Our Journey with Bacteriophage Therapy

In the sterile glow of a hospital room in 2024, I watched my wife Helen struggle to breathe, her body battered by infections that antibiotics were struggling to fight. Fear gripped me as I wondered if we’d run out of options. I had heard about antibiotic resistant bacteria before, but never assumed that we would encounter one of these superbugs.

My name is Chris, and I’m here to share our story—not just of survival, but of a lifeline called bacteriophage therapy. If you’re a patient, caregiver, or doctor searching for answers to multi-drug resistant (MDR) infections, this story (and this website) is for you.

Reliable stories about phage therapy are hard to find—scattered across a few Reddit posts or PubMed case studies. That’s why I created phagetherapyguide.com: to offer hope and a practical path forward. Our journey through my wife’s battle with MDR infections in 2024 led us to a century-old treatment that changed everything. Here’s how we found it, and how it might help you.

The Onset: A Growing Medical Mystery

My wife, Helen, is the patient in this story. In 2021 she began having recurring episodes of sinusitis and pharyngitis. The treatment was pretty much always the same–anti-inflammatory drugs in addition to antibiotics like azithromycin, clarithromycin, or Augmentin (amoxicillin + clavulanate). These episodes came and went with varying degrees of frequency. Sometimes, there was one or two per month and other times we had one or two months between episodes.

In 2023, the episodes increased in frequency, duration, and severity. None of the doctors could figure out why. In hindsight, this was a diagnosis that was too easily missed. Nobody thought to do an oropharyngeal culture which to me, sitting where I am, is baffling. The medical system in America, to my uneducated eye, focuses on the number of patients treated rather than the quality of treatment. Many people with a better handle on the state of healthcare in America have already written their diatribes and suggestions for improvement. As such, I’ll leave them to their noble work. 

In late 2023, we relocated to central America (she is Guatemalan, I’m from the USA) and began to receive better treatment from an otolaryngologist who diagnosed her with chronic sinusitis. In June, 2024 the storm began in earnest. She began feeling unwell around mid June and she started taking same protocol of medicine that had made her well before–azithromycin and anti-inflammatories. However, this time she didn’t get better. After two weeks of no real improvement we went to a local clinic where the doctor ordered some bloodwork and a chest X-ray. A half hour later, the doctor came back in with a startled look on her face, saying that my wife had 29,500WBC and consolidations consistent with pneumonia in both lungs. In other words, she had pneumonia and was septic. She told us to go to a hospital as quickly as possible.

I was shocked and didn’t really know what to think. I had a superficial understanding of what sepsis was, but the thought never crossed my mind that my wife could be septic or that she would need anything other than some oral antibiotics. Concerned, we drove home to pick up some clothes and say a prayer before heading to a hospital for more advanced treatment. 

We arrived at the hospital, where Helen’s pulmonologist and an on-call otolaryngologist (ENT) evaluated her. Diagnosed with pneumonia, she was admitted for three days, during which doctors took a sputum culture that revealed Staphylococcus aureus and Pseudomonas aeruginosa. After inpatient treatment, we returned home with a combination of Moxifloxacin (IV every 12 hours for three more days) and Cefixime (oral every 24 hours). The ENT also began planning sinus surgery for the weeks following discharge. Although lab tests showed the bacteria were susceptible to these antibiotics, they didn’t work as expected, and just days later, Helen was readmitted to the hospital.

Our First Run-In With Antibiotic Resistant Bacteria

The second stay in the hospital was far more severe than the first. It lasted for nearly two weeks and would require emergency sinus surgery which ended up being quite dangerous given the infection. After the surgery was complete and Helen was in recovery, two of the surgeons came back to her room where I was waiting. They explained that, while the surgery was successful, there were complications with her oxygen saturation during the procedure. They also said that there was a severe sinus infection that they found and had sent cultures to the laboratory for further testing.

They also recommended involving an infectious disease physician to help with the treatment. It was at this point that Dr. Sandoval, an excellent doctor, was onboarded to Helen’s case. The cultures taken during the surgery came back a few days later and, while they didn’t show S. Aureus, they did show P. Aeruginosa that was far more resistant than even 2 weeks prior. Cipro was out. Combination antibiotics like Zosyn (piperacillin + tazobactam) were out. Even some carbapenems (which are widely considered to be the nuclear option of antibiotics) were out. Dr. Sandoval ran some additional testing to see minimum inhibitory concentrations and get a better idea of how resistant the P. Aeruginosa was.

