A century-old remedy can help fight superbugs, the "global climate change of health"

Canadian Press reporters traveled to South Africa and India to investigate the growing epidemic of drug resistance, which experts describe as the greatest threat to human health on the planet. This is the final story of a six-part series exploring how the unhindered use of antibiotics pushes humanity closer to a post-antibiotic era in which common infections may be impossible to treat. The Corrective Foreign Exchange R. James Travers helped finance the project.

NEW DELHI-Pranav Johri has completed five sets of antibiotics to treat a persistent prostate problem in his early thirties, but his case has denied the doctors. "All my life has become so limited," says the 35-year-old workaholic of the Indian capital, recalling that he could not forcefully summon more than a small meal between two naps.

Athlete Apurva Virmani Johri was married a few years ago before being confined to their room, surrounded by photos of the couple doing treks around the world – a constant reminder of their previous life.

"I think the hardest part was seeing him smile," she says. "It's a person who would smile at the slightest drop."

Pranav's breakpoint occurred when his doctor told him to prepare for symptomatic management rather than cure his prostatitis, a swelling of the gland-sized nut below the bladder of a man.

The patient Frustrated over the Internet for answers to his mysterious situation, he contacted a specialist to conduct further tests and learned that the bacterium causing his prostatitis was resistant to the five antibiotics that he had taken.

He discovered stories of other people in similar circumstances who have turned to a long-standing cure their diseases: phage therapy.

Desperate, Pranav has gone to an institute. Eastern Europe specialized in the treatment nt, which involves a badtail of eaters of natural bacteria. He paid thousands of dollars for the last effort to rid his body of the infection.

Western physicians have mostly set aside phage therapy as treatment after the advent of antibiotics.

But medications, once considered a medical wonder, no longer work against a growing number of bacterial infections. Abusive abuse and overexploitation have promoted the growth of antibiotic-resistant bacteria, which has resulted in the death of about 1.5 million people each year.

While superbugs proliferate, the discovery of antibiotics is at a standstill. For pharmaceutical companies, there is little incentive to invest in drugs that quickly heal patients; the medicine for chronic diseases presents a more tempting return on investment.

This leaves patients like Pranav, whose infections do not respond to antibiotics and whose doctors no longer have any new medications to prescribe, turning to century-old practice. However, experts warn that phage therapy is a quick fix: the treatment is not widely available, supported primarily by anecdotal evidence, and requires tailored solutions for most patients.

Some medical experts hope to extend the life of drugs. Catching infections earlier and treating patients properly could help slow the resistance. But, like the discovery of antibiotics, diagnostic research does not have the funding needed for major breakthroughs.

Without more investment and progress in drug discovery, experts worry that the world is entering a post-antibiotic era. year of infections easily treated.

"This is not a problem for the future.This is a problem that currently exists," says Bob Hanbad, a professor of microbiology at the University of British Columbia , whose laboratory is focused on the design of new therapies against infections

Reviving a practice of the Soviet era

More than 100 years ago, the French-Canadian Félix de Herelle discovered phage therapy to treat bacterial infections, beginning with dysentery in humans

., Are eaters of natural bacteria. They can be found in the environment – on land, in water and even in wastewater – and work by injecting it into a bacterial cell and forcing it to self-destruct.

Phage n & # 39, do not attack the good bacteria in a human body, resulting in less side effects There are long stretches of antibiotics, such as digestive problems and joint pain that Pranav endured during his antibiotic treatment.

"Today, I feel lucky," he says, adding that he was reading stories of horror. others with permanent side effects

However, data is limited as to whether phage therapy is safe for humans. Treatment raises safety concerns, including whether it is effective and the possibility of serious infections in immunocompromised patients. Other commonly cited risks include lack of clarity about side effects and possible septic shock.

The advent of antibiotics in the 1940s led most Western practitioners to prescribe pills on phages. Doctors in the former Soviet Union and parts of Eastern Europe, however, continued to administer phage therapy.

In 1923, Dr. Herelle co-founded the Eliava Institute in present-day Tbilisi, Georgia. The institute so often treated patients with phages that it was creating a modern branching, the Eliava phalanges therapy center, to develop the growing practice of the institute

Pranav paid about C $ 6,000 plus travel expenses for his three visits to Tbilisi.

