- by Angus Cochrane
- BBC Scotland news
A Scottish surgeon has become the first in the UK to use a more than 100-year-old method to successfully treat joint disease.
It is hoped that progress can help patients with conditions that are resistant to antibiotics.
NHS Tayside says its orthopedic unit in Dundee is the first in the UK to treat joint infections using phage therapy.
It involves using specially selected viral cells, called phages, to kill bacteria.
The treatment was used on an 84-year-old woman at Ninewells Hospital.
Suffering from a badly infected hip and rib, she underwent eight surgeries to remove the infection, as well as a year and a half of antibiotics.
Within two weeks of phage treatment her infection cleared up. Her wound healed for the first time since Christmas and the patient was scheduled to return home within 8 weeks of treatment.
The procedure was carried out by consultant trauma and spinal surgeon Mr Graeme Nicol with the support of the UK’s only clinical specialist, Dr Josh Jones, and consultant infectious diseases Dr Daniela Munteanu.
“What the virus does is it attaches to the bacterial cell, it infiltrates it and it multiplies,” Mr Nicol told BBC Scotland. “In doing so, it causes the bacteria to explode.
“So, in other words, it just destroys the bacteria that are there – phage comes from the Greek devour so it works through this infection to clear it from the body.”
Once the infection is cured, the phages are destroyed by the patient’s immune system.
Patients remain on antibiotics throughout the process, Mr Nicol told BBC Scotland.
The surgeon said that as well as being used with infections in the hip, the treatment can work in the knees, wounds, bladder and other areas where phages can be used directly.
The treatment was first developed in 1919 and was widely used in the early 20th century, especially in the United States where it was commonly used against cholera.
But after the discovery of penicillin by Scot Alexander Fleming in 1928, the use of phages declined in Western countries because they are more difficult to produce and store than antibiotics.
Nicol stressed that while phage therapy is not a replacement for antibiotics, it can be a “lifeline” for patients with antibiotic-resistant infections.
The UK’s Health Security Agency has warned of a “hidden epidemic” of antibiotic-resistant infections, while the World Health Organization has described them as one of the biggest threats to global health.
Mr Nicol said such cases were an “everyday occurrence” in NHS Tayside. “We have patients stuck in hospital receiving intravenous antibiotics because there is no longer an oral option because resistance is built up to the extent that many common infections are now becoming more resistant to antibiotics,” he told BBC Scotland.
The surgeon said he hopes to see phage therapy rolled out across the UK within the next two years, with NHS Tayside producing a specialist treatment for patients with severe infections.
“Patients don’t have to travel here to get treatment,” Nicol said. “That’s the beauty of it.
“Every center has its own microbiology and infectious diseases unit and they will be able to look at it and tell us for sure that it is bacteria.
“From that point, the lab here can just watch and see if we have a virus that kills that bacteria. And then we can send it directly to them.”
He said the “labour-intensive” process – which involves finding suitable viruses in the environment and propagating them in a laboratory – would need further investment to scale up across the UK, but could be improved as it is developed.
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