Phage therapy for children in Georgia: what parents need to know

When a child suffers from repeated, persistent or hard-to-treat infections, parents can find themselves in a medically and emotionally trying situation. Despite several treatments, including antibiotics, some infections keep coming back, persist or are linked to bacteria that have become resistant.

In this context, phage therapy is attracting growing interest. This approach uses natural viruses called bacteriophages, which can target certain bacteria very specifically.

In Georgia, phage therapy is nothing new. It is part of a medical tradition of more than 100 years, centred in particular on the Eliava Institute in Tbilisi, one of the world’s historic centres for the study and use of bacteriophages.

Phage therapy in simple terms

Bacteriophages, or phages, are viruses found naturally in the environment. What makes them special is that they target certain bacteria without attacking human cells.

Unlike some broad-spectrum antibiotics, which can act on many bacteria at once and disrupt the microbiota, phages act in a much more targeted way.

This specificity may be of particular interest for children, but it comes with an important condition: the bacterium causing the infection must be identified, and its sensitivity to available phages must be checked.

Phage therapy is therefore not a standard, one-size-fits-all treatment. It relies on a personalised approach and must always be supervised through a medical assessment.

Georgia: more than 100 years of experience in phage therapy

In Georgia, phage therapy is part of a long-standing scientific and medical tradition. The Eliava Institute, founded in 1923 in Tbilisi, is one of the world’s historic centres dedicated to bacteriophages.

While phage therapy was largely set aside in Western Europe after antibiotics arrived, it continued to be studied, produced and used in Georgia.

This historical continuity gives Georgia a special place in the field of phage therapy. It explains why some Georgian doctors, including paediatricians, know this approach better than many Western practitioners. Some paediatricians consider phage therapy an important option, sometimes a preferred one, when the bacterial infection is documented and antibiotic use can be avoided or limited under medical supervision.

In practice, phage therapy may be considered when the bacterial infection is documented, especially when repeated antibiotic use is a problem or when the bacterium is highly resistant.

Why this approach is of interest for children

For children, the main interest of phage therapy lies in its targeted action. Phages are selected to act against a specific bacterium, which limits the impact on the body’s other useful bacteria.

This approach can be particularly relevant when antibiotics have already been used several times, when the infection keeps returning or when the bacterium becomes resistant.

Caution is needed, however: phage therapy should not be presented as a miracle cure. It depends on the type of bacterium, the site of infection, the child’s general condition, previous treatments and the availability of suitable phages.

When can phage therapy be considered for a child?

1. ENT and respiratory infections

Phage therapy may be discussed in certain bacterial respiratory or ENT infections, including:

• acute or chronic ear infections (otitis);
• bacterial sinusitis;
• chronic bacterial bronchitis;
• recurrent respiratory infections;
• infections associated with certain chronic respiratory diseases.

In some chronic infections, bacteria can form biofilms. These protective structures can make infections harder to eliminate and less responsive to conventional treatments.

2. Digestive infections

Phage therapy is also studied or used in certain digestive conditions, especially when bacteria are clearly involved:

• bacterial diarrhoea;
• bacterial intestinal infections;
• documented bacterial imbalances;
• certain hospital-acquired infections.

It is important to stress that not all digestive disorders are bacterial in origin. A medical assessment is therefore essential before considering this type of treatment.

3. Antibiotic-resistant infections

Phage therapy is particularly studied for antibiotic-resistant bacteria, including:

• methicillin-resistant Staphylococcus aureus (MRSA);
• vancomycin-resistant bacteria;
• carbapenem-resistant bacteria;
• extended-spectrum beta-lactamase (ESBL) producing bacteria.

A paediatric case published in Nature Communications describes a child with a severe multidrug-resistant Pseudomonas aeruginosa infection, treated with a combination of phages and antibiotics, with notable clinical improvement.

Read the article published in Nature Communications

Phage therapy and antibiotics: opposites or complements?

Phage therapy does not systematically replace antibiotics. In some cases it can be used on its own; in others, it can be combined with antibiotics.

This combination can be particularly useful when the bacterium is difficult to treat, when it is resistant or when a complementary effect is sought.

The decision must always be made by doctors, based on the bacterium identified, the type of infection, the available test results and the child’s general condition.

How does an assessment in Georgia work?

Before considering travel or treatment, it is advisable to start with a personalised review of the medical file.

For a child, care generally follows several steps:

1. review of the medical file;
2. check of the tests already carried out;
3. identification of the bacterium responsible;
4. a phage susceptibility test, if appropriate;
5. discussion of a suitable treatment if active phages are available;
6. medical follow-up during and after treatment.

This process is essential, because phage therapy depends on many factors: the bacterium involved, the site of infection, the child’s age, general condition, previous treatments and test results.

Limits to be aware of

Not all children are eligible, because not every sample makes it possible to identify a relevant bacterium, and active phages are not always available.

Results vary depending on the type of infection, the bacterium involved, the child’s general condition and the individual response to treatment.

FAQ: phage therapy for children

Does phage therapy replace antibiotics?

Not necessarily. In some cases it can be used alongside antibiotics. The decision depends on the medical file, the bacterium identified and the doctors’ opinion.

Is phage therapy suitable for all children?

No. A medical assessment is essential. Phage therapy can only be considered if a relevant bacterial infection is documented and active phages are available.

Are results guaranteed?

No. Results vary depending on the bacterium, the type of infection, the child’s general condition and the individual response to treatment. No medicine can be 100% guaranteed.

Do we need to come to Georgia straight away?

The first step is usually to send the medical file for an initial assessment. This avoids an unnecessary trip if phage therapy is not suitable for the child.

Conclusion

Phage therapy is a promising medical approach for certain complex bacterial infections in children, especially when conventional treatments have not delivered the expected results or when the bacterium is highly resistant to antibiotics.

Its value lies in its targeted action, its personalisation and its potential to be combined with antibiotics. In Georgia, this approach benefits from unique historical experience, with more than 100 years of research and medical use of bacteriophages.

For parents, the sensible first step is to have their child’s medical file reviewed to find out whether this approach can be considered in a serious, supervised way.

Have the medical file reviewed

Useful references

• Eliava Phage Therapy Center
• Nature Communications – paediatric case treated with phages and antibiotics
• American Academy of Pediatrics – Clinical Application of Bacteriophage Therapy in Children