10 June, 2022
mkurnali.ge
Antibiotic resistance has been recognized by the World Health Organization (WHO) as a global problem. Yet a medicine is being produced in Georgia that can provide serious competition to antibiotics: bacteriophages. Three years ago, Ivane Chkhaidze, the clinical director of the Iashvili Central Children’s Hospital, was contacted by colleagues from the Netherlands about bacteriophages – highlighting the growing interest in bacteriophages, which were discovered by Georgian and French scientists a century ago, as an alternative to antibiotics in modern medicine.
We talked to Ivane Chkhaidze, the clinical director of Iashvili Hospital, about the problems caused by antibiotic resistance, phage therapy and “phages”.
When did medicine start using antibiotics?
The first antibiotic used in medicine was penicillin. It was discovered by Alexander Fleming in 1928 and was first used against infections in 1942. Medical circles thought that the invention of antibiotics had practically defeated infectious diseases. In the early years this was the case, leading doctors to believe that an appropriate antibiotic could be found for any infection found in the human body. Antibiotics worked effectively, and a huge range of them became available. For example, in 1983-92, the US Food and Drug Administration (FDA) licensed 30 new antibiotics for clinical use. But they haven’t licensed any more since 2010, because of the problem of antibiotic resistance, leading to a reconsideration of antibiotics.
What caused the change in attitude towards antibiotics?
It turns out that there are some bacteria against which antibiotics are powerless – even when used in combination. That has given modern medicine a big dilemma. We know that there are bacteria in the human body, but we do not have the resources to fight it. A new generation antibiotic, the fifth-generation cephalosporin, was last delivered in clinical practice in 2010. Although dozens of new antibiotics were developed in the 1970s and 1980s, it’s been nine years since modern medicine developed a new antibiotic to fight infections.
What caused antibiotic resistance?
The reasons are many. One of the main causes of antibiotic resistance is its inappropriate use., including the failure to complete the course of antibiotics prescribed by the doctor, the selection of the wrong dose, and the use of antibiotics in agriculture. But there are a number of other reasons that have caused the development of antibiotic resistance. This is a multifactorial problem.
Another cause is the way antibiotics work. They act not only on the specific bacteria that cause the disease, but also on all the bacteria in the body. In general, there are dangerous bacteria, as well as bacteria that are necessary for the body – which we call “friendly” bacteria. When treated with antibiotics, it’s not only the dangerous bacteria that cause the disease that die, but the friendly bacteria die too.
In addition, a wide range of drugs are particularly dangerous, as they destroy much more bacteria, damaging beneficial microflora. For example, during pneumonia, we prescribe the medicine we need to fight the bacterium that causes pneumonia, but at the same time it fights dozens of others that are not to blame for pneumonia. This is a negative side of antibiotics and one of the reasons for the development of its resistance.
How long can antibiotic resistance develop?
There is no specific timeline but this process become much faster. For example, after the introduction of penicillin into clinical practice in 1942, it took 24 years to develop resistance to it, whereas resistance to daptomycin developed in one year: its use began in 2003, but resistance developed in 2004. That is, we can say that eventually all bacteria become resistant to antibiotics.
What is the solution? What does world medicine have to do to solve the problem?
Bacteriophages were discovered by a French scientist, Felix D. Erel, in 1917, who pioneered the the use of bacteriophages in clinical practice in the 1920s alongside the Georgian scientist Giorgi Eliava. Bacteriophages can be an alternative to solve the problem of resistance. There was no particular need for its use in the previous century because there was an antibiotic that “worked” very well against the bacteria. But after the emergence of antibiotic resistance, attention returned to bacteriophages. Until now, the Phage production was used mainly in Georgia and in post-Soviet countries. Because the bacteriophage was confined to Russian-language literature, there was quite low awareness of it around the world. However, as the problem of antibiotic resistance worsened, we have entered a new stage in the history of bacteriophages with participation from foreign doctors, not only Georgian ones. Over the last 10 years, up to 100 English-language papers have been published on the drug.
To be more specific, what is the principle of bacteriophages?
Bacteriophages intentionally only destroy disease-causing bacteria in the body, without any negative side effects. The main factor distinguishing it from an antibiotic is that an antibiotic has an unintended effect on all the bacteria in the body, while a bacteriophage is more specific.
If we compare the instructions on phages and antibiotics, we can easily understand the main difference between ways they act. The instructions for the phage say that it is a remedy against five types of bacteria: Streptococcus, Staphylococcus, Escherichia coli, Proteus, and Pseudomonas. While the narrowest-spectrum antibiotic annotations list these five bacteria in parallel, the broadest range of antibiotics contains dozens. As a result, the wider the range of antibiotic action, the longer the list of side effects. Physiotherapy has no side effects. We should not forget the fact that the phage does not create a resistant microflora.
Is phage therapy prescribed before the development of inflammation or directly during inflammation?
Phages can be prescribed during inflammation, but you need to know exactly what the underlying cause is. It takes courage to fight inflammation without antibiotics. However, if the doctor is convinced that it is one of the five leading bacteria, then he can use phage therapy.
How often do you use phage therapy?
“Phagyo”, the Georgian phage therapy, can be used as it has proven its effectiveness in practice many times. I have one special story about this medicine. Three years ago, I was contacted by colleagues from the Netherlands about a bacteriophage produced in Georgia. They had a patient with cystic fibrosis, a congenital disease characterized by the presence of recurrent, bacterial inflammatory processes in the respiratory system. The patient was 18 years old and already had resistance to antibiotics, which put his life in danger. Conducting a course of phage therapy with this patient gave us much better results than antibiotic therapy.
It was after this incident that I became interested in phage therapy. It turns out that there are a number of recent interesting studies in English that have led it to be considered as a valid alternative to antibiotic therapy.
