Opinion Paper

Treating bacterial infections with bacteriophages in the 21st century

Christoffel J. Opperman, Justyna M. Wojno, Adrian J. Brink
Southern African Journal of Infectious Diseases | Vol 37, No 1 | a346 | DOI: https://doi.org/10.4102/sajid.v37i1.346 | © 2022 Christoffel Johannes Opperman, Justyna Maria Wojno, Adrian John Brink | This work is licensed under CC Attribution 4.0
Submitted: 04 October 2021 | Published: 29 March 2022

About the author(s)

Christoffel J. Opperman, National Health Laboratory Service, Green Point Laboratory, Cape Town, South Africa
Justyna M. Wojno, Lancet Laboratories, Cape Town, South Africa
Adrian J. Brink, Department of Pathology, Faculty of Health Science, University of Cape Town, Cape Town, South Africa; and, Microbiology Laboratory, National Health Laboratory Service, Groote Schuur Hospital, Cape Town, South Africa

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Bacteriophages (phages) were discovered in the early part of the 20th century, and their ability to eliminate bacterial infections as bacterial viruses gathered interest almost immediately. Bacteriophage therapy was halted in the Western world due to inconclusive results in early experiments and the concurrent discovery of antibiotics. The spread of antibiotic-resistant bacteria has elicited renewed interest in bacteriophages as a natural alternative to conventional antibiotic therapy. Interest in the application of bacteriophages has also expanded to include the environment, such as wastewater treatment, agriculture and aquaculture. Although the complete phage is important in bacteriophage therapy, the focus is shifting to purified phage enzymes. These enzymes are an attractive option for pharmaceutical companies with their patent potential. They can be bio-engineered for enhanced adjuvant properties, such as a broadened spectrum of activity or binding capability. Enzymes also eliminate the concern that the prophage might integrate resistance genes into the bacterial genome. From a clinical perspective, the first randomised clinical controlled phage therapy trial was conducted with more pioneering phase I/II clinical studies on the horizon. In this opinion paper, the authors outline bacteriophages as naturally occurring bactericidal entities, their therapeutic potential against antibiotic-resistant bacteria and compare them to antibiotics. Their potential multipurpose application in the medical field is also addressed, including the use of bacteriophages for vaccination, and utilisation of the antimicrobial enzymes that they produce.


bacteriophage; bacteriophage therapy; phage; non-lytic phage; vaccination; gene-transfer; endolysins; enzybiotics; artilysins


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