Resistant Reality Check

About halfway through the 2nd hospitalization, I had to read the room. I could see the concern on the doctors’ faces. I had heard of resistant bacteria before but never thought I would encounter one. I knew about ESKAPE pathogens. But after a week in the hospital with no real end in sight, I knew that this roller coaster ride from hell was likely just getting started.

Resistance Research

It was at this point that I began investigating new treatments for mulit-drug resistant bacteria. As any good little dilettante (or mediocre dilettante in my case) would do, I started with a google search about bacterial resistance. To novitiates, the term “resistance” can be a little misleading. When something meets resistance, you simply push a little harder or give a little more to break the threshold. The reality is that with true antibiotic resistance, that threshold rises higher than the threshold for toxicity within the patient and functionally disappears. Adding more antibiotics is about as effective as adding more water; it just doesn’t do anything. Past a certain point, it’s not antibiotic resistance, it’s antibiotic immunity.

Most of the articles that I came across were about new drugs that are in the development pipeline. These are indeed good advancements, but they don’t really fix anything in the long term–bacteria will almost certainly develop a measure of resistance to these new drugs that are also in development. So instead of five treatment protocols before the “end of the line” there will now be six, and the “end of the line” still comes after. This has larger implications for the antibiotic resistance pandemic making the problem functionally intractable with legacy antibiotics.

Why It’s Important to Pay Attention in High School Biology

As I spent countless hours reading about new antibiotics in phase I, II, and III clinical trials, a friend of mine sent me “Current Treatment Strategies Against Multidrug-Resistant Bacteria: A Review.” This article essentially outlines current physician guidelines on treating MDR infections. About a third of the way down in the article, I saw the mention of a “lytic bacteriophage” which took me back to my high school biology classes. I remembered learning about bacteriophage in a lecture about DNA transcription. The bacteriophage (a virus which infects bacteria) pokes a hole into the bacterium and inserts its own genetic code which effectively turns the bacterium into a factory for more bacteriophage. The dénouement of this microscopic Trojan Horse is the sudden rupture (or lysis–hence lytic bacteriophage) of the bacterium. Not only does this cause the death of the bacterium (as do traditional antibiotics) it also releases dozens to hundreds of freshly minted bacteriophages. This amounts to a logarithmically self-replicating antibiotic.

I did a quick google search of something amounting to “bacteriophage use as antibiotics” and was shocked at the number of results that came up. Not only was this theoretically possible, there was an actual name for it–bacteriophage therapy. I found Phase II clinical trials for a bacteriophage cocktail being developed for a P. Aeruginosa in cystic fibrosis (CF) patients. I found studies done both in vivo and in vitro that established a degree of efficacy for phage therapy. I found case studies of people that received phage therapy and achieved a full recovery. Now this was interesting.

The day after I began looking into bacteriophage therapy, I asked my wife’s pulmonologist about this. He gave me a strange look and asked what I was talking about. I explained how bacteriophage therapy worked and the next words out of his mouth were, “you need to stop reading science fiction.” Now, this doctor is a lovely person. He has been a blessing and has treated my wife for decades. He was, at least on this account, wrong. Bacteriophage therapy is not science fiction; it is real, and it is one of the reasons Helen is alive today.

Home Again

12 days, a sinus surgery, and several antibiotics later, my wife was released from inpatient treatment. By this time, she and I were both on the verge of being traumatized. We didn’t know what to expect. We felt alone. While we were happy to be going home after 12 days of poor sleep, injections, the constant churning of the IV pump, and early-morning phlebotomist visits, the hospital also provided a measure of safety. At home there was no doctor that we could speak to with the push of a call button. There was nobody monitoring medications for us. There were no respiratory therapists. There was nobody to ask if something started going sideways–is that cough normal, or is that the start of another infection?

