Last week we looked at the past and present of antibiotics, the situation in Germany, and how bacteria may be winning the war against infection prevention. I also mentioned the accidental discovery of bacteriophages in the 1920s, which was overshadowed by Fleming’s penicillin discovery.

Two men who were working independently made this discovery around the same time. The circumstances were very similar to Fleming’s, in that specimens were left on a slide.

These specimens were water from a city river to enable the study of the cholera bacteria. The laboratory was in the Georgian capital of Tbilisi. When George Eliava next looked at the slide, three days later, the bacteria had gone.

There had been something else in the water which was a natural enemy to cholera and that was ‘bacteriophages’ – a name given by Felix d’Herelle, a French-Canadian scientist.

Ultimately Eliava and d’Herelle collaborated, working together on ‘phages’, as they became known. They worked at a new institute in Tbilisi and after a number of years they created more than a dozen phages which could treat a whole range of bacterial infections.

At the time, bacteriophages became part of conventional medicine in the then USSR. The result was phage therapy, which continued to flourish in the USSR, while in the US and in most of the western world, antibiotics were produced and used widely.

Some of the successes were the treatment of Russian soldiers during World War II. As a result, this therapy was successful in countering dysentery and gangrene, and treated the soldiers’ wounds. Interestingly, this therapy continued after the war and became the treatment of choice in Russia. However, due to the restrictions of the Cold War, the research did not spread into the western world.

On reflection, this treatment would probably not have been as popular as antibiotics due to the disadvantage of treatment time. Whereas a ‘broad spectrum’ antibiotic would be used to treat an infection, phage treatment does not have the ‘broad spectrum’ possibilities.

There is only one phage for each bacteria. The virus works by closing in on the bacteria alone, and destroying it. For example, there has to be an Escherichia coli bacteriophage to counteract the E. coli bacteria.

This means that the doctor has to be sure of what is causing the infection before treatment, as there is no such thing as a broad spectrum bacteriophage. However, this could be considered an advantage as the broad spectrum antibiotics are the ones that have caused the most trouble according to Superbug – Nature’s Revenge by Geoffrey Cannon – a book I referred to last week.

The advantages of phage therapy are that the side-effects compared with antibiotics are greatly reduced. One of the main issues with antibiotics is the effect on the immune system which is not apparent when using phage therapy.

Also, phages have a natural ability to adapt quickly, as quickly as the bacteria they treat. In comparison, antibiotics are a result of millions of years of evolution, frozen in time. While the bacteria they are treating continues to adapt, they remain constant.

As Cannon states in his book, “When you take antibiotics, the drug kills vast numbers of bacteria in your gut and elsewhere, on and in your body, but countless millions remain. The bacteria that survive include species unaffected by the drug… after a number of courses of antibiotics, these surviving micro-organisms are liable to multiply and to fill the space created by the drug.”

The rise of the Superbug, described in Cannon’s book, has advanced as he prophesised. Unfortunately, research into phage therapy began to dwindle in the USSR, and by the mid-1970s the Eliava Institute had virtually closed down.In 1993 the institute closed down completely.

Researchers had saved phage samples and taken them home to store in their fridges. Today, phage therapy is only active in Georgia and, to a lesser extent, in Poland.

In 1994, the West started to take a new interest in phage therapy. Researchers used it to help improve the success of skin grafts in laboratory mice. Phages for killing Listeria, the food poisoning bacteria, have started to be used in the West.

A clinical study of phage therapy for a middle ear bacterial infection has begun at London’s Royal National Throat, Nose and Ear Hospital. In addition, a research team in the US has begun to test phages against various antibiotic resistant bacteria, such as MRSA and E. coli in venous leg ulcers.

There is no doubt that antibiotics were a great success in medicine and saved millions of lives. However, the age of antibiotics is coming to an end and perhaps we now have to look towards nature’s own antibiotics.

Bacteriophages are nature’s own answer to bacteria and there is one phage for every bug.

Apparently, they are found in limitless supply. As the original founders did, just put a bucket in any river and they can be fished out in their trillions. They then adapt along with the bacteria.

Obviously, more research is required; the Russians seem to have a wealth of it already and clearly more is continuing. We are looking at the age of bacteriophages and the fading out of antibiotics.

It is a welcoming thought.

kathryn@maltanet.net