New phage therapy to treat aggressive bone infection

In an Australian first, clinical teams across The Children’s Hospital at Westmead (CHW) have successfully treated a seven-year-old girl using an intravenous bacteriophage therapy for a longstanding bone and joint infection.

Bacteriophages or ‘phages’ are viruses that selectively infect bacteria and can kill them. Phages were first discovered over a hundred years ago but due to the introduction of and focus on antibiotic treatments, robust research and development into phage therapy was disregarded. With increasing concern of resistant bacteria worldwide, phage therapy research is taking place as an alternative or addition to traditional antibiotics. 

Dr Ameneh Khatami was part of a team of clinicians at The Children’s Hospital at Westmead who secured phage therapy in Australia on the grounds of compassionate access.

Dr Khatami focused her interests on phage therapy research in the hope of finding a successful treatment for seven-year-old, Dhanvi, who suffered from a severe bone infection in the leg and foot.

Antibiotics were used as the initial treatment for the Dhanvi to try and manage the infection but unfortunately due to the aggressive and highly resistant bacterium, there were limited antibiotic options left and the infection was getting worse. Surgeons thought that if the infection didn’t slow down, amputation would have been the only next option.

“We not only sought access to phage therapy under compassionate grounds from a company in the US but also the ability to safely deliver and monitor response during treatment,” Dr Khatami said.

Over two weeks, Dr Khatami administered the phage therapy to Dhanvi to see how the bacteria reacted and how the body would respond to this treatment. As each phage therapy is unique on its own, the team were able to take a personalised approach to treatment and change the dosing schedule based on the results they were seeing.

“Within two weeks, there was a significant therapeutic effect from the phage and the body’s response initially flushed the bacterial contents into the bloodstream, killing the bacteria quite rapidly.”

“After seven weeks of phage therapy, Dhanvi recorded pain-free weight bearing on the affected leg which was achieved for the first time since the initial injury. Long-term follow-up demonstrated radiological improvement and patient was able to walk longer distances,” Dr Khatami said.

Phage therapy gives new hope as a proposed alternative, non-antibiotic treatment for infections but due to limited access, little data exist on its clinical use especially in children.

“This study shows how a detailed investigation can encourage theories relating to how phage therapy can be effective and to provide a better understanding of how the phage, the body and the bacteria interact with each other."

"Antimicrobial resistance is a worldwide problem so phages could also be used to treat bacterial infections in lieu of antibiotics if they fail,” Dr Khatami said.

“If we accumulate more evidence from patients treated with phage and have them closely monitored, we can have an increased understanding of this novel therapeutic option as a precision medicine tool to combat growing antimicrobial resistance”.

The success of the therapy has recently been published in the EMBO Molecular Medicine, Clinical Academic in Infectious Diseases and Microbiology.