Precision bacteriophage therapy for multidrug-resistant recurrent urinary tract infections: From biological rationale...

Recurrent urinary tract infections (rUTIs), driven by multidrug-resistant (MDR) uropathogens, intracellular reservoirs, and biofilms, progressively circumvent conventional antibiotic therapy. Bacteriophage (phage) therapy has re-emerged as a precision medicine strategy offering narrow host specificity, self-amplification at the infection site, and intrinsic antibiofilm activity via depolymerases. This minireview evaluates the biological rationale and translational evidence for phage therapy in MDR-rUTIs, emphasizing the clinical distinction between standardized trials for acute uncomplicated infections and personalized salvage interventions for complex rUTIs. Clinical data suggest that personalized, susceptibility-matched phage regimens have demonstrated encouraging clinical outcomes in reported cases; however, these findings are primarily based on case reports and small observational series, necessitating further validation through large-scale randomized controlled trials. In Taiwan, where extended-spectrum β-lactamase-producing Escherichia coli is prevalent, phage therapy is shaping its regulatory landscape through special-case and compassionate-use pathways. Strategic opportunities exist to leverage Taiwan's National Health Insurance database and centralized good manufacturing practices-compliant biobanks to transition phages into a regulated component of antimicrobial stewardship. However, addressing biological and logistical hurdles - specifically neutralizing antibody formation and manufacturing scalability - remains essential for broad implementation. This review provides a framework for integrating phage therapy into precision care pathways for rUTIs in the Asia-Pacific region.