The following is the second of two guest posts by SamD* from Auckland New Zealand who describes his first hand account of his unsuccessful Phage Therapy in Georgia. Sam had a complicated infection treated by antibiotics for many years. Post 1 is his tale and Post 2 is his thoughts about phage therapy considering his experiences.
Sam is very interested in thoughts or suggestions regarding his case and can be contacted at email@example.com *This is a pseudomonym.
The Lessons I learned regarding Phages
- Patients needing treatment of multi-pathogenic environments with a history of extensive antibiotic treatment require a treatment facility who are experienced, who are transparent about potential treatment outcomes, rigorously establish sensitivities to antibiotics and use them unfailingly concurrently, and persevere with the concurrent treatment until all pathogenic responses are resolved.
- A phage treatment plan’s schedule must differentiate between physiologically complex, possibly multi-pathogenic environments like urogenital and airway systems, versus muscle-tissue infections like the classic lower limb examples often associated with phages, and allocate time and money accordingly, the first as much as a magnitude of 6 over the second.
- That 6 over 1 assessment: Much of the time allotted to be spent at a treatment provider is spent waiting for the production of phages, if problems arise as a result of the actual use of the phage, there will very likely be no time to deal with the consequences unless significant extra funds are spent. Arrival >> tests taking up to 7 days for results >> Phage preparation time (if a match is available) 2 weeks to 3+ months >> Virulent reaction to phage >> the long process starts all over again.. and.. etc.
- Phage in-Clinic treatment v. long-distance both have pros and cons that at first glance confers no distinct advantage either way. An in-Clinic presence should offer more prompt treatment and better communication but the enormous consideration of waiting time and charges should negate these advantages, until the virulent reactions are considered. In many countries, rigorous testing and the availability of a wide range of antibiotics for best sensitivity choice may be absent, so the distance patient upon taking the new bacteriophage** and antibiotic (only targeted to the last infection, not the next) would be in a difficult position medically if another infection appeared as a result.
- The application of the first bacteriophage didn’t only bring about a new dominant infection, it meant the phage treatment of the original target had to be immediately discontinued and on retesting, the original bacteriophage was no longer highly-specific to the original infection and had to be re-produced. As well, antibiotic sensitivities of the original infection changed markedly. (Note: in an uncomplicated treatment schedule that phage would not be discontinued, and one would expect to remove the pathogen, albeit with months of phage-taking, alternating 3 weeks on, 3 weeks off, to avoid immune system responses).
What happens next?
- I had read the NZ Herald Massey Phages Project article in the closing days in Tbilisi and contacted Dr Hendrickson soon after my return, hence this post. She showed great interest and has been extremely helpful in analysing the elements of phage treatment and encouraging the treatment experience to be recorded on the Phage Hunt NZ blog.
- I next wrote to the second “International” Bacteriophage Clinic in Tbilisi giving them the phage treatment/repeat infection details with no country/clinic details to see what they would say; a paraphrased summary of several emails is “With multi-pathogenic environments like the urogenital system, we must always administer antibiotics concurrent with a phage. It is common for new, ascendant infections to occur. Nevertheless, we continue producing phage solutions and administering concurrent antibiotics for each occurrence, without stopping until no more appear. We usually find the ascendant infections are variants of the original infection being treated, as against your second different bacteria infection.” (The current infection has similar antibiotic sensitivities to the last Staphylcoccus haemolyticus report which suggests it is now a variant of the last infection).
- Being back in New Zealand with an unknown infection also means a return to a medical system which offers no answers or treatment ability for complex urogenital infections. As before, the infection became chronic in the two weeks that passed in returning to New Zealand from its first occurrence. My system seems to have seen so many antibiotic courses and repeat infections that an infection quickly moves to a state where symptoms are virulent and debilitating, but sub-acute, and the local simplistic detection method of urinalysis fails the WBC level entry requirement for culture. No positive culture, no treatment of any kind. I have failed over a long time to find anyone in New Zealand in public medical practice who understands the significant differences in physiological status, and detection methods required, between acute and chronic pathogenic urogenital conditions. Microscopy, EPS tests, a consideration of the role of bacterial slime and biofilms have all proved to be beyond the scope of locally available treatment. Post-phage I am back to depending on an antibiotic to poorly maintain a condition more virulent and with a wider tissue spread than at any time in the past.
Bacteriophage Therapy Protocol Summary
- It would be an understatement to say I know how a phage guinea pig might feel after a failed experiment; but more recently received information confirms for me that although my experience cannot be easily learned from available internet-based information, the phage treatment Clinic kept the realities of treatment complications close to the chest, only revealing them when they had to and were quick to deny further treatment when the going required persistence and resilience.
The second commercial Tbilisi phage Clinic has now offered to pick up where their peers left off, and rigorously progress treatment to a conclusion, however the cost involved so far has been fairly substantial and the money has run out.
- A Bacteriophage protocol in this area appears to need a lot more work; ideally an in-vitro test of an environment sample with the newly produced bacteriophage before application, if such a thing were possible, and a phage cocktail of a much wider spectrum for any one bacterial species. Otherwise the current treatment method as seen in Georgia presents an unaffordable monetary cost for many prospective patients.
If anyone has questions or observations you’d like a reply to, you can write to me here: firstname.lastname@example.org
**Where Bacteriophage is written in BOLD, Sam had initially used the word Autophage, a term that he came across in Georgia and which appears to be the way clinicians there refer to Bacteriophages used therapeutically.