A controlled clinical trial of a therapeutic bacteriophage preparation in chronic otitis due to antibiotic-resistant Pseudomonas aeruginosa; a preliminary report of efficacy.
OBJECTIVE
To evaluate the efficacy and safety of a therapeutic bacteriophage preparation (Biophage-PA) targeting antibiotic-resistant Pseudomonas aeruginosa in chronic otitis.


METHODS
Randomised, double-blind, placebo-controlled Phase I/II clinical trial approved by UK Medicines and Healthcare products Regulatory Agency (MHRA) and the Central Office for Research Ethics Committees (COREC) ethical review process.


METHODS
A single specialist university hospital.


METHODS
24 patients with chronic otitis with a duration of several years (2-58). Each patient had, at the time of entry to the trial, an ear infection because of an antibiotic-resistant P. aeruginosa strain sensitive to one or more of the six phages present in Biophage-PA. Participants were randomised in two groups of 12 treated with either a single dose of Biophage-PA or placebo and followed up at 7, 21 and 42 days after treatment by the same otologist. Ears were thoroughly cleaned on each occasion and clinical and microbiological indicators measured.


METHODS
Physician assessed erythema/inflammation, ulceration/granulation/polyps, discharge quantity, discharge type and odour using a Visual Analogue Scale (VAS). Patients reported discomfort, itchiness, wetness and smell also using a VAS. Bacterial levels of P. aeruginosa and phage counts from swabs were measured initially and at follow-up. At each visit patients were asked about side effects using a structured form. Digital otoscopic images were obtained on days 0 and 42 for illustrative purposes only.


RESULTS
Relative to day 0, pooled patient- and physician-reported clinical indicators improved for the phage treated group relative to the placebo group. Variation from baseline levels was statistically significant for combined data from all clinic days only for the phage treated group. Variation from baseline levels was statistically significant for the majority of the patient assessed clinical indicators only for the phage treated group. P. aeruginosa counts were significantly lower only in the phage treated group. No treatment related adverse event was reported.


CONCLUSIONS
The first controlled clinical trial of a therapeutic bacteriophage preparation showed efficacy and safety in chronic otitis because of chemo-resistant P. aeruginosa.
Wright
A
A
UCL Ear Institute and Royal National Throat, Nose and Ear Hospital, Grays Inn Road, London, UK. anthony.wright@ucl.ac.uk
Hawkins
C H
CH
Anggård
E E
EE
Harper
D R
DR
D000328:Adult; D000368:Aged; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D002908:Chronic Disease; D015169:Colony Count, Microbial; D004311:Double-Blind Method; D024881:Drug Resistance, Bacterial; D004739:England; D005260:Female; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D010032:Otitis Externa / Q000175:diagnosis / Q000382:microbiology / Q000628:therapy*; D019720:Otoscopes; D010147:Pain Measurement; D011552:Pseudomonas Infections / Q000175:diagnosis / Q000382:microbiology / Q000628:therapy*; D017105:Pseudomonas Phages / Q000254:growth & development; D011550:Pseudomonas aeruginosa; D010948:Viral Plaque Assay
D000890:Anti-Infective Agents