Once in a while, I’ll end up reading about something I haven’t read in years. That’s the kind of person I am, and I tend to do that toward things I don’t have much money nor knowledge invested in. So, let’s take a look at the advances in phage therapy.
A controlled clinical trial of a therapeutic bacteriophage preparation in chronic otitis due to antibiotic-resistant Pseudomonas aeruginosa; a preliminary report of efficacy
Wright, A.*, Hawkins, C.H. † , Änggård, E.E. † & Harper, D.R. †
*UCL Ear Institute and Royal National Throat, Nose and Ear Hospital, Grays Inn Road, London , and † Biocontrol Limited, BioCity, Pennyfoot Street, Nottingham, UK
Correspondence to Anthony Wright, UCL Ear Institute and Royal National Throat, Nose and Ear Hospital, Grays Inn Road, London, UK. Tel.: 0845 680 0971; fax: 0845 680 0972; e-mail:anthony.wright@ucl.ac.uk C.H Hawkins, E.E Änggård & D.R. Harper Biocontrol Limited, BioCity, Pennyfoot Street, Nottingham, UK Tel.: 0044 207 935 4579; fax: 0044 207 935 3635
Copyright © 2009 Blackwell Publishing Ltd
Clin. Otolaryngol. 2009, 34, 349–357
ABSTRACT
Objectives: To evaluate the efficacy and safety of a therapeutic bacteriophage preparation (Biophage-PA) targeting antibiotic-resistant Pseudomonas aeruginosa in chronic otitis.
Design: Randomised, double-blind, placebo-controlled Phase I/II clinical trial approved by UK Medicines and Healthcare products Regulatory Agency (MHRA) and the Central Office for Research Ethics Committees (COREC) ethical review process.
Setting: A single specialist university hospital.
Participants: 24 patients with chronic otitis with a duration of several years (2–58). Each patient had, at the time of entry to the trial, an ear infection because of an antibiotic-resistant P. aeruginosa strain sensitive to one or more of the six phages present in Biophage-PA. Participants were randomised in two groups of 12 treated with either a single dose of Biophage-PA or placebo and followed up at 7, 21 and 42 days after treatment by the same otologist. Ears were thoroughly cleaned on each occasion and clinical and microbiological indicators measured.
Main outcome measures: Physician assessed erythema/inflammation, ulceration/granulation/polyps, discharge quantity, discharge type and odour using a Visual Analogue Scale (VAS). Patients reported discomfort, itchiness, wetness and smell also using a VAS. Bacterial levels of P. aeruginosa and phage counts from swabs were measured initially and at follow-up. At each visit patients were asked about side effects using a structured form. Digital otoscopic images were obtained on days 0 and 42 for illustrative purposes only.
Results: Relative to day 0, pooled patient- and physician-reported clinical indicators improved for the phage treated group relative to the placebo group. Variation from baseline levels was statistically significant for combined data from all clinic days only for the phage treated group. Variation from baseline levels was statistically significant for the majority of the patient assessed clinical indicators only for the phage treated group. P. aeruginosa counts were significantly lower only in the phage treated group. No treatment related adverse event was reported.
Conclusion: The first controlled clinical trial of a therapeutic bacteriophage preparation showed efficacy and safety in chronic otitis because of chemo-resistant P. aeruginosa.
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