The viral solution to antibiotic resistance

Antibiotic resistance is making some infections harder to fight than ever before. Some bacteria have become so resistant that even the strongest antibiotics are useless against them. With fewer options available, doctors are turning to phage therapy–an experimental treatment using viruses found in nature that target and destroy specific bacteria.

Phage therapy has only IND (Innovative New Drug) and compassionate treatment approval by medical regulators like FDA and EMA for individual cases and isn’t widely available. Only a few people around the world have received it. One of the first people in India to take this treatment was Pranav Johri. In 2016, at age 33, he faced a stubborn prostate infection that no antibiotics could cure. After exhausting all options, he turned to phage therapy at Eliava Institute, a century-old institute dedicated to bacteriophage research and application in Georgia.

Ten years ago, getting doctors and medical institutions to even accept the problem of AMR was a huge challenge. Since then, we’ve come to a point where everyone acknowledges the problem, and we’re working on ways to tackle it.

Johri’s experience speaks to the promise of phage therapy in fighting antibiotic-resistant infections, even as access remains limited. We spoke to him, now running Vitalis Phage Therapy which is the official Indian partner of the Eliava Phage Therapy Center, to understand how this treatment fits into the global fight against antimicrobial resistance.

Understanding phage

Q. How long have you been involved in the field of AMR?

My involvement in the field of AMR started from my own experience of going through an antibiotic resistant infection not being able to find answers from the medical community. I live in Delhi and was seeing the top doctors in the city. Unfortunately, they had nothing to offer to a patient suffering from an antibiotic-resistant infection. After multiple failed antibiotic treatments, my doctors declared my infection to be multi-drug resistant and prescribed me a buffet of medicines to ‘manage’ my infection and symptoms since it could not be treated with antibiotics. That led me to look for alternative treatments in cases where antibiotic treatments fail, and that led me to phage therapy. After the successful treatment of my multi-drug resistant infection with phage therapy, my wife and I founded Vitalis Phage Therapy.

We started the initiative with two goals. First, to raise awareness about AMR and its impact on the patient's quality of life, as well as on life itself. Second, to promote phage therapy as an effective way to combat antibiotic-resistant infections. That’s how I got involved in the field of AMR.

Today, we are working with medical institutions, across the country for phage therapy treatments for their patient suffering from antibiotic resistant infections. We’ve organised treatment for cases of urinary tract infections, lung infections, wound infections, and even sepsis.

Q. What is the procedure like? When and why does it fail? 

Phage therapy is not a standardised treatment but a customised approach to tackling bacterial infections using bacterial viruses (phages), the natural predators of bacteria. The specific phage used depends on factors such as the sensitivity of the bacterial strain to that specific phage, whether the infection is acute or chronic and the patient’s condition. The approach is different for each case but is very effective in fighting antibiotic resistance when other treatments no longer work.

Since we started six years ago, we have organised phage therapy treatments for over 250 people, with a success rate of 70–75%. However, success can vary. For example, if someone has a urinary or kidney infection caused by kidney stones, the stones must be removed. Otherwise, they provide a safe place for bacteria, causing the infection to come back.

In some cases, like advanced sepsis, treatment may fail if started too late. This often happens when the patient is already in a coma or the infection in the bloodstream has become too severe.

Q. Why is the treatment not yet popular in India? 

There are many reasons for this, including political, historical, and regulatory factors.

Phage therapy is currently available in India and 145 other countries as a compassionate treatment. Patients can use it as a personalised option because it’s not yet part of standard medical protocols due to regulatory issues.

Today, phage therapy is at least recognised by regulators as a real option for treating bacterial infections. Work is ongoing to research and create ways to make it more available and accessible.

Taking responsibility

Q. What can be done better in terms of creating awareness? 

The challenge in India is that we face two problems: access and excess. In big cities like Delhi, Bangalore, Mumbai, Hyderabad, or Chennai, we deal with excess, where people are overusing and misusing antibiotics. They take antibiotics for conditions where they are not needed, like viral infections, and they don’t follow the correct dosage guidelines.

But if you move 200 kilometres away from the big cities and into the countryside, the problem shifts to access. Most people in rural areas don’t even have pharmacies or drug stores where these medicines are available.

Also read: Inside Tamil Nadu's battle against AMR

Awareness is the biggest challenge and needs to be addressed. Whether it’s in agriculture, the food industry, or animal husbandry, there is so much overuse and misuse of antibiotics. These antibiotics enter our food chain and our bodies.

It's like inoculation: the bacteria gets exposed to antibiotics and develops resistance. When we actually need antibiotics for an infection, the bacteria may already be resistant.

When the season changes and viral infections increase, people start taking antibiotics without thinking. Most aren’t even aware of the risks they’re putting themselves and the community at. Antimicrobial resistance (AMR) is not an individual risk, it’s a community risk. We all share the same water, sewage, and food, so it’s all connected. There’s a concept called One Health, which means we need to address the issue from the perspective of the whole environment and ecosystem, not just in isolation, because that would not be effective.

The government, regulatory bodies, and other stakeholders must focus on raising awareness. We need awareness campaigns like those for smoking. For example, cigarette packages carry clear warnings about the risks of smoking and lung cancer.

We need similar mass campaigns for AMR. Only then will society as a whole recognise the problem. Today, AMR is mostly known only within the scientific and medical communities, and not widely understood by the general public.

Q. What can an individual do? 

There are many things we can do. Most people are taking antibiotics when they don’t need them. Why is this happening? We need to stop it. We need to address the issue at the level of both doctors and pharmacies. Why are they prescribing antibiotics so often?

People should be saying, don’t give me antibiotics. Today, you can even buy colistin at pharmacies, even though it’s a controlled medicine. These issues need to be addressed at the regulatory level. We’re still far behind. While many guidelines exist on paper, there’s a gap when it comes to real-world implementation.

Q. How focused are the stakeholders on the problem of AMR? 

There is growing focus on the issue. Ten years ago, getting doctors and medical institutions to even accept the problem of AMR was a huge challenge. Since then, we’ve come to a point where everyone acknowledges the problem, and we’re working on ways to tackle it.

During COVID, every country tracked the number of infections. If we did the same for AMR, we would see similar numbers. It needs that same level of focus.

We are making progress, but the pace needs to speed up because AMR is not slowing down. It’s growing exponentially.

The problem requires a focused approach, just like how the world responded to COVID, including regulators, medical institutions, and the scientific community. We need the same focus for AMR because it’s just as much of a pandemic. It’s silently killing people because it doesn’t get the same media attention COVID did.

During COVID, every country tracked the number of infections. If we did the same for AMR, we would see similar numbers. It needs that same level of focus.

Also read: What happens when you stop taking antibiotics midway