Clinical Application of Bacteriophage Therapy in Children.

Read article HereSubmitted by: Guyu Li and Elizabeth RistagnoDepartment of Pediatrics, Mayo Clinic Children's, Rochester, MN, USABackground:The global rise of antimicrobial resistance has driven interest in bacteriophage therapy as a novel, emerging, and safe adjunct treatment for multidrug-resistant (MDR) bacterial infections in both adults and children.Key Findings:Bacteriophages lyse specific bacterial hosts by targeting binding sites on the bacterial cell membrane without meaningful pathologic interaction with human cells and minimal impact on the human microbiome. Bacteriophage attachment may also alter porin and efflux pump function, potentially restoring antibiotic susceptibility.Phages can be delivered via oral, topical, inhalation, or intravenous routes, but their preparation, doses, and frequency are not standardized. Clinical reports of bacteriophage therapy are mostly non-randomized and uncontrolled. Most reported benefits have been observed in MDR infections in patients with cystic fibrosis, cardiac device infections, or prosthetic joint infections. Mild adverse events, such as transient fever, flushing, and hypotension, may occur, due to bacterial toxin release or endotoxin contamination of phage preparations.Data in children are limited, especially from clinical trials. A randomized, placebo-controlled pediatric trial evaluating oral bacteriophage therapy against E. coli diarrhea showed no significant benefit. In the review of 14 pediatric cases, the most common infections treated were pulmonary infections, mainly targeting Pseudomonas aeruginosa, Staphylococcus aureus, and Achromobacter spp. Other infections included bacteremia, osteomyelitis, sternal wound abscesses, skin wounds, intra-abdominal infections, urinary tract infections, and disseminated Mycobacterium abscessus infections. Most children showed clinical improvement after treatment with combined phage and antibiotic therapy.The use of multiple bacteriophages can decrease the risk of developing phage resistance during treatment. Standardized dosing and regulatory guidelines are urgently needed.Take-Home Message:Bacteriophage therapy appears safe and promising for treating MDR infections in children. Prospective, controlled pediatric trials are needed to define optimal treatment strategy and real-world effectiveness.