The rapid spread of antibiotic resistance threatens medical progress and drifts us into a post-antibiotic era, where common infections or minor injuries will kill. The number of new antimicrobials under clinical development remains extremely limited and their progression into the clinical market is disappointingly slow, highlighting the urgency for innovative approaches in the management of multi-drug resistant (MDR) infections.
The ubiquitous bacterial viruses named bacteriophages, which are at least 10 times more abundant in the environment than bacteria, represent such an alternative. Soon after their discovery in the beginning of the 20th century and because of their capacity to kill bacteria, lytic bacteriophages were used as therapeutic agents for the treatment of human bacterial infections. The first success of the so-called “phage therapy” has been reported in 1919 when D’Hérelle cured five hospitalised children from severe dysentery in Paris. Between 1920 and 1940, approximately 150 scientific papers on phage therapy were published each year. At that time, phage preparations were used to treat numerous diseases caused by various bacterial species. Phage therapy was also used in Lausanne where Feihl treated 77 patients suffering from S. aureus infections with phages prepared by the bacteriology laboratory of the “Cantonal Hospital”. In 1949, he reported a success rate of 83% in his medical dissertation.
The discovery of penicillin in 1928 and its massive production since World War II prompted the disappearance of phage therapy in the Western World despite its proven efficacy. As a consequence, the last bacteriophage preparation still available in France was withdrawn from the pharmacy stock list in the late 70s. However, phage therapy did not totally disappear. Georgia, Russia, and Poland continued to produce therapeutic phage preparations and millions of patients suffering from a great variety of infectious diseases are still successfully treated with only very few side-effects.
In response to the constant increase of bacterial resistance to antibiotics, phage therapy currently encounters a high renewed interest in the Western World. For instance, the French “Commissariat Général à la Stratégie et à la Prospective” recently recommended the Government to phage therapy as follows: i) finance clinical trials, ii) stimulate fundamental research, and iii) produce phage cocktails according to Good Manufacturing Practice standards. Indeed, regulatory agencies considers that phage therapy should go through the same authorisation procedures as any new human medication.