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Safety and tolerability of bronchoscopic and nebulised administration of bacteriophage
Jagdev Singh1, Stephanie Lynch2, Jonathan Iredell3
1Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia; Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia.
Introduction:
Pseudomonas aeruginosa is an organism well known for causing significant morbidity and mortality in people living with chronic lung conditions such as cystic fibrosis. We describe the safety, tolerability, and potential efficacy of bronchoscopic and nebulised bacteriophage administration, offering insights into a potential breakthrough for the treatment of chronic infections particularly in children and adolescents.
Method:
A 12-year-old female (F12) and a 17-year-old male (M17), both diagnosed with cystic fibrosis and chronic P. aeruginosa lung infection, underwent bacteriophage treatment (BT). The administration involved bronchoscopic instillation and subsequent nebulisation. This was performed concurrently with intravenous antibiotics and regular physiotherapy delivered in an in-patient setting for 14 days. Microbiological, clinical, and lung function assessments were conducted to assess this treatment modality.
Results:
No adverse events (fever, localised reaction, wheeze or bronchospasm) occurred during BT. F12 demonstrated a 4% increase, while M17 showed a 5% improvement in FEV1% from their best FEV1% over the past three years following BT. A 12% (F12) and an 8% (M17) improvement from baseline FEV1% was observed. For F12 P. aeruginosa was not isolated from her sputum despite 12 previous hospitalisations for intravenous antibiotics.
Conclusion:
Bronchoscopic and nebulised routes of bacteriophage administration were well-tolerated in these two adolescents. This early report underscores the potential of this treatment modality and encourages clinicians and researchers to actively explore this innovative approach.
Insights
Bacteriophage therapy offers a safe and effective new treatment for chronic Pseudomonas aeruginosa infections in adolescents with cystic fibrosis. This approach shows promise for improving lung function and eradicating bacteria, particularly in pediatric patients.
Area of Science:
- Medical Microbiology
- Pulmonology
- Biotechnology
Background:
- Pseudomonas aeruginosa chronic infections cause significant morbidity and mortality, especially in cystic fibrosis patients.
- Current treatments have limitations, necessitating novel therapeutic strategies.
Purpose of the Study:
- To evaluate the safety, tolerability, and potential efficacy of bacteriophage therapy in adolescents with cystic fibrosis and chronic P. aeruginosa lung infections.
- To explore bronchoscopic and nebulized bacteriophage administration as a treatment modality.
Main Methods:
- Two adolescents with cystic fibrosis and chronic P. aeruginosa infection received bacteriophage treatment (BT) via bronchoscopic instillation and nebulization.
- Treatment was administered concurrently with antibiotics and physiotherapy over 14 days in an inpatient setting.
Main Results:
- Bacteriophage therapy was well-tolerated with no adverse events reported.
- Both patients showed improvements in lung function (FEV1%), with one patient achieving bacterial eradication.
- Significant improvements in FEV1% from baseline were observed for both patients.
Conclusions:
- Bronchoscopic and nebulized bacteriophage administration is a safe and tolerable treatment for adolescents with cystic fibrosis.
- Bacteriophage therapy presents a promising innovative approach for managing chronic P. aeruginosa infections, especially in pediatric populations.
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