A few days after his first treatment at the institute, Pranav said his fever was gone and that the thermometer showed normal temperature for the first time in months. He and his wife went out to celebrate and Pranav managed to visit, and eat lunch and dinner – an impossibility a few days before.

New drugs were needed, but the resistance will never stop

discovering phage therapy, Pranav felt that he had no more d & rsquo; # 39; option. Antibiotics made it sicker and the doctors offered no alternative.

"I never forgot the desperation I felt when I was going through the worst of this problem," he says, angry at being a collateral damage from such a man.

People managed to get a man flying on the moon, to develop portable devices that packed all the power computers and to create tiny microchips, says Pranav, his voice becoming more and more animated while he was talking. he groans

"How were we so irresponsible with a cure?"

Antibiotics peaked in the 1950s. Alexander Fleming discovered penicillin, the first true antibiotic in the world, in 1928, and doctors began prescribing it widely in the mid-1940s. Over the next few decades , a slew of antibiotics has entered the market. But the discoveries were stalled in the 1980s and researchers have not discovered any new clbad of antibiotics for decades. According to Hanbad of the University of British Columbia, many experts dismissed the discovery of bedaquiline in 1997 because it was a narrow-spectrum antibiotic

. Only a few years after doctors started to prescribe penicillin regularly, Fleming started to warn the public of resistance. Now treatable infections, like gonorrhea, are harder – if not impossible – to treat.

The fact that antibiotic-resistant diseases, such as drug-resistant tuberculosis, have an overwhelming impact on the poorest populations in developing countries Florian Von Groote-Bidlingmaier, Director of TASK Applied Science, responsible for testing for multidrug-resistant tuberculosis in Brooklyn Chest Hospital in Cape Town, South Africa. new drugs for drug-resistant TB have emerged in recent years, including bedaquiline and delamanide, and others are under development. Researchers have also created shorter combinations of new drug combinations to reduce side effects and increase compliance.

However, new drugs will probably suffer the same fate as their predecessors; the bacteria will eventually develop resistance. Already, doctors report seeing patients with strains resistant to bedaquiline.

"There will never be a complete cessation, I think, of drug resistance," says Mel Spigelman, CEO of TB Alliance, a New York-based NGO. The goal, he says, is to make sure new discoveries push back resistance for 50 years instead of 5.

He believes in developing treatments with fewer side effects that stop patients. drug treatment – a major problem with current TB drugs – would significantly reduce resistance.

Opening of the First North American Phagotherapy Center

At Least One Western Medical Researcher Joins Patients to Review Phagic Therapy – But It Took A Hand to Death to Open the eyes.

Steffanie Strathdee, an infectious disease epidemiologist, recalls visiting husband Tom Patterson at an American hospital where he slipped

Tom, now 71, fell sick the last night of his trip to Egypt in November 2015. By the time he was moved to the hospital in the hometown of the San Diego couple, the doctors told them that he was probably going to die.

Steffanie begged him to have a sign that he wanted to live.

In his state of hallucination, Tom saw himself as a snake. He could hear it, but he could not find his hand.

"Finally, I was able to roll up, wrap around his hand and squeeze it," he recalls

. Steffanie came across phage therapy, a treatment that Canadians of American descent learned at a virology clbad at the University of Toronto

"We were really desperate," she says.

The US Food and Drug Administration, after all, does approve phage therapy only as a last resort – or, as Steffanie says, when a patient is at the door of death

"," she says.

For several days, Tom received two phage badtails created by two different groups of researchers for several days. One entered his abdomen and the other was injected by IV.It is thought that it is part of a handful of patients, if not the first person to undergo IV phage therapy for multidrug-resistant bacteria in the United States

He woke up a few days later, he had to relearn basic tasks like swallowing and talking, but that day marked the beginning of a complete recovery.

Tom, who co-writes a book with his wife about the experience, hopes his story will help advance "

" This it is worth it, the anxiety and the time that I have lived, if everything goes from the front.

The University of California San Diego School of Medicine, whose doctors and scientists first helped treat Tom and several other patients since, announced last week that it would open the center of innovative applications of phages and therapeutics.

