As antibiotics stop working, are we headed for the age of the phage?

The human race has a deadly drug problem. The scourge that poses an existential threat is not heroin or cocaine. Although such drugs do exact a heavy price on societies around the world, the cost of dealing with them is nothing compared to the looming disaster threatened by our out-of-control dependence upon antibiotics.

We owe much to antibiotics. After the discovery of penicillin in 1929, bacterial diseases such as pneumonia, bacterial meningitis, tuberculosis and even strep throat lost their power to kill with impunity. Antibiotics are used to prevent the risk of infection in patients undergoing surgery. Cancer patients receiving chemotherapy, which compromises the immune system, take antibiotics to guard against potentially fatal infections.

But just 90 years after Alexander Fleming witnessed the mold penicillin destroying the bacterium Staphylococcus aureus in a Petri dish, our love affair with antibiotics has turned sour.

Regarded as miracle drugs by patients and doctors alike, antibiotics have been dished out for decades — often for no good reason. They cannot kill viruses, for instance, yet many patients with viral infections demand antibiotics and often get them. The problem with this inappropriate overuse of antibiotics, as the World Health Organization has been warning for years, is that the bugs have developed resistance to antimicrobials, which are the agents that kill or prevent the growth of harmful micro-organisms.

As a result, according to WHO, treatments for a growing list of infections — including tuberculosis, sepsis, urinary tract infections, foodborne diseases and the once-tamed hospital bug MRSA — “have become less effective in many parts of the world.” Without antibiotics, “modern medical procedures such as major surgery, organ transplantation, treatment of premature babies, diabetes management and cancer chemotherapy will become very high risk.”

Some countries are waking up to this danger, including the UAE, which in 2018 ordered doctors to stop overprescribing antibiotics and clamped down on pharmacies that illegally issue the drugs without a prescription. The intervention was long overdue. Six years earlier, research published in The Lancet medical journal found that “in many Middle Eastern countries antibiotics can easily be obtained over the counter.”

Various studies have highlighted examples of irresponsible prescribing. One in Kuwait found that 50 percent of 270 patients with upper respiratory tract infections were given antibiotics, yet only eight actually needed them.

Bacteriophages (phages, for short) are viruses that attack bacteria, and there are an awful lot of them out there waiting to be useful.

Jonathan Gornall

Misinformation is partly to blame. According to a study by researchers at Imam Abdulrahman bin Faisal University in Dammam, published in 2018 in the journal BMC Public Health, some patients in Saudi Arabia firmly believe antibiotics are “for everything,” or that they can boost the immune system. Many stockpiled the drugs or took them with them when they went abroad, “just in case.” The study states that overuse has resulted in “exponentially growing antibiotic resistance” in the Kingdom.

Some countries are trying to address the problem. A conference on antimicrobial resistance in Dubai last March heard that the “relentless efforts” of the UAE’s Ministry of Health had resulted in a 43 percent drop in antibiotic use. But not every country is making such progress and until they all start to do so, it is a losing battle. A WHO review of 65 countries between 2016 and 2018 found wide variations in the volumes of antibiotics consumed, ranging from 4.4 to 64.4 daily doses per 1,000 inhabitants.

As resistance grows, the era of the antibiotic might well be drawing to a close, which is a scenario with the sort of apocalyptic consequences more usually seen in Hollywood disaster movies. There is hope on the horizon, however, and it comes not from a newly developed superdrug but from an alternative treatment to antibiotics that predates penicillin.

The bacteriophage was discovered 10 years before penicillin, but the science of the time lacked the ability to use it effectively and it was largely forgotten after Fleming’s discovery. Now it could prove to be the savior of humankind.

Bacteriophages (phages, for short) are viruses that attack bacteria, and there are an awful lot of them out there waiting to be useful. A recent paper in the World Journal of Gastrointestinal Pharmacology and Therapeutics hailed phages as “the most abundant biological entity on Earth, (which) play a crucial role in regulating bacterial populations (and) are responsible for the death of approximately 20 percent to 40 percent of all marine surface bacteria every 24 hours.” The researchers, from the University of California, Berkeley, concluded that although much is still unknown about the interactions between phages, bacteria and humans, “the time to take phage therapy seriously seems to be rapidly approaching.”

Trials in humans are already under way. In January last year, French researchers reported that a cocktail of 12 bacteriophages had successfully destroyed the bacteria in a dozen burns victims with dangerously infected wounds. They did so more slowly than the antibiotics given to patients in a control group, but the researchers concluded that efficiency would probably improve if the phages were used in greater concentrations.

In any event, if antimicrobial resistance continues to increase at its current runaway rate, the comparison with antibiotics could soon become academic and phages will be the only option left.

After a century in the wilderness, the bacteriophage’s time might have come — and not a moment too soon; experts believe that by 2050 resistance to antibiotics could be claiming 10 million lives every year.

• Jonathan Gornall is a British journalist, formerly with The Times, who has lived and worked in the Middle East and is now based in the UK. Copyright: Syndication Bureau