FAQs
The FAQs on this site were developed by Dr. Emma Finlayson-Trick and Dr. Gregory German, in collaboration with Dr. Alexander Hynes, Riley Alvarez, and Dr. Sasan Hosseini.
The FAQs on this site were developed by Dr. Emma Finlayson-Trick and Dr. Gregory German, in collaboration with Dr. Alexander Hynes, Riley Alvarez, and Dr. Sasan Hosseini.
1. What is phage therapy?
Bacteriophages, commonly known as phages, are viruses that selectively attack bacteria, and not humans. Phages have a natural ability to fight infections and to get to places difficult to reach or penetrate. When antibiotics fail, phages are increasing considered as a form of therapy to treat an otherwise untreatable infection. In Canada, this is through clinical research and trials.
2. Is phage therapy safe?
Phages are all around us and in us, targeting bacterial cells, not human cells. Phage therapy today appears essentially safe. A recent systematic review of 52 clinical studies from around the world reported that phage therapy was ‘well tolerated in most cases’. There are multiple steps involved in removing bacterial products that are present while making phage preparations used in therapy. Compared to antibiotics, the side effect profile of phage therapy is lower as phages are specific for their bacterial target.
3. Why isn’t phage therapy more common?
Phage therapy is common and over the counter in Eastern Europe. Phage therapy has been used for more than 100 years. Antibiotics and vaccines made it so that for a long time, we did not need to use phage therapy. Antibiotics, however, are becoming less effective, so there is renewed global interest in phage therapy. We anticipate that as randomized controlled trials are completed, phage therapy will become more mainstream.
Besides Eastern Europe, there are now phage therapy centers in places such as San Diego, Pittsburgh, Minnesota, Connecticut, Sweden, Belgium, France, Australia, and Switzerland. Phage therapy is a form of personalized medicine and we are still working through all the steps involved.
4. Can phage therapy treat any bacterial infection?
Picking the right phage to treat an infection is a time-consuming process, so scientists are focusing on the bacteria that cause common, but sometimes difficult-to-treat infections. These bacteria include E. coli, Pseudomonas aeruginosa, Staphylococcus species, and some types of Mycobacterium.
Currently phage therapy is not used to treat what causes Lyme disease.
In addition, phage therapy is not used to treat infections caused by Neisseria gonorrhea (Gonorrhea), Treponema pallidum (Syphilis), Legionella (Legionnaire’s disease), Clostridioides difficle, Bacteroides fragilis, Mycobacterium tuberculosis (TB), Ureaplasma, or Mycoplasma.
1. Is phage therapy used in Canada?
Phage therapy is not currently a licensed treatment in Canada. However, patients with serious multi-drug resistant or device-related bacterial infections that are not responding to antibiotics may be eligible. These select patients can access phage therapy through their physician provider as a single patient trial. This trial is overseen by a Research Ethics Board with an application to Heath Canada for use as an Investigational New Drug. This has been done less than a handful of times and takes months of research work and sufficient funds. Canadians occasionally receive phage therapy products or treatments overseas including in the Republic of Georgia, where preparations are over the counter.
We need more phage therapy trials and access in Canada. Consider giving to your local hospital or University, or become a member of Phage Canada. Traditional multi-patient trials are under consideration in Canada and US trials are considering expansion into Canada.
2. What are the Canadian priorities for phage therapy?
Canada is mainly focusing on three types of bacteria including E. coli, Pseudomonas aeruginosa, and Staphylococcus species (which includes methicillin-resistant Staphylococcus aureus or MRSA). Canada is also recognized internationally for our expertise in treating drug resistant Burkholderia cepacia. Phage Canada’s mission expands to support and advance phage research and phage therapeutics in across medical, environmental, and agricultural domains.
In addition to types of bacteria, Canada is also focused on using phage therapy to treat three common types of bacterial infections, including urinary tract infections, orthopedic infections with implanted devices, and chronic respiratory infections. Future area of interest include treatment for chronic blood stream infections and removal of multi-drug resistant bacteria from the body (also known as decolonization).