Back again

Another short week after returning home, my wife had a scary relapse of pnuemonia with symptom onset occurring in literally a matter of hours. That morning she woke up feeling well, and by that afternoon, her oxygen saturation had dropped and she was having trouble breathing. This would amount to the third hospital stay in same number of months and would last for 7 days this time. We arrived at the hospital unsure of what to do with ourselves. I tried to stay strong for her–the last thing she needed was an inconsolable mushy ball of a husband.

Reality Sinks In

For the third time, Helen was admitted with the routine battery of tests: sputum sample, CT scans, and a blood test that revealed 24,500WBC. Based on the last cultures, my wife was started on the third-line treatment (out of 5 lines) available. Ceftazadime and Amikacin were the drugs of choice for this time in the hospital. However third line antibiotic therapies get uncomfortably deep into the bench of options. 

3rd line therapies come with a card-deck sized package insert of potential nasty side effects of neurotoxicity (nerve damage), ototoxicity (ear damage), nephrotoxicity (kidney damage), and more. During this third hospitalization, I talked with her Dr. Sandoval about the idea of phage therapy. Unlike my wife’s pulmonologist, she had actually heard of phage therapy. Later I found out that she had actually been a part of a small scale study with bacteriophage that was done in a local hospital. She said, however, that we were not at the stage where we should consider phage therapy because there are still more antibiotic options. I, however, was seeing that we were already on a third-line treatment out of five lines. Not only that, we were on a third line treatment a little only 6 weeks after being on the first line treatment and there were only two lines left.

The P. Aeruginosa had gone from apparently susceptible to flouroquinolones (Ciprofloxacin, Levofloxacin, Moxifloxacin) to being carbapenem and beta-lactam resistant in essentially two months. Outside of that, patients and doctors find themselves in the territory of combination therapy, so-called “novel agents,” and dangerous drugs of last resort like Colistin. Taking a pill at home is a dream when you reach this point–not only are oral antibiotics not an option, many IV antibiotics are not even an option. And when you run out of antibiotics, there are no more options. That’s it.

This third and final time was the most hopeless and desperate that we’ve ever been. The first four days we had no idea if the treatment was even working. My wife wasn’t feeling much better and we only saw the doctor twice during those four days. I began to imagine a bleak future of a prolonged hospitalization every couple of months until nothing worked anymore.

Bacteriophage Knowledge is Power

Considering the number and severity of hospitalizations in such a short amount of time, I was unconvinced that phage therapy was a fruitless rabbit trail. If anything, it seemed like traditional antibiotics were fruitless. Yet there were hippity-hoppity-ing along the cephalosporin rabbit trail. From my vantage point, we went through three lines of treatment in two months. If there are only two lines left, then we had, at best, another six weeks maybe. Now, this isn’t precisely how it works and, hindsight being 20:20, I think that we would have had far more than 2 months (maybe 2 years) even in the absence of bacteriophage therapy.

My neuroticism notwithstanding, I began to read as much as I could about phage therapy. I couldn’t do much from a hospital room; but I had a computer, a high speed internet connection, and an iron determination to find a way out.

Bacteriophage Therapy Safety

First of all, I decided to read up on the safety of phage therapy. The reader should understand that phage therapy is an un-credentialed area of medicine in the West. There is an unfortunate paucity of evidence for bacteriophage compared to the epistemological gold standard of double blind placebo controlled trials with thousands of subjects. However, one thing that has been fairly well established is the safety of bacteriophage therapy.

Studies are great to have. However, simple first-principles reasoning helps deduce their safety. Bacteriophage are the most abundant “organism” on the face of the earth. With every breath you take, you are breathing in bacteriophage. Every drink of water and every bite of food has bacteriophage in it. Yet, none of us are getting ill from bacteriophage. Second, bacteriophage are very specific in their infective abilities, sometimes even down to the sub-species level. While it would be imprudent for me to say that they never infect human cells, their mechanism of action is like a key in a lock. A P. Aeruginosa key will not “open” an E. Coli cell. If the bacteriophage don’t even work across the same genus, there is no reason to believe that the gap would narrow across higher order taxonomic divisions.

