With the increasing challenge of antimicrobial resistance, the global medical community is actively seeking alternative therapeutic approaches. One of the most promising strategies in this context is the use of bacteriophages and phage therapy. This treatment involves the use of live viruses that specifically target and destroy pathogenic bacteria while preserving beneficial microorganisms. Georgia—particularly the George Eliava Institute of Bacteriophages, Microbiology, and Virology—has been an international leader in this field for many years. In an interview, Dr. Dea Nizharadze, the chief physician of the Phage Therapy Clinic, discusses the natural role of bacteriophages, their clinical applications, the practice of personalized medicine, and international experience in the field.
What is a bacteriophage, and what role does it play in the living natural environment?
Dea Nizharadze: A bacteriophage is a virus that feeds on bacteria responsible for infections. It is an essential component of our ecosystem and is naturally found in the environment, as well as abundantly present on the skin surface and within the human body—particularly in the gut microbiome.
In which clinical cases is phage therapy recommended, and what are the most common symptoms or complaints that patients present with?
Dea Nizharadze: Bacteriophages—more precisely, phage-based preparations—are used in the treatment of bacterial infections, particularly in conditions that are traditionally managed with antibiotics. At our clinic, patients most frequently seek help for chronic urinary tract infections, disturbances of the intestinal microbiota, purulent skin infections, postoperative surgical wound complications, ENT (ear, nose, and throat) conditions, and gynecological disorders. We treat patients not only from Georgia but also from 86 other countries.
How is phage therapy positioned within modern medicine in the context of the growing problem of antimicrobial resistance?
Dea Nizharadze: The global medical community regards bacteriophages and phage therapy as a significant solution to the challenge of antimicrobial resistance. Resistance to antibiotics does not pose an obstacle to phages. For this reason, research on phages is expanding worldwide. Researchers hope that the advancement of phage therapy will substantially protect populations from complications of bacterial infections and their associated risks. At the Eliava Phage Therapy Center, the majority of foreign patients seeking treatment have infections that no longer respond to antibiotics, rendering conventional therapies ineffective. For these patients, phage therapy often represents the last therapeutic option.
Phage therapy is often associated with personalized approaches. How is this model practically implemented in your clinic?
Dea Nizharadze: Phage therapy indeed represents a prime example of personalized medicine. Currently, we have six phage preparations available that target various microbes, including Staphylococci, Streptococci, Corynebacterium species, Proteus, Salmonella, Shigella, Enterococci, and others. These preparations are prescribed only after thorough bacteriological testing. If the pathogen is not sensitive to any of the existing phage preparations, a customized phage formulation is developed specifically tailored to the patient’s microbial strain. Such personalized treatments often yield particularly high therapeutic efficacy. Additionally, each patient’s condition is evaluated by a multidisciplinary team at our clinic, further emphasizing the importance of a personalized approach.
How do you assess the effectiveness of phage therapy in the treatment of chronic infections?
Dea Nizharadze: The Phage Therapy Center has been operational for many years, and we continuously analyze statistical data, which helps us identify important trends. Treatment outcomes vary depending on the system involved. We observe the highest efficacy in managing infected wounds and chronic urinary tract infections. The effectiveness is comparatively lower in ear, nose, and throat (ENT) diseases, although this still depends on the specific case. Regarding antibiotic-resistant strains, as I mentioned earlier, they generally remain susceptible to phage therapy.
Approximately how much time does phage therapy require to achieve clinical results, and what is the typical progression during the treatment process?
Dea Nizharadze: The outcome depends on the specific diagnosis, the duration of the disease, any comorbidities the patient may have, and other factors. When we say phage therapy is personalized, we mean that the therapeutic effect is highly individual, and the pattern of improvement varies accordingly. For example, in cases of wounds and skin infections, recovery tends to occur relatively quickly, and the clinical improvements are more apparent.
