Phage therapy — bacteria-killing viruses — might be the most important alternative and adjunct to antibiotics.
Phage therapy remains experimental in the West while the trials collect data. For patients to access it today, they must either receive it from a company sponsor with FDA permission for compassionate use or participate in a trial.
“Surveillance is the key,” Merril says. “By testing a patient’s bacteria against the phage we have in order to provide them with their personalized treatment, we are getting a double benefit — not only matching to the patient but we’re also doing surveillance to see what bacteria is out there, and if we don’t have coverage, we have an entire team dedicated to taking that bacteria and discovering new phage that can be added to the collection.
Of course, phage therapy needs to be cost effective to manufacture, and regulators will need to broaden the scope of what can be considered an off-the-shelf medicine. Developers anticipate that the FDA may eventually approve a vast library of phage that can be continuously expanded, once efficacy data is available, rather than a single phage at a time.
Our increasingly sophisticated tools, like gene editing and machine learning, are further accelerating those changes for the benefit of patients in need. Importantly, she says, phage can be synergistic with antibiotics, so even if a certain phage doesn’t directly kill the bacteria, it can put selective pressure on the bacteria to mutate in such a way that it becomes sensitive to antibiotics again.
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