Bacteriophage Therapy Efficacy

After I saw that phage therapy is safe, I began to look for efficacy, where to my surprise, bacteriophage seemed to be between 70% – 90% (or more) effective in treating bacterial infections. This number is not homogenous, neither is it well established, so it comes with a big grain of salt. However, another tidbit that I learned is that even if bacteriophage are not “effective” in eradicating an infection, they can substantially change a bacteria’s susceptibility. I will write an article about this in the future, however, the fact that it could turn a MDR bacteria into a susceptible bacteria was good enough for me. 

Finding Bacteriophage Therapy Clinics

Finally, I began to look for different clinics where Helen could get phage therapy. I found one with U of C San Diego, one in Poland, and two in Tbilisi Georgia. I am aware of phage therapy clinics existing in Russia. However, they do not advertise themselves to Westerners nor are Western search engines indexing un-credentialed Russian pharma companies. As such, none of these clinics made it into my roster.

I sent emails to all of these different clinics and stayed up until midnight or 1am for several days in a row calling Tbilisi and Warsaw with no luck. Eventually I heard from Steffanie Strathdee, an author, epidemiologist, and the head of U of C San Diego’s Phage Research program called IPATH–Center for Innovative Phage Applications and Therapeutics. Dr. Steffanie Strathdee is to phage therapy research in the West what Oppenheimer was to the Manhattan project. Her book, The Perfect Predator was my primer into phage therapy and I highly recommended it to anyone currently reading this page. Not only is it a source of hope, the ordeal Steffanie and her husband went through gave me some much-needed perspective with our own story. 

Steffanie was the first person to respond to me and she informed me that my wife was not yet sick enough to qualify for the program at U of C. While I admire Steffanie and her work (which was immensely helpful in making the decisions that we made later on), I was frustrated to say the least at the interaction that I had with U of C. When I asked what the eligibility criteria were for phage therapy at U of C’s IPATH program, I received no response.

I eventually heard back from all of the clinics that I had originally emailed, though this was a slow process and took a number of days. Both clinics in Tbilisi, when they read my wife’s medical history and saw the most recent antibiograms, accepted her case unconditionally. The clinic in Warsaw, Poland asked for far more information and we decided to not move forward with the clinic in Warsaw though I’m confident they do good work. 

This, however, was the first small win that we had achieved in a while. My wife’s case was accepted at both clinics in Tbilisi, Georgia. 

Is the Cure Worse Than the Disease?

Back, at the hospital, however, things were both getting better and worse at the same time. The Amikacin + Ceftazadime mix was doing a great job at kicking the pseudomonas, however it was also doing a great job at killing the rest of the “good” bacteria in her body. 

Two days before discharge, we learned Helen had contracted Clostridoides Difficile: a dangerous gut infection that can be caused by aggressive antibiotic usage. The relapse rate of C. Difficile infections (CDI) in patients who have already had a CDI once is uncomfortably high and it can cause a life-threatening disease called toxic megacolon. So future antibiotic use had to be kept at an absolute minimum–in other words, a fourth hospitalization could not happen.

A week after arriving at the hospital, my wife was discharged to go home. We were happy to be out of the hospital, but this felt like strike three and any further hospitalizations would be exponentially worse. A few weeks later, she developed urinary tract infection symptoms that were also likely contracted in the hospital. Tests confirmed another MDR infection: E. coli. Later, in Tbilisi, we would learn that this same infection was also in her intestines. Within a few weeks the P. aeruginosa was back too, however, it was not as virulent and stayed as a low-grade chronic infection that only required daily nebulization without antibiotics. My wife was stable on a macro level, the situation was precarious. We were out of time and running low on hope.

Preparations for Phage Therapy

By October 2024, Helen had been stable enough for eight weeks. No further hospitalizations were required, however, the UTI had reared its ugly head twice prompting two trips to a nearby clinic for a kidney ultrasound an subsequent treatment with Fosfomycin. There was a degree of stability, but every day felt like Russian Roulette.

Fortunately, I had spent the previous 8 weeks diving into phage therapy, bacterial resistance mechanisms, and reading a majority of the studies available on bacteriophage therapy. Any doubts I had in the beginning about the viability of phage therapy were now gone. I was convinced that this was by far the best option to achieve remission.

