Reckless overuse of antibiotics has led to several disease-causing bacteria – like Mycobacterium tuberculosis that causes TB developing resistance to medicines.
In the summer of 2016 as Delhi sweltered, Pranav Johri was feeling the chills. The 33-year-old businessman had felt a pulling pain in his groin region a few weeks ago that only grew worse, coupled with a low fever and persistent aches. He was soon diagnosed with Chronic Bacterial Prostatitis along with Chronic Epididymitis an inflammation of the prostate gland and the epididymis, caused by a bacterial infection. He was prescribed a 10-day course of antibiotics, and, when it didn’t show visible results, a four-week course of a second antibiotic.
Nothing worked. A second doctor and urine culture later in August, he was put on a different antibiotic regime but with little result. “Every summer, my wife and I would go mountaineering. Now, I couldn’t even move normally without assistance,” he said.
As October rolled around, Johri was running out of options the pelvic pains had worsened, so had the chills and shivers. His doctor suggested the bacterial infection was antibiotic-resistant and his best bet would be to manage symptoms. “It was like a wave hitting me, my doctor admitting that we had run out of options. I started to consult and read up on antibiotic resistance. It is then that I read about phage therapy,” he said.
What Johri had stumbled on was no new frontier in medical science but a 100-year-old system that pivots on naturally occurring viruses, or phages, to attack and destroy bacteria. Phage therapy is certified for human treatment only in a few European countries, primarily Georgia.
On November 14, 2016, he flew to Georgia to admit himself at the George Eliava Institute of Bacteriophage, Microbiology and Virology in Tbilisi. Johri admits he wasn’t completely convinced as most doctors dismissed phage therapy as fringe. “But it was my only shot,” Johri said.
In Tbilisi, doctors found four major bacterial strains in his samples and administered a phage cocktail – since each virus attacks a specific strain of bacteria, a cocktail of medicines is needed to treat a complex infection. The application was oral, rectal and topical. By the fourth day, the pain had started easing. “It felt like a miracle,” Johri said.
But the fourth strain – Streptococcus Mitis – was still proving resistant, and, so doctors proposed a ‘custom phage’ engineered by isolating the bacterial strain and growing a phage accordingly. In two months, it worked. “We are not generally concerned of side effects, the phage itself is very safe. We were able to achieve very good results with Pranav,” said Dr Naomi Hoyle of Eliava Phage Therapy Center.
Johri flew back to Tblisi in March 2017 and then again in November. By the New Year, the strength was back in his limbs. He is spending the winter in a ski resort.
Bacteriophages (Latin for ‘bacteria-eater’) are naturally occurring viruses, available in the order of trillions in the environment. A phage resembles the structure of a spaceship, explained BL Sarkar, emeritus scientist, Vibriophage Reference Laboratory at the Kolkata-based ICMR-National Institute of Cholera and Enteric Diseases, with spidery tail fibres to recognise and attach to the target’s surface.
The phages inject their DNA material into the bacteria, replicate rapidly and rupture the cell walls in a process called lysis. They are the opposite of broad-spectrum antibiotics, which work against a large variety of bacteria. “The phages are specific to their target bacterial host cell but are unresponsive to human or eukaryotic cell whereas antibiotics target both pathogenic microorganisms and normal microflora,” Sarkar explained.
This makes phage therapy both challenging and unique. Because of its targeted nature, there is little commercial incentive in scaling up production because its use will never be as generic as, say, penicillin. But precisely of this character, it is a boon in a world with rising resistance to wide-spectrum antibiotics, said Tushar Suvra Bhowmick at the Center for Phage Technology at Texas A&M University. “Phages are very safe to apply in the human body as it doesn’t affect normal microflora of the gut system. There is very little side effect,” she said.