- Controlled trials and studies are often limited in complementary and alternative medicine and involve small numbers of participants. They are often conducted under less rigorous controls, guidelines and environments than those undertaken for the development of new pharmaceutical medications such as antibiotics. Do your research, there should be clear, peer reviewed, empiric evidence as to the efficacy of complementary, unlicensed therapies such as phages rather than theorisation about how they may be beneficial in the treatment of a chronic UTI.
- The cost of current treatment for patients not based in Eastern Europe. Clinics will offer inclusive packages for patient treatment including travel, accommodation and clinical care but at present phage therapy offered is for single, identified bacterial organisms rather than complicated multi-bacterial infections. It may be necessary for clinics to make different cocktails for treatment of the same infection, this increases the cost to the patient and may mean multiple visits to treat each individual bacterium identified.
- Bacterial specification – treatment is reliant on the identification of each bacterium via current standard laboratory testing protocols. This makes an assumption that these bacteria are responsible for a chronic UTI infection.
- Bacteria can evolve different receptors either before or during treatment; this can prevent phages from completely eradicating bacteria for as the bacteria evolve, bacteriophages must evolve as well to keep up with the ever changing bacteria. In the case all bacteria are eliminated, the specific phage might evolve and attack good bacteria in the specific area of administration.
- The need for banks of phages makes regulatory testing for safety harder and more expensive under current rules in most countries. Such a process would make difficult the large-scale use of phage therapy.
- Phage therapy is usually most effective with a cocktail injection, which is generally rejected by western health regulators. For phage therapy to be considered as treatment these authorities must change their regulatory stance on combination drug cocktails.
- Administration of phage therapy may mean the treatment is absorbed through the stomach wall into the bloodstream. For immuno-compromised patients, this could hypothetically worsen a patient’s condition. There are also similar concerns for patients with conditions such as Crohn’s disease, inflammatory bowel disease, and type 1 diabetes and at present these safety concerns still need to be addressed.
- The immune system response to phages also differs between individuals and is dependent on the specific phage strains used. To determine the safety of phage treatments for human health, future research will need to focus on human clinical trials as much of the current research on the immunological response to phages is limited to animal models
- Public awareness and education about phage therapy are generally limited to scientific or independent research rather than mainstream media. Much of this is down to reliance for many years on antibiotic therapies and at present there are insufficient randomised control trials showing success in the usage of phage therapy for countries to consider licensing the treatment in hospital and clinic settings.
