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

Desperate, Pranav went to an institute in Eastern Europe specializing in treatment, 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 helped to stimulate 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, professor of microbiology at the University of British Columbia whose laboratory is focused on designing new therapies against infections

"It's sort of global climate change." Reviving a Soviet-era practice

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

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

Phage do not attack good bacteria s in a human body, resulting in fewer side effects than long runs 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 what was then the Soviet Union and part of Eastern Europe continued to administer phage therapy.

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

Pranav paid about $ 6,000 C in addition to his three trips to Tbilisi to treat his antibiotics.

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 tour, and had lunch and dinner – an impossibility a few days before.

New drugs are needed, but resistance will never stop

discovering phage therapy, Pranav felt that he had no more drugs. 39; options. Antibiotics made it sicker and the doctors offered no alternative.

"I have never forgotten 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 were able to fly a man on the moon, develop portable devices that contained all the power computers, and create tiny microchips, says Pranav, his voice growing more lively as he was able to get his hands on. he groans

"How have we been so irresponsible with a cure?"

Antibiotics peaked in the 1950s. Alexander Fleming discovered penicillin, the first true antibiotic in the world, in 1928, and physicians 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

. At the same time, drug-resistant bacteria began to appear. Only a few years after doctors started to prescribe penicillin regularly, Fleming started to warn the public of resistance. Curable infections, such as gonorrhea, are more difficult to treat, if not impossible to treat

. The fact that antibiotic-resistant diseases, such as drug-resistant TB, have an overwhelming impact on poor people in developing countries does not help. According to Florian Von Groote-Bidlingmaier, director of TASK Applied Science, responsible for multidrug-resistant tuberculosis trials at Brooklyn Chest Hospital in Cape Town, South Africa, who can not afford expensive treatments. 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 patterns 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.

"I will never stop, in my opinion, generating resistance to drugs," says Mel Spigelman, CEO of TB Alliance, a New York-based NGO. To discover and develop new anti-tuberculosis drugs

The goal, he says, is to make sure that new discoveries push back resistance for 50 years instead of 5.

He believes in developing treatments with less side effects drug treatment – a major problem with current anti-TB drugs – would significantly reduce resistance.

Opening of the First North American Phagotherapy Center

At Least One Western Medical Researcher Joins Patients to Review Phage Therapy – But it Required a Direct Fist to Death to open your eyes.

Steffanie Strathdee, an epidemiologist specializing in infectious diseases, recalls visiting Tom Patterson at an American hospital where he slipped

Tom, now 71, became ill at the last night of his trip to Egypt in November 2015. By the time he was transferred to the hospital in the couple's hometown, he was injured. San Diego, 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 could not find his hand.

"Eventually, I was able to wrap, wrap around his hand and squeeze it," he recalls.

To save her own husband Steffanie came across phage therapy, a treatment that Canadians of American descent learned in a virology clbad at the University of Toronto [19659002"Wewerereallydesperate"shesaidofallhopeofgivinghimphages

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

"One of the doctors described her as an Ave Maria."

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 he is part of a handful of patients, if not the first person to undergo phage therapy through an IV for multidrug-resistant bacteria in the US

He woke up a few days later, had to relearn basic tasks like how to swallow and talk, but this day marked the beginning of a complete recovery.

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

" It's worth it, l & # 39; The anxiety and the time that I have lived, if everything goes from the front. "

The University of Medicine School California San Diego, whose doctors and scientists first helped to treat Tom and several other patients since, announced last week the opening of the Center for Innovative Applications of Phage and Therapeutics [19659002] 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 granted marketing authorization for drugs clbadified as phagotherapy, which means that doctors who want to try it in patients with dementia will not be able to do so. 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 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 each patient.

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 institutions 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 make up the bulk of the evidence of 39, successful treatment of phages, and it is unclear how long it will take to conduct clinical trials and develop robust phage libraries.

In the meantime, one of the most important efforts is d & # 39;

With better diagnostic tools, doctors can identify patients' diseases faster and determine the resistance profile of the bacteria, and they can then prescribe the right drug. rather than treating patients with medications that will not work while test results are pending.This practice can further exacerbate the growth of resistance and ner 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 test 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 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. test, but more funding for research and development is needed

A Canadian Call for Action

Investing Now in Preventive Measures Could Help the Government Avoid Future Losses says Hanbad, professor of microbiology at 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 sees no public 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 on Drug Resistance released last year, notes Jacqueline Arthur, Manager, Strategic Issues in Antimicrobial Resistance.

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

"We must work together to determine where Canada is best positioned to be a leader, not only in Canada but also abroad. 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 funding for his 80-member group covering universities, government, and industry would be at least a definitive step after years of discussions without any change led by the government.

a slow action if it is the biggest threat to human health. "

The foreign exchange correspondent R. James Travers partially funded this series, commemorating Jim Travers' career and aiming to allow Canadian journalists to make important reports to the public. 39, to provide Canadians with first-hand and in-depth coverage of stories beyond the country's borders, Travers spent six years reporting on Africa and the Middle East and beyond. has deeply believed in the power of international reporting.