures and determine
methicillin resistance or susceptibility. The test returns results in about five hours, compared to two to three days for standard microbial identification and susceptibility test methods. It was the first accelerated antibiotic-susceptibility test approved by the FDA.
Counteracting bioweapons and toxins Government agencies in the West have for several years been looking to
Georgia and the former
Soviet Union for help with exploiting phages for counteracting bioweapons and toxins, such as
anthrax and
botulism. Developments are continuing among research groups in the U.S. Other uses include spray application in horticulture for protecting plants and vegetable produce from decay and the spread of bacterial disease. Other applications for bacteriophages are as biocides for environmental surfaces, e.g., in hospitals, and as preventative treatments for catheters and medical devices before use in clinical settings. The technology for phages to be applied to dry surfaces, e.g., uniforms, curtains, or even sutures for surgery now exists. Clinical trials reported in
Clinical Otolaryngology Phage display Phage display is a different use of phages involving a library of phages with a variable peptide linked to a surface protein. Each phage genome encodes the variant of the protein displayed on its surface (hence the name), providing a link between the peptide variant and its encoding gene. Variant phages from the library may be selected through their binding affinity to an immobilized molecule (e.g., botulism toxin) to neutralize it. The bound, selected phages can be multiplied by reinfecting a susceptible bacterial strain, thus allowing them to retrieve the peptides encoded in them for further study.
Antimicrobial drug discovery Phage proteins often have antimicrobial activity and may serve as leads for
peptidomimetics, i.e. drugs that mimic peptides.
Phage-ligand technology makes use of phage proteins for various applications, such as binding of bacteria and bacterial components (e.g.
endotoxin) and lysis of bacteria.
Basic research Bacteriophages are important
model organisms for studying principles of
evolution and
ecology.
Agriculture Phages can be used to combat bacterial infections such as
blackleg. A line of phage-based products is licensed in the United States, and Georgia has long used agricultural phages. Elsewhere, research and pilot testing are still underway. This is notably the case in Switzerland, where research is being conducted by the Fribourg School of Engineering and Architecture in collaboration with the
Lausanne University Hospital (CHUV). ==Detriments==