Abstract
Superficial bacterial infections, such as dermatological, burn wound and chronic wound/ulcer infections, place great human and financial burdens on health systems globally and are often complicated by antibiotic resistance. Bacteriophage (phage) therapy is a promising alternative antimicrobial strategy with a 100-year history of successful application. Here, we report a systematic review of the safety and efficacy of phage therapy for the treatment of superficial bacterial infections. Three electronic databases were systematically searched for articles that reported primary data about human phage therapy for dermatological, burn wound or chronic wound/ulcer infections secondary to commonly causative bacteria. Two authors independently assessed study eligibility and performed data extraction. Of the 27 eligible reports, eight contained data on burn wound infection (n = 156), 12 on chronic wound/ulcer infection (n = 327) and 10 on dermatological infections (n = 1096). Cautionary pooled efficacy estimates from the studies that clearly reported efficacy data showed clinical resolution or improvement in 77.5% (n = 111) of burn wound infections, 86.1% (n = 310) of chronic wound/ulcer infections and 94.14% (n = 734) of dermatological infections. Over half of the reports that commented on safety (n = 8/15), all published in or after 2002, did not express safety concerns. Seven early reports (1929–1987), described adverse effects consistent with the administration of raw phage lysate and co-administered bacterial debris or broth. This review strongly suggests that the use of purified phage to treat superficial bacterial infections can be highly effective and, by various routes of administration, is safe and without adverse effects.
Highlights
The antibiotic resistance crisis threatens to return medicine to the pre-antibiotic era and is predicted to cost up to $100 trillion and lead to an annual 10 million premature deaths by 2050 [1,2]. The effects of this crisis are compounded by a decline in the number of new antibiotics brought to market, driven by a range of factors that discourage investment [2]
[34], seven from grey records were identified from other sources; three from a review article [34], seven from grey literature literature sources to to bebe indexed or available online and and another published after sources known knowntotothe theauthors authorsnot not indexed or available online another published the search date but included for completeness
While phage therapy was disregarded by Western medicine, Russia and other Eastern European countries, Georgia, continued to employ phage therapy [3], and today phage therapy products are still available over the counter in pharmacies [60]
Summary
The antibiotic resistance crisis threatens to return medicine to the pre-antibiotic era and is predicted to cost up to $100 trillion and lead to an annual 10 million premature deaths by 2050 [1,2]. The effects of this crisis are compounded by a decline in the number of new antibiotics brought to market, driven by a range of factors that discourage investment [2]. Phage therapy has remained commonplace in Eastern Europe and the former Soviet Union, with institutions such as Eliava (Tbilisi, Georgia) and Hirszfeld (Wroclaw, Poland) continuing to carry out phage production, research and therapy [5]
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