This May Save Your Life! Bacteriophage Treatment for Bacterial Diseases*

Recently, I listened to a special episode featuring Lina Zeldovich on her book The Living Medicine, from This Podcast Will Kill You. I was totally inspired because it discussesd the healing power of bacteriophages, which apparently treat antibiotic-resistant bacterial infections successfully, reportedly without side effects. (Bacterial phages are viruses that selectively kill specific bacteria and have been used to treat multi-antibiotic-resistant conditions). 

This emerging therapy is an aspect of  individualized treatment. Zeldovich reports that it can not only be used to treat, but also to prevent the occurrence of bacterial illnesses. I rushed out to buy the book, The Living Medicine: How a lifesaving cure was nearly lost and why it will rescue us when antibiotics fail. Zeldovich is a great science storyteller and the book really captured me. I read it in two evenings and wanted to share this information, since a day may come when it could save your life.

 This is a must-read for all of us, particularly for health professionals. It offers hope through a non-toxic strategy in the fight against antibiotic-resistant disease. The book provides a perspective on the challenges of bringing this effective healing strategy to acceptance and implementation when cultural biases and financial disincentives have stood in the way.;

Zeldovich, describes the development and history of bacterial phage medicine and why it has taken so many years to become accepted in the West. Only after several high-profile cases has this approach become of interest. A prime example is the 2016 treatment of Dr. Tom Patterson, a professor at UC San Diego, who contracted a life-threatening Acinetobacter baumannii infection while traveling (Garnett, 2019). The bacteria that caused his infection was resistant to every available antibiotic. After he slipped into a coma, his doctors feared the worst. As a last resort, his wife, Dr. Steffanie Strathdee, worked with scientists to identify phages that could target the infection. Within 48 hours of receiving intravenous phage therapy, Patterson woke up. He went on to make a full recovery, one of the first documented cases in the U.S. in which phages saved a patient’s life.

Pros and cons of antibiotics

Until antibiotics were discovered, bacterial infections were often fatal. This changed with the discovery of penicillin by Alexander Fleming in 1928. During World War II, antibiotics saved countless solders’ lives in the treatment of infected wounds, pneumonia, and blood poisoning. The antibiotic approach was quickly adopted in the United States, beginning in the early 1940’s, since penicillin could be mass-produced and thus was highly profitable for the pharmaceutical companies. Despite the initial success of the drug, bacteria quickly developed antibiotic resistance to penicillin due to the ability of bacteria to produce β-lactamase, an enzyme capable of breaking down the drug.  

Antibiotics were and are extraordinary drugs.  When a patient is becoming sicker and sicker as a bacterial infection spreads, the infection can be stopped in its tracks with an effective antibiotic. Before the era of antibiotic resistance, patients recovered as if by magic, simple by giving an antibiotic orally or intravenously,

I still remember when our son developed pneumonia at the age of 12, initially with coughing, a high fever, chest pain, and a great deal of congestion. But as the infection progressed, he began to have difficulty breathing and his energy was fading.  We were initially hesitant to give the prescribed antibiotic because we hoped his immune system would be able to fight the infection. My hesitancy was based upon the fact that antibiotics do not selectively kill the bacteria causing the illness, but also destroy beneficial bacteria that are part of the human biome. 

Millions of women who have taken an antibiotic for an infection subsequently experience chronic vaginal yeast infections. This occurs because antibiotics such as tetracyclines, which are used to treat UTIs, intestinal tract infections, eye infections, sexually transmitted infections, acne, and gum disease, also kill the healthy bacteria of the human biome in the vagina. Since nature abhors a vacuum, yeast then overgrow where healthy bacteria used to predominate, thus allowing a vaginal infection (candidiasis) to occur (Spinillo et al., 1999)

In the case of my son, as it became clear that he was getting weaker and his immune system was not successfully clearing the infection, we followed his doctor’s advice and gave him the antibiotic. Magically, within two days he was better, and we continued with the course of antibiotics to clear his body of all the bacteria that was causing the pneumonia. Treatment is always a decision that involves balancing risk and benefit, getting sicker or getting well, given the possible negative side effects of the treatment. At the same time, it was possible that the antibiotic would not work since there was no time to run a lab test for that specific bacteria. If it had not worked, he would have needed another, different antibiotic, and if that had failed, a third drug.

Today, antibiotic resistance has grown into a worldwide crisis. The World Health Organization estimates that antimicrobial resistance directly caused 1.27 million deaths and contributed to another 5 million deaths globally in 2019. In the United States alone, the CDC reports over 2.8 million antibiotic-resistant infections occur every year, leading to at least 35,000 deaths and more than 3 million cases of infection by Clostridioides difficile (C. diff) occur (CDC, 2019).

Potentially fatal diseases that have become antibiotic resistant include Staphylococcus aureus (such as methicillin-resistant Staph aureus or MRSA) and Streptococcus pneumoniae (strep), as well as Klebsiella pneumoniae, Acinetobacter baumannii, Escherichia coli, and Pseudomonas aeruginosa. These six pathogens alone were responsible for nearly 1 million deaths in 2019. Other dangerous resistant infections include multidrug-resistant tuberculosis (MDR-TB), extensively drug-resistant typhoid fever, and carbapenem-resistant Enterobacteriaceae (CRE), sometimes described as “nightmare bacteria” (Murray, et al., 2022).

