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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)...

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    $\begingroup$ Welcome to WorldBuilding! If you have the time please take the tour and visit the help center to learn more about the site. Have fun! $\endgroup$ – Secespitus Apr 4 '17 at 20:31
  • $\begingroup$ I added two tags I think you missed. And I like your idea. I guess answer is yes, but can't prove it. $\endgroup$ – Mołot Apr 4 '17 at 20:53
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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."

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  • $\begingroup$ That quote also shows a good reason for why antibiotics are currently the main method of treatment - "However, in contrast to antibiotics, they are very specific". $\endgroup$ – Rob Watts Apr 4 '17 at 21:28
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    $\begingroup$ @Rob Watts, It can be a good thing to be very specific. In the body, we don't want to kill all of the bacteria, only the ones causing the disease the therapy is targeted to eliminate. Killing the good flora used in digestion and allowing opportunistic bacteria to take over causes unwanted side effects. $\endgroup$ – N2ition Apr 4 '17 at 21:50
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    $\begingroup$ @N2ition unfortunately, figuring out exactly what kind of bacteria is causing you to be sick is not a trivial task. Unless you've got a long-term illness like Tuberculosis, you'd be likely to die or recover on your own before doctors are able to figure out what bacteriophage they need to give you. $\endgroup$ – Rob Watts Apr 4 '17 at 21:58
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    $\begingroup$ @RobWatts just put sample in vials with phages and see which one works. Plain, fast and simple. $\endgroup$ – Mołot Apr 5 '17 at 9:08
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    $\begingroup$ We do have pretty rapid molecular (elisa type stuff) tests for things like strep and HIV. There are rapid pcr tests for other organisms. So the old "broad spectrum antibiotics" approach may not be first line therapy for long. The problem is that giving antibiotics to buy you time is easy, delaying any treatment for someone who is really sick until you get a positive organism ID is gonna be tough to sell. $\endgroup$ – Jason K Apr 5 '17 at 16:58
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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.

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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.

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