Use of Bacteriophages in Surgery
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
doesnt 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 dont 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 doesnt
affect the obligate flora and doesnt 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
The Prospects of Bacteriophage Use in Surgery
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
Putting of phages in the tissues is especially effective by ultra-low
frequency cavitation the bacteriophage and proteolytic enzyme are added to the
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
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. Its 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.