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by Guram Gvasalia, MD, PhD

Bacteriophage presents the highly effective medication against surgical infections, which can be used for prophylaxis as well as for treatment. Bacteriophage doesn’t present the alternative to antibiotics; on the contrary, combined use of these medications increases the antibacterial effect.

Besides, as compared with antibiotics the bacteriophage, is characterized by a number of advantages:

Bacteria don’t have the ability to acquire the secondary resistance against phage. Phage is characterized by strong tissue permeability. Moreover, the concentration of the phage in the focus of infection and correspondingly, the antibacterial activity is not declined (as it is characterized for the antibiotics) but is permanently high and is even increasing under conditions of bacterial presence by the reason of phages reproduction activity. (Phages elimination from the focus of infection is carried out only after eradication of the corresponding microbe; bacteriophage is totally compatible with the antibacterial medications, including antibiotics. It doesn’t affect the obligate flora and doesn’t cause dysbacteriosis. It is specific only against corresponding microbe. The overcoming of chromosome and plasmid resistance is impossible while by adaptation, is possible to overcome the phages resistance. The antibiotics are not used locally in the wound, while the phagotherapy of local infections is highly effective.) Finally, the phagotherapy is significantly cheaper than antibiotic therapy.

The Prospects of Bacteriophage Use in Surgery

Prophylaxis:

For preventive measures of postoperative wounds and intra-operative infections of abdominal cavity. After incision and opening of the thoracic cavity the wound (cavity) is irrigated with bacteriophage and the operation is made in the tissues invaded by phages. After finishing the operation, the procedure is repeated once again.

Treatment of Pyoinflammatory Diseases:

Soft tissue pyoinflammatory diseases – cellulites, phlegmon, abscess, pyodermia, pyomyositis – after incision and tissue removal is processed by sodium solution and irrigated by bacteriophage. Phage impregnated tampons can be put in the wound. The permanent putting of phages in the wound by tampon impregnation or by drainage is preferable. The optimal drainage of the exudates presents the significant condition – under conditions of pus stasis the penetration of phage into the focus of infection is hampered, the liquid phage is impregnated and looses the concentration.

The phage therapy effect is increased by use of proteolytic medications locally, which increases the phages tissue permeability and decreases the potential of microbe resistance.

Putting of phages in the tissues is especially effective by ultra-low frequency cavitation – the bacteriophage and proteolytic enzyme are added to the special solution.

Processing of Purulent Cavities:

Pleural, abdominal and abscess cavities. After preliminary rinsing of drainages placed in the cavities, the cavity is rinsed by liquid phage medication. At the end of the procedure the 3-5 ml of medication is left in the cavity.

The permanent flowing irrigation of cavities (wounds):

In the cavities (wounds) must be the excretive drainage from low point and micro irrigator at higher level. The permanent irrigation – lavage is carried out by permanent or fractional flushing.

Creating the Depo-Focus of bacteriophage:

Is achieved by using the immobilized bacteriophage, antibiotic, and proteolytic enzyme on the biodegradable polymer. This medication “PhagoBioDerm” is manufactured in two forms – perforated plates and in the form of powder. It is used:

  • for preventive measures: leaving in the surgical wound (in this case the powder is preferable)
  • for therapy: after reaching of the good lavage of purulent wound and ensuring the perfect drainage by liquid medication, the wound needs dressing. In this case the “PhagoBioDerm” plate or powder is placed in the wound for 2-5 days and the wound is not dressed during indicated period.
  • in deep cavities – abdominal cavity, liver abscess, soft tissues, maxillary sinus –  the permanent leaving of “PhagoBioDerm” is possible. It’s full lysis and resorption is done within 2-4 months. In this period of time the antibacterial concentration of bacteriophage permanently exists.
  • the predetermination of micro flora sensitivity to phage especially increases the effect of phage therapy.