3. Does Canada have clinical phage labs for phage matching?
There are two main phage banks in Canada. They include the Félix d'Hérelle Reference Center for Bacterial Viruses at the Université Laval in Quebec and the National Microbiology Laboratory in Winnipeg. There are also two Canadian companies, Cytophage (Winnipeg) and Qeen BioTherapeutics (Quebec), who have had success with their phage banks.
In addition to having access to phage banks, a crucial element of phage therapy is phage matching, which refers to correctly identifying phages that work against the bacteria of interest. There is no specific proven protocol for phage matching, but a European led coalition is working on a draft, which has Canadian input from Dr. Gregory German.
4. Does Canada have a Phage Therapy Treatment Centre?
No, Canada does not have a Phage Therapy Treatment Centre. This would require $10 million or more in funding to support. The University of Toronto has received $5 million and they are raising funds to become Canada’s Phage Therapy Treatment Centre with support from other laboratories and Universities.
5. Does Phage Canada work with international phage therapy centres?
Dr. Greg German and colleagues collaborate with physicians and scientists from around the world, including, but not limited to, the following groups:
• Center for Innovative Phage Applications and Therapeutics (IPATH), San Diego (Dr. German receives Canadian referrals from IPATH)
• Center for Phage Biology and Therapy at Yale University, Connecticut
• Eliava Phage Therapy Center in the Republic of Georgia
• Tailored Antibacterials and Innovative Laboratories for Phage Research (TAILOR) at Baylor College of Medicine, Texas
1. Can you help me find a doctor to treat me with phage therapy?
Canadians interested in phage therapy likely have chronic infections that have been followed by their healthcare teams, including laboratory-based microbiologists. Infectious disease doctors and microbiologists are readily available to help handle chronic infections. Many of them are knowledgeable about phage therapy.
Your physician can reach out to Dr. Gregory German of the St Joseph’s Health Centre Outpatient Infectious disease service via email (Gregory.German@unityhealth.to) or fax at 416-530-6050. Dr. German will review your case with your doctor and depending on location determine if an infectious disease or microbiologist physician (including himself) can assist in your care.
Please consider participating in Phage Canada to learn more.
2. What information does my doctor need to share?
Your doctor needs to share the following information:
• The bacteria causing your infection and the duration of your infection (needs to be at least three months, but more likely more than a year)
• The bacterial antibiogram, which shows the bacteria’s antibiotic resistance pattern
• What treatments have been tried and who has been involved (medical and surgical teams)
• Antibiotic allergies
3. What happens if my doctor cannot isolate any bacteria?
A bacterial culture is needed before phage therapy can be considered. A bacterial culture is used to find active phages against the bacteria, and therefore finding phage would not be possible without a sample of the patient’s bacteria. Genetic sequencing tests cannot be used to find active phages, and therefore cannot be a replacement for a bacterial culture. Having little or no options for cure is important to speed up the approval process.
4. What is Phage Canada’s success in treating patients with phage therapy?
Dr. Greg German of Phage Canada treated Victoria Marshall in Toronto for her chronic E. coli urinary tract infection. There are additional examples of phage therapy cases (not affiliated with Phage Canada), such as for the treatment of a Staphylococcus epidermidis prosthetic joint infection, and there is a randomized control trial currently in progress.
1. What is AMMI Canada?
The Association of Medical Microbiology and Infectious Disease (AMMI) Canada is a national association that represents approximately 750 physicians, microbiologists, and healthcare experts who specialize in treating and diagnosing infection. To learn more about AMMI Canada, please click the following link.
2. What is the Phage Therapy Working Group?
Since 2021, AMMI Canada members have been working together to support clinical care, regulatory processes, laboratory opportunities, and educational engagement related to phage therapy in Canada. The working group is chaired by Dr. Greg German, and co-led by Drs. Susan Poutanen and Emma Finlayson-Trick.