Reduced potential for bacterial development of resistance

Auto “dosing”

In situ activity increases numbers (though only given favorable bacterial densities)

Low inherent toxicity

Virions consist of only proteins and DNA

Low normal flora impact

Low likelihood potential for superinfection by endogenous flora, e.g., C. difficile

Narrow resistance evolution

Selection for resistance limited mostly to within populations of targeted bacteria

Lack of cross-resistance

Antibiotic-resistant bacteria tend to retain phage sensitivity

Rapid discovery process

Phages with large therapeutic windows are often easy to isolate

Potential for modification

Phages can be easy to molecular characterize and manipulate

Use with other agents

Versatility in formulation development and combination with other drugs

Dosing versatility

Phage formuations can take many forms and can be delivered via many routes

Biofilm clearance

Certain phages, unlike most chemical antibiotics, can be relatively good at this

Favorable pharmacokinetics

Delivery to targets or persistence in situ often is either good or improvable

Single-dose potential

Can provide dosing convenience; auto dosing consequence

Low-dosage potential

Of possible economic or safety utility; auto dosing consequence

Single-hit killing kinetics

Nonetheless effectively multi-hit since phages still multiply adsorb bacteria

Engineered lower toxicity

Particularly elimination of bacterial lysis, but auto dosing advantage is thus lost

Low environment impact

Narrow specture of anti-bacterial activity, lability, low inherent toxicity

Not antibiotics

Fewer societal concerns with use, such as in agriculture; avoids antibiotic allergies

Natural products

Potential appeal to natural medicinals market

Relatively low cost

As drugs, reasonable production costs

Public perception

Public perception of use of phages as antibacterials seemingly is positive

1Advantages are as seen relative particularly to the use of chemical antibiotics as antibacterial agents.
2Line break between upper and lower portions of list is indicative of what we feel are greater (upper) versus lesser (lower) advantages to phages as antibacterial drugs.
3Ratio of drug dosage that gives rise to toxic effects to that which gives rise to efficacy. The larger the ratio, the safer the drug and/or the easier it is to work with.
Table 1: Advantages Associated with Phage Use as Antibacterials1.
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