Bacterial resistance develops because bacteria, like all living organisms, evolve. Antibiotics, which are typically chemicals produced by molds or other organisms, work by killing or interfering with the life cycle of specific types of bacteria. However, antibiotics are often a blunt instrument: they resemble a form of what has been referred to as carpet bombing in warfare, in which the  enemy is destroyed, but the whole neighborhood is also destroyed. While antibiotics may eliminate the bacteria causing the infection, they can also damage or destroy many beneficial bacteria in the gut, on the skin, and other areas of the body.

One in five medication-related visits to the emergency room are from reactions to antibiotics (CDC, 2025). This collateral damage can disrupt the gut microbiome, weaken immunity, and create opportunities for other harmful microbes to flourish. In addition, frequent antibiotic use could possibly contribute to obesity, as evidenced by the fact that low dosages of antibiotics are often given to farm animals, not only to prevent disease, but to increase their weight. Antibiotics appear to alter the gut microbiome to make it more efficient at extracting nutrients and energy from feed (Cox, 2016). 

Antibiotics have been one of the major focuses of pharmaceutical drug development; however, they can cause serious side effects and tend to become less effective over time as the bacteria develop antibiotic resistance.  Many bacteria can develop antibiotic resistance in less than a 6 month time period (Poku et al., 2023). Once bacteria develop antibiotic resistance to one drug, a new antibiotic drug needs to be discovered, developed, and produced. Even the newer and stronger antibiotics rapidly loose their efficacy as the bacteria develop resistance to it. In the long term, it is a loosing battle, and a totally new approach is needed.

Bacteriophage therapy

One new approach worth closer consideration is bacteriophage therapy. In nature, bacteria and viruses have been locked in a constant evolutionary battle for billions of years. Bacteria are vulnerable to specific viruses, so a bacteriophage, or phage, refers to a virus that specifically infects and kills a particular strain of bacteria. As bacteria change to evade attack, phages evolve to counter them, maintaining an ongoing balance to some degree. The theory is that because phages are very specific and only act on one particular type of bacteria, that potentially makes them a uniquely precise form of medicine.

The challenge involves matching the phage to the pathogenic bacterium, and there are an astonishing number of different phages and bacteria. In two patients with the same symptoms or diagnosis, the causal bacteria could be a slightly different subspecies.  When used clinically, bacteriophages work only against specific type of bacterium. This makes phage therapy a useful form of individualized medicine.

To be successful, the bacteria that causes the patient’s infection must first be identified. This is different from the way in which antibiotics are commonly used in primary care.  When a patient develops symptoms, often an antibiotic is given before the bacteria has been identified, and if it does not work, another antibiotic is given.

In contrast, phage therapy depends on matching the specific disease-causing bacteria to a specific phage. Phage medicine requires a library of thousands of known phages as an essential prerequisite to treatment. Clinical care involves identifying the phage that can target and destroy that specific bacterium. Then the phage is cultured, purified, and administered in either a liquid preparation, capsule, ointment, intravenously or at a wound site depending on the type of infection.

Unlike antibiotics, which often damage beneficial microbes, phages only target the bacteria they evolved to destroy, leaving the rest of the human biome intact. Because viruses are capable of reproduction, once a phage reaches its bacterial host, it multiplies rapidly and produces hundreds of new phages that continue to attack the specific disease-causing bacteria as shown in Figure 1. According to reports from phage medicine, symptoms improve dramatically within 24 hours. The phages are self-limiting and their numbers naturally decline once the infection is cleared.

Figure 1. Electron micrograph of a phage attaching and injecting it viral genome into the cell and its life cycle

At present, phage therapy has already shown success against a variety of resistant infections, including methicillin-resistant Staphylococcus aureus (MRSA), Acinetobacter baumannii wound infections (a major problem in military medicine), multidrug-resistant Klebsiella pneumoniae, and even certain cases of tuberculosis. Instead of being the last line of defense, in the future this may become the first line of defense.

The initial research and clinical use has been concentrated in Russia and Eastern Europe. The United States largely abandoned phage therapy after the discovery of antibiotics. Several factors contributed to this trend.

1. Funding barriers. Funding agencies in the West have not seen phage therapy as a credible option. In many cases, the review committees that decided which grant applications to approve have tended to fund research that supported their own biases and their interests in antibiotic research. As a result, research money was rarely allocated to study or develop phage therapies.  Generally, high- risk, novel research ideas are almost never funded by federal agencies except DARPA which is more open to new concepts when they offer a high potential of success.
2. Economic realities discourage investment. Unlike antibiotics, which can be mass-produced as a single chemical and sold at high volume for profit, phage therapy requires maintaining large, evolving phage libraries and tailoring treatments to each patient. This individualized model offered little appeal to large pharmaceutical companies seeking standardized products with a high payout.
3. Development is not scalable. A specific bacteriophage must be selected for each specific pathogenic bacteria, and a large phage collection must be maintained to identify the correct phage.
4. Scientific and cultural bias. American researchers have tended to dismiss work coming out of Russia and Georgia, failing to recognize the rigor and effectiveness of decades of phage therapy practiced there. Limited scientific exchange was also a factor during the Cold War. A similar bias, for example, has influenced the adoption of psychological treatment strategies developed in Russia. In the U.S., the focus was more on using instrumental learning while neglecting the power of Pavlov’s classical condition.