As previously mentioned, the Phage Therapy Center often receives quite complex patients, especially from abroad. Many of these patients have genetically determined conditions that are complicated by infections. In such cases, it would be inaccurate to speak of complete recovery, as the infection is a consequence of the underlying genetic disorder. However, phage therapy significantly improves the quality of life for these patients. Every patient who comes to us observes tangible improvements in their condition over time, and this progress is the most important outcome for the Phage Therapy Center.
What challenges does phage therapy face as a scientific discipline, and what difficulties arise at the clinical, commercial, or informational levels?
Dea Nizharadze: In the field of phage therapy, it is particularly important to have more robust evidence and research-based practice. We work closely with the staff of the Eliava Institute, which, as you know, is a scientific organization with over 100 years of experience and is one of the most authoritative institutions worldwide. The institute’s scientists continuously share the latest developments in bacteriophages and phage therapy with us, which ensures our ongoing professional growth and maintains high standards of care.
Are bacteriophages considered only a “last resort” treatment, or is it possible that in the future phage therapy could become a first-line option?
Dea Nizharadze: Medicine is a constantly evolving field full of innovations, so I believe that with new research and advancements, phages will not remain merely a “last resort.” Alternative methods will continue to emerge, making antimicrobial treatment more diverse and effective.
What advantages does phage therapy have over antibiotics in clinical practice?
Dea Nizharadze: Phages do not harm bacteria that are beneficial to the body. They selectively and sparingly target only the undesirable microbes. As a result, treatment is not accompanied by many adverse side effects. Since phages are a natural part of our ecosystem, allergic reactions to them are minimal, which is a significant advantage. Besides their antimicrobial activity, phage preparations also have an immune-boosting effect, positively influencing the overall condition of the body. Additionally, ongoing research confirms that phages play a crucial role in maintaining balance within the gut microbiome. Bacteriophages are a normal component of the intestinal microflora and exert beneficial effects in gastrointestinal diseases not as antibacterial agents, but as microbiome restorers.
How well-known is Georgia as a central hub for phage therapy within the international medical community?
Dea Nizharadze: It is with great pride that I can share Georgia’s status as a true leader on the international stage. Presentations by our representatives at conferences consistently receive special attention and genuine admiration. The most recent conference, dedicated to phage therapy, was held just, recently in Berlin. Scientists from various countries presented their experiences in the field of phage therapy, but our contribution was the most extensive. The audience was thoroughly impressed. Such recognition is not unfamiliar to us, but it is always gratifying to be acknowledged.
Many physicians still do not fully recognize the significance of phage therapy and approach its use with caution. In your opinion, why is that?
Dea Nizharadze: The cautious attitude of physicians towards phage therapy is completely understandable. Georgia follows Western medicine principles, where treatment must be evidence-based. Local specialists constantly study international guidelines and protocols as part of their professional development and to uphold medical standards. Despite its century-long history, phage therapy was primarily practiced within the Soviet sphere and largely remained outside the scope of international research. This is why Georgia has preserved one of the world’s most valuable collections of bacteriophages. In recent years, phage therapy has been actively re-emerging on the global scientific agenda. Numerous countries are currently conducting clinical trials that will further establish phage therapy as an evidence-based approach. However, in clinical practice, many cases present where phage therapy is the patient’s last hope. In such situations, physicians cannot wait solely for new research results, especially when successful clinical experience already exists. Today, phage therapy in Georgia is gradually being integrated within modern, evidence-based standards. Its efficacy is supported both by data published in international medical journals and by the real clinical outcomes of many patients.
How do you envision the future of medicine: Is the era of antibiotics coming to an end, or should the new generation of phage-based preparations be used synergistically alongside them?
Dea Nizharadze: The synergistic effect between phage therapy and antibiotics is significant. Although phages cannot completely replace antibiotics, in certain cases they can serve as convenient and effective agents when used in combination with antibiotics.
Looking at the issue from a broader perspective, the use of phage therapy will significantly reduce the irrational use of antibiotics. It is crucial that antibiotics are prescribed only in strictly defined conditions. When these approaches are structurally and properly organized, it will lead to a substantial improvement both in the globally recognized threat of antimicrobial resistance and in the treatment outcomes for individual patients, which is our direct goal.