IPATH will be the first phage therapy center in North America and Steffanie, the school, will be one of two center directors. IPATH will conduct rigorous clinical trials to validate phage therapy as a treatment for multidrug-resistant infections

Although phage therapy appears promising, it lacks rigorous scientific research – one of the most important reasons

Health Canada has not issued marketing authorization for drugs clbadified as phagotherapy, which means that physicians who want to try it in patients with An antibiotic-resistant infection must submit a clinical trial application to Health Canada. The department has never received one.

Patients seeking treatment are more likely to find clinics abroad.

About 130 foreign patients have visited the phage therapy center in Georgia since January, says Mzia Kutateladze, director of the institute. Most of the foreign patients are European, she says, but the center has also treated some Canadians

. Even though the treatment was more accessible, phages are complicated to mbad produce like standardized antibiotic pills. They each respond to one or a few specific bacterial strains and must often be adapted to individual patients.

In the center of Eliava, doctors have access to several commercial phages that Kutateladze says work for most local patients and some foreigners. But when these do not match, researchers must develop a personalized phage. It's a difficult process that can take one to two months, she says, and costs $ 2,100 more.

The growth of so-called phage libraries in hospitals and research institutes could speed up the process, says Steffanie. Think of it as a cold room, with all these different phages that have already been identified, characterized, purified and ready to go. "

Diagnosis" at the center "of the challenges of antibiotic resistance, solutions

For now, stories like those of Pranav and Tom constitute the bulk of the evidence of success of phage treatment, and it is not known how long it will take to conduct clinical trials and develop robust phage libraries.

Meanwhile, one of the most important efforts is to increase life expectancy of drugs still available and functional

With better diagnostic tools, doctors can identify patients' diseases more quickly and determine the resistance profile of the bacteria, so they can prescribe the right drug rather than to treat patients with drugs that will not work while the test results are pending.This practice can further aggravate the growth of resistance and leads to r unnecessary side effects.

"I think that diagnoses are at the heart of many challenges and solutions," says Heidi Albert, director of the Foundation for Innovative New Diagnostics (FIND) in South Africa, an NGO that helps to provide new diagnostic tools.

FIND helped develop a drug-resistant tuberculosis test for a device called GeneXpert that allows doctors to screen for TB and find out if it is resistant to any of the four. "

" In tuberculosis, it's one of the real success stories, "she says. It also facilitates screening of children and people living with HIV, demographic data that are notoriously difficult to diagnose, and provides an accurate indicator for determining if a patient's strain is multidrug-resistant. GeneXpert requires a much less sophisticated infrastructure than the alternative test method.

But it's not perfect, she admits. The test requires an uninterrupted power source and some temperature-controlled areas for testing and storage. These requirements may be too much in demand in low-income countries, including India, where the FIND office in New Delhi is experiencing intermittent power outages.

FIND is working to make the test device smaller and less infrastructure dependent.

A Call for Action in Canada

Investing now in preventive measures could help the government avoid future losses, says Hanbad, a professor of microbiology at the University of Michigan. McGill University. University of British Columbia.

He recently co-founded the Canadian Anti-Infection Innovation Network to build on the country's efforts to combat antibiotic resistance. He is asking the government to invest $ 100 to $ 200 million, but he does not yet see government funding for the network

but the Public Health Agency of Canada insists that Canada wants to be a leader in this file. Innovation is one of the four pillars of the Pan-Canadian Framework for Action against Drug Resistance released last year, notes Jacqueline Arthur, Manager of Strategic Issues in Antimicrobial Resistance.

The country is a small or medium-sized player in the field of new drug discovery, she says, but also has expertise in other areas of the drug pipeline.

"So, we really have to work together to establish where Canada is best positioned to be a leader, not only for Canada, but says:

Dr. Howard Njoo, Deputy Chief Public Health Officer of Canada, also believes that the country must be strategic about how it can use its strengths to add to global efforts.

"No Country or Group of Academics or Researchers Will Understand It"

But Hanbad says that the funding of his 80-member group, made up of academics, government officials and the government Industry, would be at least a decisive step after years of discussions without any change led by the government

. slow action if it's the biggest threat to human health. "