Health technology watchdogs in Scotland have given the go-ahead for bacteriophages, naturally occurring viruses that attack and destroy bacteria with no risk to humans, to be used to combat hard-to-treat infections.

In advice issued by the Scottish Health Technology Group (SHTG), clinicians are being told that bacteriophage therapy may now be considered for use directly at the site of infection as an alternative treatment for life threatening so-called ‘superbug’ infections that have developed resistance to a range of antibiotics.

They can also be used in cases where people are allergic to antibiotics and surgery to manage an infection is too dangerous.

In its advice to the NHS in Scotland, the SHTG acknowledges that there is a lack of high-quality research into bacteriophage therapy.

One review of clinical studies cited in the SHTG advice document showed good results in joint infections and osteomyelitis. Another showed 87% patients with dermatological infections, 65% of patients with chronic wound or ulcer infections, and 49% of patients with infected burns achieved therapy, with or without conventional antibiotics being used as well.

A bacteriophage laboratory has now been set up within NHS Tayside. Currently, bacteriophage therapy is not licensed by UK regulators so clinicians will have to follow guidance on unlicensed medicinal products.

SHTG provides evidence and advice to NHS Scotland on the use of new and existing health technologies which are likely to have significant implications for people’s care.

Chair of the SHTG Council, Neil Smart, said:

“We recognise the potential for bacteriophage therapy to play a vital role in combating the challenge of antimicrobial resistance. Resistance is a very real global health threat and the use of bacteriophage in Scotland represents an important marker towards future success in dealing with bacterial infections. 

“The evidence points towards bacteriophage being a safe and effective treatment for people with specific difficult to treat infections, and the coordinated collection of data will help to inform future decision making on the broader use of bacteriophage.”

Scotland's health secretary, Humza Yousaf, said the SHTG advice offers important additional option for clinicians:

“Containing antimicrobial resistance remains a constant global challenge, and one that the Scottish government is determined to continue to tackle.

“We are working with key stakeholders, through the UK AMR National Action Plan, to identify effective solutions and drive forward further improvements and innovations.

“Exploring alternative interventions and therapies, such as bacteriophages form an important element of the National Action Plan, and I welcome the news that such innovations are taking effect in Scotland.”

Discovered over a century ago, as bacteriophages are naturally occurring, they cannot be patented.

SHTG had to undertake its own cost effectiveness economic modelling of bacteriophage therapy and concludes:

‘The addition of bacteriophage therapy to standard of care is likely to be a cost effective use of resources within a subpopulation of patients with treatment-refractory diabetic foot infection at high risk of lower extremity amputation.’

The review was triggered following a request from a clinical director for surgery and a clinical bacteriophage therapy specialist colleague amidst concerns that, despite the best available management with antibiotics, some people continued to experience significant infection-related disability.

SHTG says the use of bacteriophage therapy in Scotland must now be accompanied by the collection of data on where they are used and outcomes for patients.

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