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Phage therapy for severe bacterial infections: a narrative review

Aleksandra Petrovic Fabijan, Ali Khalid, Susan Maddocks, Josephine Ho, Timothy Gilbey, Indy Sandaradura, Ruby CY Lin, Nouri Ben Zakour, Carola Venturini, Bethany Bowring and Jonathan R Iredell
Med J Aust || doi: 10.5694/mja2.50355
Published online: 7 October 2019

Summary

  • Bacteriophage (phage) therapy is re‐emerging a century after it began.
  • Activity against antibiotic‐resistant pathogens and a lack of serious side effects make phage therapy an attractive treatment option in refractory bacterial infections.
  • Phages are highly specific for their bacterial targets, but the relationship between in vitro activity and in vivo efficacy remains to be rigorously evaluated.
  • Pharmacokinetic and pharmacodynamic principles of phage therapy are generally based on the classic predator–prey relationship, but numerous other factors contribute to phage clearance and optimal dosing strategies remain unclear.
  • Combinations of fully characterised, exclusively lytic phages prepared under good manufacturing practice are limited in their availability.
  • Safety has been demonstrated but randomised controlled trials are needed to evaluate efficacy.
  • Aleksandra Petrovic Fabijan1,2
  • Ali Khalid1,2,3
  • Susan Maddocks1,3,4
  • Josephine Ho1,2,4
  • Timothy Gilbey5
  • Indy Sandaradura1,3
  • Ruby CY Lin1,2,3
  • Nouri Ben Zakour1,2,3
  • Carola Venturini1,2,3
  • Bethany Bowring1,2
  • Jonathan R Iredell1

  • 1 Centre for Infectious Diseases and Microbiology, Westmead Hospital, Sydney, NSW
  • 2 Westmead Institute for Medical Research, Sydney, NSW
  • 3 University of Sydney, Sydney, NSW
  • 4 Westmead Hospital, Sydney, NSW
  • 5 Wagga Wagga Base Hospital, Wagga Wagga, NSW


Acknowledgements: 

This work is supported by grants (1104232 and 1107322) from the Australian National Health and Medical Research Council. AmpliPhi Biosciences Corporation partially contributed to the funding of a bacteriophage therapy investigator‐led clinical trial at Westmead Hospital and Westmead Institute for Medical Research.

Competing interests:

No relevant disclosures.

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