Helen’s infectious disease doctor was one of the few physicians who even had a working knowledge of what it was. Even so, she took a very conservative approach (which for legal reasons I totally understand). She told us that it was indeed an option, however it was a “compassionate care” option which should only be pursued after all other courses of action had been exhausted. 

Around mid-October I sent Helen’s infectious disease physician a text message (I had her personal phone number by now) explaining the current lay of the land. Helen now had three MDR infections (Intestinal and urinary E. Coli + P. Aeruginosa) and future antibiotic use was extremely risky with the C. Difficile. I told her that we had managed our expectations with phage therapy and that we were looking for a non-antibiotic suppressive treatment and that legacy antibiotics were looking to be more risky than beneficial. Helen wasn’t getting any worse, however, she wasn’t getting any better. 

A few hours later I received a response that was as close as we were going to get to a green light. She said that she agreed that it would be beneficial to look for additional treatment options and that she was confident that the clinic in Tbilisi would treat Helen ethically. Given the gravity of the situation, we would have been well within our right to pursue this treatment, independent of her message. However, by this time, Dr. Sandoval had taken what appeared to be a personal interest in Helen’s case and we valued her opinion and expertise far above that of anyone else.

Preparations for Phage Therapy in Tbilisi

I then got back in touch with both clinics in Tbilisi, Georgia and we ultimately opted for the Eliava Phage Therapy Center. We made this decision because of the institutional pedigree–about 100 years of phage research–though the other option, the Phage Therapy Center, is a legitimate option as well. 

I had done all of the research. I knew that phage therapy was safe. I knew that it worked most of the time. I knew that the clinic in Georgia was willing and able to take her case. I had read as many online testimonies as I could–both good and bad. I had spent hours looking at websites, printing off NIH and PubMed studies, highlighting them and making sure I understood them. It was time to go.

Travel to Tbilisi

After much prayer, consideration, and coordination with the team at EPTC, my wife and I purchased tickets to travel to Tbilisi at the end of October, 2024. After four different flights, 40 hours of travel and 10 hours of time change, we arrived in one of the most surreal places I’ve ever been to. I am, as Americans go, fairly well traveled. I am bilingual and getting down and dirty in new cultures has always been my MO when traveling. However, Tbilisi was a different animal. Perhaps it was the fact that there were no more safety ropes that freaked me out–if she got sick there, I wouldn’t know what to do. I don’t speak their language and my ability to advocate for my wife would be severely truncated. But there we were. Gamargjoba!

We arrived at about 4:40am on October 31st and had coordinated with Lana, the patient coordinator at EPTC to begin treatment that same day in the afternoon. Our first airbnb was about 10 minutes walking to the George Eliava Institute campus so we walked down to meet the clinic and therapy that I had invested hundreds of hours researching. 

Eliava Phage Therapy Center

The Eliava Phage Therapy Center is a rather unassuming building at the George Eliava Institute campus. It’s not gaudy or flashy even though it is, by all accounts, the world’s epicenter of phage research and phage therapy. In retrospect, I shouldn’t be surprised since phage therapy is the viral equivalent of amoxicillin. No need for a level-one trauma center or the Georgian Mayoclinic to administer a simple oral medication. 

Humble structures notwithstanding, the physicians at EPTC are excellent at their job and are excellent people. They cared, and they took as much time with my wife as she needed–up to an hour and a half in some instances diving into medical histories and, most importantly, listening. 

The first day they did a full workup: blood tests, stool tests, urine tests, ultrasounds, and more. All of the samples were sent off to their lab for the phage-equivalent of an antibiogram (known as a “phagogram”). My wife was seen by a gynecologist, an otolaryngologist, a neurologist, and daily by Dr. Lia, the head physician and internal medicine doc at EPTC. They also provided to us, at no additional cost, a nebulizer with 220v plug since our converter burned out when we used our 110v nebulizer. They used natural medications when they could and all treatment-related expenses were included. 

On one occasion, my wife needed some medicine that EPTC didn’t have on hand, so one of the doctors went with us to a pharmacy in Tbilisi to get the medication my wife needed (thank you, Lika)! Beyond this, my wife received daily attention at the clinic (which is NOT an in-patient center. Please do not go to EPTC if you need in patient treatment) in the form of follow-ups and supportive therapies.

