By Guus Veldkamp
About 100 years ago, the world was a very different place. The average life expectancy in the industrialized world was 46 for men and 48 for women. In the Netherlands the average is now 82 years, according to the CBS. This difference is huge. Two big contributors to this change are suggested to be improved sanitation and the rise of pharmaceutical antibiotics[1-3]. The latter must have saved millions of lives; infectious diseases that were once feared, have now become easily treatable. Unfortunately, this might not last forever. Antibiotic resistance is becoming a major threat to the current medical treatment of common infectious diseases. There are, however, suggestions for alternatives for antibiotics, with a return to bacteriophage therapy as one of the more popular suggestions.
Bacteriophage therapy was something I had personally never heard of, until a recent episode of “Dokters van Morgen” brought it to my attention. In this episode, they explained what it was, but why it is hardly known in western medicine was also discussed.
Basically, bacteriophages are virus-like compounds that target a specific bacterium or group of bacteria. They reproduce inside the bacterial host, killing it in the process, while remaining harmless to other bacteria or organisms. Bacteriophages are the most common organisms on earth and play a key role in regulating bacterial populations.
Using bacteriophages for therapeutic purposes is not a recent development, but there is a recent increase in interest in them. In the pre-antibiotics era they were investigated but the results were mixed and the arrival of antibiotics in the 1940’s secured their dismissal. In contrast to bacteriophages, antibiotics can target a whole array of different bacteria and are therefore significantly easier to use and develop. In addition, antibiotics are more effective against infections of unknown origin.
Unfortunately, antibiotics are not perfect. The biggest problem is obviously antibiotic resistance. Furthermore, antibiotics have many known side effects, like nephrotoxicity or ototoxicity. They can induce anaphylactic reactions and they target beneficial bacteria in the gut microbiome as well. Bacteriophages are, theoretically, safer than antibiotics because they target the harmful bacteria and nothing else. However, there is a lack of clinical trials to prove this. Most importantly, bacteriophages are not susceptible to antibiotic resistance and are naturally able to evolve their own mechanisms to overcome bacteriophage resistance.
Since the problem of antibiotic resistance is only going to grow, bacteriophage therapy might just be worth considering. There are still some technical difficulties to overcome, but perhaps it becomes a healthcare-revolution, as the introduction of antibiotics was 70 years ago. This time without the problem of resistance, I hope.
 Derek M Lin, Britt Koskella, and Henry C Lin. Phage therapy: An alternative to antibiotics in the age of multi-drug resistance. World J Gastrointest Pharmacol Ther. 2017 Aug 6; 8(3): 162–173.
 South-East Asia Regional Office. (2018). Water, Sanitation and Hygiene: An essential ally in a superbug age. Available at: http://www.searo.who.int/mediacentre/features/2017/water-sanitation-and-hygiene-an-essential-ally-in-a-superbug-age/en/ [Accessed 17 Jan. 2018].
 World Health Organization. Antimicrobial resistance global report on surveillance. Geneva: Switzerland; 2014.
 World Health Organization. (2018). Antimicrobial resistance. Available at: http://www.who.int/mediacentre/factsheets/fs194/en/ [Accessed 17 Jan. 2018].
 Dokters van Morgen: uitzending 24 oktober 2017. AVROTROS. Available at: https://zorgnu.avrotros.nl/uitzendingen/24-10-2017/
 Koskella B, Brockhurst MA. Bacteria-phage coevolution as a driver of ecological and evolutionary processes in microbial communities. FEMS Microbiol Rev. 2014;38:916–931.