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Review Article | DOI: https://doi.org/10.31579/2690-1919/061
* Department of clinical pharmacy, Aditya Pharmacy College, East- Godavari District, Andhra-Pradesh, India
*Corresponding Author: G. Sunil Paul, Department of clinical pharmacy, Aditya Pharmacy College, East- Godavari District, Andhra-Pradesh, India
Citation: G. Sunil Paul, Phage Therapy, The Best Choice To Overcome Antibiotic Resistance, But Can Never Replace Antibiotics. J Clinical Research and Reports, 4(2); DOI:10.31579/2690-1919/061
Copyright: © 2020 G. Sunil paul. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received: 27 February 2020 | Accepted: 10 April 2020 | Published: 06 May 2020
Keywords: bacteriophages; replicate; superbugs; resistant; lytic phase; antimicrobial; therapy
Phages are also known as bacteriophages which are normally viruses that infect and replicate within the bacteria. Phages were first discovered by Frederick W. Twort (1915) and also by Félix d' Hérelle (1917). In 1920 some scientists and physicians used phages in humans for treating various bacterial infections when antibiotics were not yet discovered. Later phages therapy was promoted by F. d Herelle who used to travel many countries and helped others on how to use phage therapy in humans. In 1940 phages have lost their importance due to the discovery of antibiotics. [18] G. ELIAVA institute of bacteriophages in Georgia has never lost its interest on phage therapy, they never quit their research on phages till now. The researchers used to collect phages from Environment sources and store them in phage bank. This collection of phages by the ELIAVA institute has provided information on which phages can be selectively used against bacteria isolated for personalized therapies.
[1] Phages are also known as bacteriophages which are normally viruses that infect and replicate within the bacteria. Phages were first discovered by Frederick W. Twort (1915) and also by Félix d' Hérelle (1917). In 1920 some scientists and physicians used phages in humans for treating various bacterial infections when antibiotics were not yet discovered. Later phages therapy was promoted by F. d Herelle who used to travel many countries and helped others on how to use phage therapy in humans. In 1940 phages have lost their importance due to the discovery of antibiotics. [18] G. ELIAVA institute of bacteriophages in Georgia has never lost its interest on phage therapy, they never quit their research on phages till now. The researchers used to collect phages from Environment sources and store them in phage bank. This collection of phages by the ELIAVA institute has provided information on which phages can be selectively used against bacteria isolated for personalized therapies. However data from a single institute is not sufficient to approve medicines all over the world. Due to wide spread in antibiotic resistance, it became very hard for the healthcare provider to treat bacterial infections, so the rest of the world along with G. ELIAVA institute has kept their interest in utilizing phage therapy for treating infections in humans caused by superbugs[18].but there is a misconception that phage therapy can be a best alternative to antibiotic therapy. We cant completely replace antibiotics with phages, instead we can use them as adjavunt therapy. To approve phage therapy in clinical practice more data is needed which can be obtained by conducting more clinical trails. Studies which were conducted years ago do not provide enough data to approve phage therapy for clinical use. So, phage therapy will not be approved by the FDA until it clears all the stages of clinical trials. However, there are very few situations that phage therapy was very effective where antibiotics failed to do so. These are abundant in nature and are present wherever the bacteria are found like soil, water, deep within the earth's crust [4]. Oceans are a large source of phages it is estimated about 1030 bacteriophages in this world [4].
Why phages can’t replace antibiotics?
Disadvantages of phage therapy
When and how these phages destroy the bacteria?
Lytic phase is a part of phage life cycle, during which these phages produces specialized protein-based enzymes called lysins and send them into bacterial cytoplasm that are capable of degrading the bacterial cell wall and finally causes the lysis of bacteria [19].
How phages destroy the bacteria: phages after invading the bacteria undergo following steps [19]:
With their tail fibers these phages get attached to the bacterial cell wall. After the process of attachment these phages release their DNA into the host cell or bacterial cell, which causes the degradation of bacterial DNA after being incorporated into it. Then these phages their own viral genomes and proteins, all these genomes and proteins are assembled together to form a new phage. All these steps takes place during the lysogenic phase of phage life cycle [19,4].
After producing enough phages, these phages produces some proteins called lysins which causes the lysis of bacterial cell wall and are released out of the bacterial cell to attack other cell. This happens in the lytic phase of phage life cycle [19].
Reasons for antibiotic resistance? [11]
Bacteria are becoming resistant due to improper use of antibiotics. These bacteria have been developing different defence mechanisms to protect them from antibiotics.
Due to these reasons there is a need to find an alternative way to get rid of these resistant bacteria (superbugs) [11,14]. Examples of some lytic enzymes produced by phages and their specific hosts [1]:
These are few phage enzymes that infect and lyse the host cell [1].
Measures to be taken to prevent antibiotic resistance:
These measures are helpful in controlling the further resistance but can’t treat infections caused by bacteria which are already resistant to antibiotics [14]. So the world is focussing on different methods to treat infections caused by superbugs [11].
So the only weapon that we have now to overcome antibiotic resistance is phage therapy but this can not be used more than once in a patient.
When and how to use phage therapy in humans?
The phage therapy involves the use of bacteriophages, which are perfect weapons to kill the bacteria. These superbugs are dangerous to human body cells which make the person ready to die [19].
Note : always choose antibiotic therapy as 1st line therapy
If any other alternative is available, consider it as 2nd line therapy.
If there is no option and the patient is about to die then consider phage therapy as 2nd or 3rd line therapy.
In almost all cases where phage therapy was used, the scientists tried these phages only when the patient is about to die, this shows us that how danger the phage therapy is to humans. Apart from that we only have case reports which were successful. Phages are very dangerous when compared to antibiotics, [25]One of the best described disease-specific alterations in the gut phagobiome is associated with inflammatory bowel disease, where phages have pathogenic effects by inducing dysbiosis and microbiota disease[25]. So we should not use phages for treating infections which can be treated by antibiotis. We can use phages therapy as a last line therapy when there is no choice. Apart from that we can help to prevent antibiotic resistance by increasing awareness among the people.
So we conclude that phage therapy can only be a last choice for treating infections and can also be used as a supportive therapy but will never replace antibiotics.
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