The actual phage therapy preparations are little 5ml glass vials with a solution of sterile bacteriophage isolates. The George Eliava Institute is also GMP (Good Manufacturing Practices) certified for those wondering. 

While we opted to travel for treatment, there is a distance treatment option which I believe would be appropriate for many people; perhaps even most people. We had tried to do the distance approach already but the sample that EPTC requested was held in customs for 6 weeks. My wife and I actually arrived in Tbilisi before the sample did. This was one of the contributing factors to our decision to travel there. 

What Next? Bacteriophage Resistance?

We were in Tbilisi for a total of 8 days. On the final day of treatment, we met with Dr. Lia who went over all of the different test results with us and one of our worst fears were confirmed. The menagerie of bacteria were all resistant to the commercial bacteriophage preparations. The good news, however, is that they could make custom bacteriophage preparations for her for an additional cost. After some questions about lead time and delivery, we opted for the custom bacteriophage preparations.

I remember walking back to our hotel room with my wife feeling like we had just failed and eliminated our best and only option for remission of the infections. The phage would take approximately 3 months to manufacture taking us well into the following year for the anticipated delivery time.

The rest of the trip was relatively uneventful and, apart from a short trip to see my parents on the way back, little else worth mentioning happened.

Some Perspective on Bacteriophage Resistance

A quick note for those who feel broadsided by the idea of bacteriophage resistance: this is a very common issue. In fact it is even more common than antibiotic resistance. In the wild, bacteria are constantly being exposed to different species of bacteriophage. As a result, bacteria have natural immune mechanisms such as altering binding sites on their membranes to avoid infection by the bacteriophage. However, this problem is at least an order of magnitude more manageable than antibiotic resistance. Whereas there may be two-dozen or so antibiotic option to deal with a totally susceptible bacterial infection, there are thousands of species and sub-species of bacteriophage. This is more or less equivalent to having thousands of different antibiotics for each kind of bacteria whereas there are only 60 – 80 antibiotic agents approved for human use in the USA.

Furthermore, standard practice in bacteriophage therapy is actually to create a cocktail of different bacteriophage species. This means that when a patient receives phage therapy, each vial of phage contains several different strains of that are all active against the bacteria. Unlike traditional antibiotics that must go through several years of testing, new bacteriophage cocktails can be developed in as little as 8 to 12 weeks.

Snatching Victory from the Jaws of Defeat

We basically thought that the treatment had failed. However, about a month after returning home, my wife did some additional cultures. Here we found out that the E. Coli (both urinary and enteric/intestinal) was no longer there. She had taken no antibiotics in the interim and so the only thing that we could think of is that the commercial phage had actually worked! The interesting thing about bacteriophage is that it can actually work in the patient even though in the laboratory, the bacteria are resistant.

This difference between in vivo (in the person) and in vitro (in the laboratory) is idiosyncratic but is a phenomenon that is fairly well established according to the ETPC physicians and a number of studies. In vivo, the bacteriophage also interacts with the host’s immune system where the bacteria are forced to make adaptive tradeoffs. This leaves them vulnerable to the host’s immune system or the phage which can result in eradication.

Additionally, bacteriophage can also evolve alongside bacteria to “outsmart” the bacteria’s own immune system. There is no way to determine exactly why she had success with the treatment despite a resistant laboratory result. However, it is the only reasonable hypothesis. 

Where We Are Now

And so this is our story up to this point. Currently, every 15 days Helen takes the phage and then rests for 15 days. We are not sure if the P. Aeruginosa is still there, if it will come back, or if it is gone forever. However, we’re happy with the simple fact that it’s been nearly a year since the last hospital visit and many months since the last round of antibiotics

This was our entry point into multi-resistant infections with dangerous pathogens and it was also our entry point into new therapies that are able to put a meaningful dent in the looming pandemic of antibiotic resistance. It taught us resilience and the power of unconventional solutions in the face of antibiotic resistance. If you’re battling resistant infections, don’t lose hope. Phage therapy is a viable option, and our story proves it can work. For questions, email me at [email protected]—write “URGENT” in the subject line for urgent requests. More information on phage therapy, scientific studies, and practical steps will soon be available on our website. We’re here to help you find your own path to healing.