These scientific prejudices, financial disincentives, and geopolitical divides have meant that phage therapy was almost totally absent in Western medicine although it continued in Eastern Europe, where it has saved countless lives. Phage therapy is currently becoming recognized and desperately needed because of the increase in multi-drug-resistant infections.

Phage treatment challenges

The greatest challenge with phage therapy is that it must be individualized to the pathogen. Each patient’s infection may require a different phage, because phages are exquisitely specific to the bacterium they target.  A phage that destroys one strain of E. coli, for example, may have no effect on another subspecies of E. coli. While the same phage can sometimes be used for multiple patients with the same infection, in most cases treatment must be customized to the individual patient.

This requires maintaining vast phage libraries that researchers and clinicians must be able to screen rapidly in order to find the right match. The scale of this challenge is staggering, although AI technology may be part of the solution. Scientists estimate that there are 10³¹ (ten million trillion trillion) specific phages on Earth, making them the most abundant biological entities known. Only a tiny fraction of these have been studied, and only a relatively smaller number are currently catalogued for medical use.

Specialized research institutes, particularly in Georgia, Poland, and Russia (and now in the U.S. and Europe) have developed large collections of phages that can be tested against samples of specific bacterium. Building, maintaining, and updating these libraries is labor-intensive and requires constant monitoring, since both bacteria and phages evolve. Phage therapy does not lend itself easily to large-scale commercialization. Nevertheless, phage therapy represents one of the most promising approaches to resistant infections.

Summary

Unlike antibiotics, which disrupt the human microbiome and can cause significant side effects, phages are naturally occurring, highly targeted, and generally well tolerated. Because they attack only a specific bacterium, without disturbing beneficial microbes, phages have the potential to be used not only as a treatment but also for prevention, helping to control bacterial populations before they cause disease. Harnessing this form of living medicine could mark an evolutionary shift in modern healthcare, offering a sustainable, balanced way to prevent and treat infections. Read the outstanding book by Lina Zeldovich, The Living Medicine: How a lifesaving cure was nearly lost and why it will rescue us when antibiotics fail.

References

admin. (2025, August 28). Special Episode: Lina Zeldovich & The Living Medicine. This Podcast Will Kill You. Accessed September 1, 2025. https://thispodcastwillkillyou.com/2025/08/28/special-episode-lina-zeldovich-the-living-medicine/

CDC. (2019).  Antibiotic Resistance Threats in the United States, 2019. Atlanta, GA: U.S. Department of Health and Human Services, CDC. https://www.cdc.gov/antimicrobial-resistance/media/pdfs/2019-ar-threats-report-508.pdf

CDC. (2025). Do antibiotics have side effects. Atlanta, GA: U.S. Department of Health and Human Services, CDC Accessed September 5, 2025. https://www.cdc.gov/antibiotic-use/media/pdfs/Do-Antibiotics-Have-Side-Effects-508.pdf

Cox, L.M. (2016). Antibiotics shape microbiota and weight gain across the animal kingdom, Animal Frontiers, 6(3), 8–14. https://doi.org/10.2527/af.2016-0028

Garnett, C. (2019). Personal quest resurrects phage therapy in infection fight. NIH Record, LXXI(6). https://nihrecord.nih.gov/2019/03/22/personal-quest-resurrects-phage-therapy-infection-fight

Murray, C. J. L. et al. (2022). Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. The Lancet, 399(103250, 629 – 655. https://doi.org/10.1016/S0140-6736(21)02724-0

Poku, E., Cooper, K., Cantrell, A., Harnan, S., Sin, M.A., Zanuzdana, A., & Hoffmann, A. (2023). Systematic review of time lag between antibiotic use and rise of resistant pathogens among hospitalized adults in Europe. JAC Antimicrob Resist, 5(1), dlad001. https://doi.org/10.1093/jacamr/dlad001

Spinillo, A., Capuzzo, E., Acciano, S., De Santolo, A., & Zara, F.  (1999). Effect of antibiotic use on the prevalence of symptomatic vulvovaginal candidiasis. Am J Obstet Gynecol, 180(1 Pt 1),14-7. https://doi.org/10.1016/s0002-9378(99)70141-9

Zeldovich, L. (2024). The Living Medicine: How a lifesaving cure was nearly lost and why it will rescue us when antibiotics fail. New York: St. Martin’s Press. https://www.amazon.com/Living-Medicine-Lifesaving-Lost_and-Antibiotics/dp/1250283388

*Created in part from the information in the book, The Living Medicine-How a lifesaving cure was nearly lost-and why it will rescue Us When Antibiotics Fail, by Linda Zeldovich  and with the editorial help of ChatGPT5.