Can we have a world where bacteriophages are the main treatment of bacterial infection?

Question

In Georgia (Soviet Union) bacteriophages are used to to cure bacterial infection. In this video one can see how they are produced. So it might be possible in an alternate timeline, that Paul Ehrlich came up with this in the late 19th century. The right filter (Camberland filter) was available to get rid of the bacteria.

Then in the alternate timeline, this therapy is developed and becomes a standard treatment. Then antibiotics are discovered much later (because there already is a treatment) and later it is noticed that bacteria becomes resistant (to antibiotics) faster because of the use of bacteriophages.

Does this concept make sense?

EDIT: Note, the bacteriophage production is very different from the today medicine production. Instead of developing one pill after extensive testing, the production is very localised, i.e. every hospital has a bacteriophage production (and interchange them with other hospital). Moreover the hospital gives them out to every medical practice. Then if you have some bacterial infection the doctor test if any of his bacteriophage kills the infection, if not you get send to hospital where they have more bacteriophage, if no one helps either they produce new one as seen in the above video from minute 33 onwards (they get water from the local river and filter the bacteria out)...

Answer 1

Bacteriophages and antibiotics use different pathways and receptors for their mechanisms of action. So in general no, antibiotic resistance shouldn't lead to bacteriophage resistance or vice versa.

Here is a quote from an article discussing this.

Dr. Sulakvelidze pinpoints the essential difference between phages and traditional antimicrobials. "The mechanisms by which antibiotics and lytic phages kill bacteria, and the mechanisms of bacterial resistance to antibiotics and phages, are fundamentally different from one another. Lytic phages can killbacteria that cannot be killed by currently available antibiotics, and the use of phages in various settings (including for improving food safety) does not create selective pressure for antibiotic-resistant strains to emerge," explains Dr. Sulakvelidze. "Lytic phages are very effective in killing their targeted host bacteria. However, in contrast to antibiotics, they are very specific -- phages will lyse related strains or a subgroup of strains (usually within the same bacterial species or within closely related bacterial species), but they will not lyse strains of other, unrelated bacteria."

Answer 2

Yes, easily. Here is a article by Carol Potera discussing continued study and use of bacteriophage treatments by Eastern Europians: Phage Renaissance: New Hope against Antibiotic Resistance https://ehp.niehs.nih.gov/121-a48/

This article examines the continued overuse and mis-use of antibacterial medications causing increasing resistance to them. It's explains in the 1920's and 30's use of bacteriophage for treatment of bacterial infections was discovered and used by physicians, but with inconsistent results. The much better success of antibiotics obliterated use of bacteriophage in Western medicine.

With today's much more advanced understanding of molecular biology, phage therapy is once again emerging as a valuable warrior in the medical battlefield. The article also states there are currently two companies using phage therapy products for the FDA and the USDA for use against food-borne infections.

The caveat with their use accelerating antibacterial resistance is summed up in the article's statement: "However, phages are not totally bad (for the bacteria) and even offer bacteria a fitness advantage by transferring genes for antibiotic resistance and toxins to bacteria."

In your world, perhaps molecular technology isn't advancing fast enough to overcome this limitation.

Answer 3

Bacteriophage can be used to treat illness, but bacteriophage resistance can occur just as antibiotic resistance occurs. It is a matter of the microbial arms race concept.

Bacteriophage infect cells through proteinaceous receptors, I believe, always. Antibiotics kill bacteria by targeting one of five or so different basic functions of the bacteria: Cell wall, protein synthesis, DNA synthesis, membrane cohesion, etc.

Bacteriophage may be less toxic to humans, since their receptors do not occur on human cells. But, bacteriophage are rarely (ever?) wide spectrum. They are usually species - specific. So, Penicillin was useful against many types of bacteria, but it would be unlikely to find a phage that has this sort of spectrum of effectiveness.

Your final question is whether antibiotic resistance would spread easier, if phage therapy was used. In theory, yes, because phage are vectors and can move the antibiotic resistant genes around as they grow and lyse the cells.

One big problem with some infections (like tuberculosis) is that some proportion of the cells wall themselves off and become dormant, thus antibiotics (and phage) are less useful. A combination therapy, one that gets those dormant bacteria growing, is called for, to make the bacteria susceptible to treatment.