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Viruses vs. Superbugs: A Solution to the Antibiotics Crisis?

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Phage therapy, like passive immunization, is a great "back to the future" medical story. It has gotten some attention from science journalists but, to date, everybody has just told part of the story. Thomas Hausler, in writing "Viruses vs Superbugs", has filled out the story and offers a persuasive case for phage therapy's continued relevance. The history chapters are especially fascinating. I was not previously aware of the extent to which epidemiological studies had been conducted.

This is mostly a history of bacteriophage therapy with an emphasis on the pioneering work of French bacteriologist Felix d'Herelle beginning before World War I. Much of the early work was done during the Great War in places like the Soviet Union to combat bacterial infection associated with battlefield wounds. D'Herelle himself went to such places as India to study cholera phages and was able to save the lives of many people.

Bacteriophages are viruses that exclusively attack bacteria much the same way other viruses attack our cells by invading and taking over the DNA machinery to reproduce themselves. After getting the bacterium to produce perhaps as many as a thousand or more viruses the phages burst open the bacteria cells walls with enzymes and flow out to attack other bacteria. With such a multiplier effect it doesn't take long to infect and destroy billions of bacteria. Typically there are some bacteria that are immune to the particular phage but their numbers are so small that our immune systems finish them off. Some of the cures in the book have been spectacular. Hausler reports on dying patients up and feeling fine in a day or two.

Over the years there were many such successes. However, because the actual studies and experiments were conducted with less rigor than modern standards require and because there were dosage problems and unsubstantiated claims, bacteriophage therapy has had a checkered history. When penicillin and other antibiotics came into widespread use in the forties, phage therapy was all but forgotten. Now with bacteria becoming more and more resistant to antibiotics, interest in phage therapy has returned. Hausler devotes a significant portion of the book to describing the problems and promises of phage therapy and explains why progress toward using phages against resistant bacteria has been so slow.

Where it seems likely that new successes will occur (and are occurring) is in veterinarian medicine. Until it becomes easier (and cheaper) to get phage products through the FDA in the US, most of the work will probably be with animals, especially those animals like cows, pigs, and chickens that become our food. With part of the problem of bacteria becoming resistant to antibiotics due to their use in animal feed, using phage therapy instead, or in combination with antibiotics, could become widespread.

While it is true that bacteria evolve and become resistant to their phages, it is also true that phages themselves can evolve to bypass bacterial resistance. In other words there is a primordial "arms war" going on between phages and bacteria of which we can take advantage. One method microbiologists use to find phages that work against specific bacteria is to take water from sewers where the bacteria have been excreted from people or animals and search that water for phages. There will be found the phages that have evolved to attack the bacteria that have evolved!

The book has plenty of endnotes and a good index. Of special interest perhaps are the appendices, one listing common bacteria and what they do to us, and the other detailing the advantages and disadvantages of phage therapy.

All and all this is a good introduction to an exciting and promising area of medical science. But note well the question mark at the end of the book's subtitle: "A Solution to the Antibiotic Crisis?" It would appear that phage therapy will not solve the crisis by itself, but will most likely allow us to rely less on antibiotics, thereby allowing some antibiotics to be used for longer periods of time before bacterial resistance sets in.

Even though I have done a fair amount of study of bacteriophages this book informed me of much I didn't know. For example, the use of phages during an epidemic in Los Angeles in the '40's. Well written and highly recommended for anyone intrested in the history of this subject.