If one has a urinary tract infection, for instance, the pathology lab will identify the bacterium to be, say, Escherichia coli. It will also determine the pathogen’s sensitivity to over a dozen antibiotics. It is ne if the bacterium is sensitive to many or all of the drugs.
The nightmare scenario is when it is resistant to all of them. Increasingly, antibiotics don’t work because the bacteria have developed resistance. It is estimated that globally, about million people are dying of conditions related to an- timicrobial resistance each year. This may double by 2050. It is a silent pandemic. What is the solution? Largely, pharmaceutical companies have lost interest in developing new antibiotics. Whereas a drug for cancer is used for a long time, antibiotics are given for just a few days. Also, due to the problem of AMR, new antibiotics are used as sparingly as possible to prevent the development of resistance. Therefore, there is no nancial incentive for companies to work on new antibiotics.There is some drug development happening, but probably not enough to address the AMR problem. Bacteriophages are ‘good viruses’ that naturally prey on bacteria. They are all around us, in the water, in the soil, in our gut, on our skin, etc. There are believed to be 10 times as many phages as bacteria on earth.
Phages were beginning to be used against bacterial infections about a century ago, but antibiotics superseded them once they were discovered. Unlike an antibiotic, phages may only kill a few strains of a particular bacterium. Therefore, only countries in the Soviet bloc, cut o from the antibiotics, continued to use them. An institute in Tbilisi, Georgia, with over 100 years of experience, is famous for its phage expertise. Due to AMR, the rest of the world is now rediscovering phages, and relevant research is ongoing in many countries. Phages have been used for burns, foot ulcers, gut infections, respiratory infections, urinary tract infections, etc. There are two main strategies that have been used. One, isolate the bacteria from the infected tissue, check which phage works against it in the lab, grow more of that phage, and administer it to the patient. These phages may come from a phage bank of one’s own, or in very serious cases, one may even ask phage banks elsewhere in the world for help.These are natural phages.Then there are genetically engineered phages, which have been modi ed in the lab to, say, expand the variety of bacteria they can kill. The world is desperate for new treatment modalities for AMR. Thus far, no government in the Western world has approved a phage as a drug. But they may allow patients to access phages in the form of“compassionate use”, “emergency-use expanded access,” or “special access”routes. These are often approvals for single, named patients who are in desperate need. Yet another route, used in Belgium for instance, is the “magistral route” where particular pharmacies can ‘compound’ a phage speci cally for a particular patient.The regulatory headache may be solved if the following scenario, which
Jean Paul Pirnay and colleagues in Belgium are researching, works out.
Create a device in which all of the following steps can be conducted: isolate the bacteria from an infection, sequence its genome, use AI to determine which phage genome is the most likely to work, create the phage from scratch in the device, and administer it to the patient on the spot.
In such a scenario, the phage wouldn’t be regulated as a drug. Instead, the device would be regulated. And the device would only contain routinely used molecules, such as nucleotides and enzymes that would be used to assemble the phage. The scale of AMR is such that we need many large initiatives to tackle it. If a group of microbiologists is looking for a grand challenge that uses AI, surely the Pirnay route is one worth exploring?
Vijay Garg
Retired Principal Educational columnist Eminent Educationist street kour Chand MHR Malout Punjab
Saturday, July 19, 2025