[nextos]

We need more research in bacteriophages. They can be engineered to avoid any resistance, and they can replace antibiotics in all use cases.

Besides, they are much more selective. Getting antibiotics when needed is OK, but they can lead to other health complications down the road.

[clnq]

Phage therapy is already used in Eastern Europe and Russia. I received phage therapy there myself against an antibiotic-resistant GI infection about 15 years ago. It has been effective. Of course, this is a sample size of 1.

I genuinely believe that ideological and political stigma still stands in the way of phage research and use in the West as it did in the cold war when phages were considered "Soviet". More thoughts on this - https://www.theguardian.com/science/2019/may/09/cold-war-pol....

Soviets, Russian and Georgian scientists did a lot of good work; I'm ashamed to see it shunned in Western medicine when I know it can already be effective and save lives if an industry developed around the medical use of phages. Lives lost to antibiotic resistance in the West will be the price of politicizing science.

More on the normality of clinical phage use in the Soviet Union and Eastern Europe - https://www.tandfonline.com/doi/pdf/10.1586/14789072.2.6.815.

[hristov]

Another reason why phages aren't used in western countries is that it is difficult to make money off of them. As I understand it, phages are bred uniquely for each strain which means it is difficult to patent them. The strains change all the time, therefore the phages have to change, by the time you get a patent for one, it is already likely to be ineffective.

Furthermore, the process of breeding phages for each disease is something drug companies really do not want to do. They want to manufacture pills, ship them in boxes to hospitals and get their money. Doesn't work with phages. You have to take samples at the hospital from a patient of the bacteria, breed a phage that eats that bacteria and then send that phage back to the patient.

This kind of back and forth seems way to expensive and complicated to the modern drug company. They do not want to build infrastructure around all the country's hospitals to ship contagious samples and to have labs all over the country to breed and manufacture phages.

[clnq]

I don't know how the economics can or would work out for a modern drug company. It's agreeable that Western personalized medicine seems to lag behind Europe and Asian countries like China.

However, this Georgian phage producer does sell patentable boxed-up phages that consume common bacteria, like S. aureus, which has been discussed for its antibiotic resistance in academia a lot - https://phage.ge/products/pyo-bacteriophage/?lang=en. Years ago, I stumbled across some online stores that used to sell these products in Europe and the US, but now I can't find them.

This makes me think that a traditional distribution model for these drugs can work. But there is too much medical skepticism for phage demand. And phages are often slower to work than antibiotics, so the latter option is more practical in treatment... when it works.

[rdedev]

The problem with phages is that our immune system can recognize them easily and flush them out of the body. It doesn't stick around long enough to do the work. It could work if the dose is massive or if the infection is localized to one specific area.

Btw this is what I learnt from reading a blog from someone who has worked with this stuff. I'm not a biologist and it's been a long time since I read that article so I can't seem to find it. So take the above stuff with a grain of salt

[krisoft]

> The problem with phages is that our immune system can recognize them easily and flush them out of the body.

The problem with phages is that they are finicky to administer. There is no "get this phage and it will kill all bacteria in and around you" treatment. They are specific. This of course has its own benefits too, but makes the process of administering harder.

With antibiotics the doctor comes to the conclusion that it is a bacterial infection. Then they write a prescription. And then you can buy the drug from any drug store. Antibiotics are largely shelf-stable and there is only a handful of different ones, so any drug store can keep all the major ones.

With phages the pipeline is more complicated.

You need to take a sample from the patient, you need to cultivate it, and then you need to check which phage or phage cocktail gets rid of that specific bacteria the best. That is a lot of lab work. Won't work at scale unless we automate it. And then there are questions like: How do they keep the phages healthy and happy? Are they working with a fixed selection of phages (a phage library if you will) or do they try phages based on the symptoms? Once they know which phage is the right one how does the patient get them? Can we stock them in our existing drug stores? Are they shelf-stable / can they be made shelf-stable? Which phages should the drug stores stock?

All of this can be of course answered and the problems ironed out. We put a man on the moon after all. We can do hard things if we want to. It is just a lot of faff.

[rdedev]

The reason I explained in my previous comment deals with the interaction between our body and the phage. A lot of drugs fail in this phase. What works in a cell culture need not work in the body. Even if you find the right phase for your infection it still might not work. All this might be solved with genetic engineering. But there a lot of work to do.

Also as an aside, physics is easier than biology. Once you figure out a solution that works, it always works in the future. The moon is not actively changing its orbit to survive. Bacteria or cancer for that matter always end up finding a way to overcome

[nextos]

This is not necessarily true. Our gut has trillions of bacteriophages. They are actually really useful as they keep bacterial populations under control.

Many bacteriophages are not immunogenic, i.e. our immune system will ignore them. Others are very immunogenic, and are actually used as vaccine platforms.

[rdedev]

Bacteriophages in the bloodstream is different from our gut. Our gut has a lot of bacteria too but the immune system rarely bothers with them till they start popping up outside the guy. We've coevolved with phages for a long time. So our immune system knows that they are mostly benign but don't like them hanging around the bloodstream and flush them out pretty quick

[Fomite]

Posted above, but putting it here too:

Phage comes up a lot here - it seems to be on of HN's favorite biology topics. I have a deep and abiding fondness for phage, but they're not quite as awesome as they seem at first glance. From the perspective of an infectious disease epidemiologist who has been super-interested in phage for my whole career (literally tried to get a job out of undergrad with a phage therapeutics startup):

1) There's no such thing as a "broad spectrum" phage. They're organism specific, and that means not only would you need to keep a phage library on hand, but you'd have to do a lot of diagnostic tests. That's going to be both expensive and tricky. There are treatment guidelines for things like sepsis right now that are basically un-doable with phage therapy because of the time it takes to tune a phage library.

2) Phages are living things. Not only is that a weird regulatory framework to be in for a drug, but it also means that you need to be able to keep phage alive. In contrast, antibiotics are inert.

3) Phage therapy is also relatively new in the West (after being abandoned for some very real, very serious safety concerns back in the day), which means there's just less of a R&D infrastructure behind it.

There have been people working on commercializing phage therapy since I was in undergrad (I'm now a tenured professor). The problem is it's hard, and antibiotics are so much better as a treatment that there's kind of a ceiling on the excitement that they can generate, especially when trying to treat at scale.