A Literature Review and Survey of Bacteriophage Therapy against Multidrug-Resistant Organisms and the Perceived barriers to Clinical Research

The emergence of antimicrobial resistance presents a global health concern. These infections can result in adverse or fatal health outcomes. Due to this phenomenon, the scientific community must consider effective alternative or supplemental treatments such as bacteriophage therapy. Bacteriophage therapy has been in existence for at least a century and has shown to alleviate multidrug resistant infections in multiple clinical trials in the former Soviet Union. However, at the present time, there are limited large-scale clinical evidence performed on patients in vivo, except for a few cases in the United States and Europe. The research question for this capstone project is “What are the perceived barriers to clinical research for bacteriophage therapy?” In this capstone paper, we explore the perceived barriers to clinical research through the evaluation of laboratory articles, human compassionate case studies and phage expert surveys. Both recent non-human in vitro and in vivo animal laboratory articles (n=10, post-2010) and human clinical articles (n=10, post-2009) present perceived barriers as further lab testing needed and large-scale clinical trials needed, respectively. The online survey from 29 phage experts state that perceived barriers consist of lack of funding and willing laboratories to perform clinical research, the scientific unknowns of bacteriophage therapy (i.e. side effects, bacterial resistance development, long term effects post-treatment and genes with unknown functions), the pharmaceutical lobby and the lack of rigorous clinical trials data outlining pharmacology, safety and efficacy. These perceived barriers influence the current state of bacteriophage therapy and explain the slow and cautious progression of the field. Bacteriophage therapy potentially serves as a promising treatment to avert further global morbidity and mortality. The acknowledgement and eventual removal of these perceived barriers would help to make it more accessible in medicine.