Bacteriophage therapy: an overview and the position of Italian Society of Infectious and Tropical Diseases.

In recent years, the increase of antibiotic resistance and the lack in the pipeline of novel antimicrobial molecules make bacterial infections difficult to treat. Among European countries, Italy is the one region with a higher number of deaths caused by antibiotic-resistant bacteria. Moreover, a major concern is represented by biofilm-related infections. The ability of bacteria to form biofilm in presence of implanted-medical devices represents a further challenge for the treatment of bacterial infections. Thus, the development of alternative strategies to fight multi-drug resistant bacteria embedded in biofilms is an urgent need. Nowadays, bacteriophage therapy represents one of the potential and promising treatment options to overcome antibiotic resistance phenomenon. Bacteriophages are viruses capable to infect and replicate within bacterial cell. They are widespread in soil and water and play a role in microbial physiology. Since their discovery at the beginning of the twentieth century bacteriophages were used with therapeutic purposes against bacterial infections. However, the advent of the antibiotic era spurred medical doctors to abandon phage therapy in return for the most promising antibiotic therapy. For historical reasons, only few countries in the world, including Georgia, Russia and Poland have carried on the use of phages for therapeutic purposes and have developed specialised research and treatment centres, where phage therapy is permitted and applied to cure infectious disease. Although the efficacy of bacteriophages for treatment of infections is widely documented, the introduction of phage therapy in common management of bacterial infections in European hospital is hindered by the lack of an appropriate legal and regulatory framework. Different strategies have been used to overcome this problem, like the "Magistral Phage" preparation in Belgium. Here, we provide a review of the fundamental concept on bacteriophage therapy and propose this treatment as a possible alternative choice when antibiotics and surgery are not enough to eradicate a bacterial infection. We believe that the introduction of phage therapy in Italy might improve the quality of life of patients suffering of chronic bacterial infections and fight antibiotic resistances problem. To reach this goal the support and the promotion of Italian government and the scientific authorities is essential. SIMIT, the Italian Society of Infectious and Tropical Diseases, proposes to support the creation of an Italian Task Force to improve knowledge on bacteriophage therapy, collect stronger evidence about their efficacy and develop appropriate protocols for phage administration.