CHRONIC WOUNDS
WHY BACTERIOPHAGES FOR CHRONIC WOUNDS?
Quick check: Phage therapy for chronic wounds
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Efficacy: Highly specific against multidrug-resistant pathogens (MRSA) and biofilms that block conventional wound dressings and antibiotics.
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Safety: Local application (irrigations/gels) is painless, protects healthy tissue, and supports the natural wound environment.
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Status: Used primarily as an individual treatment attempt for non-healing wounds (e.g., diabetic foot) or via specialised compounding pharmacies.
This specialist article was reviewed on the basis of current clinical data on the treatment of infected wounds and modern microbiology.
Phage therapy for chronic wounds: Knowledge base & background
Chronic wounds—such as diabetic foot syndrome, pressure ulcers (bedsores), or venous ulcers (leg ulcers)—place a major burden on those affected. These wounds often do not heal for months or years because they are colonised with bacteria that have become resistant to antibiotics. Phage therapy offers a biological way out of the resistance trap.
The causes of chronic wounds
A wound is considered chronic if it shows no tendency to heal within eight weeks despite appropriate treatment. The causes are varied, but microbial colonisation is the decisive factor:
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Multidrug-resistant organisms (MDROs): Hospitals and nursing homes are places where germs such as MRSA (methicillin-resistant Staphylococcus aureus) are common.
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The biofilm shield: In chronic wounds, bacteria usually live in a biofilm. This slimy matrix protects them like armour from the immune system and makes them up to 1,000 times more resistant to antibiotics.
Symptoms
Symptoms and treatment for chronic wounds
It is not certain that chronic wounds cause pain. This can vary depending on size and depth and on movement. However, common symptoms certainly include itching, weeping, and above all an unpleasant odour—especially when bacteria are present in the wound. In such cases, pain also occurs more frequently.
Phage therapy
Phage therapy for chronic wounds
Phage therapy is used in Eastern Europe to treat chronic wounds. In particular, those affected who already have an intolerance to antibiotics benefit from this therapy. However, antibiotics and bacteriophages are also used in combination.
The best-selling phage cocktail contains phages that lyse or kill the following bacteria:
Streptococcus pyogenes, Staphyloccus aureus, Escherichia coli, Pseudomonas aeruginosa, Proteus vulgaris, Proteus mirabilis.
Staphylococcus aureus
Staphylococcus aureus
As mentioned above, a chronic wound is mainly caused by the bacterium Staphylococcus aureus and Pseudomonas aeruginosa. For this reason, this phage cocktail is used for chronic wounds.
Buy bacteriophages for chronic wounds
Treatment with bacteriophages is usually started immediately. Since bacteriophages have no side effects, this approach is safe.
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The goal of phage therapy is to bring the phages to the site where the bacteria are located.
Use of bacteriophages for
chronic wounds
The wound is cleaned with a physiological saline solution. The wound is then irrigated with the phage cocktail. Depending on the size of the wound, 1–10 ml is used for irrigation. The amount depends on the size of the wound.
It is important that the entire wound surface is moistened with the phage solution. The dressing used to close the wound is also soaked with the bacteriophage mixture. This treatment is carried out once per day.
The treatment period is usually 10 days. If the bacteria present are difficult for the phages to access, the treatment may take longer.
During phage therapy, no agents may be used that can kill bacteriophages, such as silver ointments / zinc, etc.
Summary:
Amount: 1–10 ml (depending on the size of the wound)
Application: 1x per day
Duration: 10 days
Diagnostics for phage therapy
If desired, phage therapy diagnostics (phagogram) can be performed beforehand to identify the disease-causing pathogen.
Mögliche Bezugsquelle Phagen:
Bacteriophages can only be effective if the corresponding host bacterium is present.
Scientific classification & evidence base
Chronic wounds are almost always colonised by complex bacterial communities (biofilms) that form a barrier against the immune system and antibiotics. The Eliava Institute (Georgia) has decades of success in saving limbs through phage application. In Europe, the PhagoBurn project (funded by the EU) provided pioneering insights into standardising phage therapy for burn wounds.
Current data from 2025/2026 emphasise the role of phages in decolonising problem pathogens such as Staphylococcus aureus and Pseudomonas aeruginosa. Belgian approaches at the Queen Astrid Military Hospital show that local application of phage cocktails reduces the inflammatory burden and enables tissue granulation where conventional therapies had previously failed.
Frequently asked questions (FAQ)
Are bacteriophages approved for wound treatment in Germany? In Germany, phages are currently not approved as standard wound care products. However, the therapy is legally possible as part of an individual treatment attempt (in accordance with the Declaration of Helsinki) or can be prepared by pharmacies as a patient-specific compounded formulation on a physician’s order.
When can an improvement in wound healing be expected? Initial signs such as reduced odour formation and exudation (wound fluid) often occur within 3 to 5 days. Visible reduction of the wound area and the formation of new tissue usually require continuous application over several weeks.
Can phages be used together with antibiotics or antiseptics? Phages often act synergistically with antibiotics because they break up biofilms. Caution is advised with antiseptics (e.g., octenidine), as these can also inactivate phages. There should be a time interval between wound cleansing with antiseptics and phage application.
Is a swab (phagogram) necessary before wound treatment? Yes, a phagogram is strongly recommended. Since chronic wounds are often colonised by different bacterial strains, the laboratory must ensure that the phages used respond precisely to the pathogens in the wound.
Scientific sources & references
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PubMed : Bacteriophage Therapy of Chronic Nonhealing Wound: Clinical Study
https://pubmed.ncbi.nlm.nih.gov/31081402/
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PubMed: PhagoBurn: Results of the first European multicentric trial on phage therapy.
https://pubmed.ncbi.nlm.nih.gov/30292481/
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PubMed: The landscape of biofilm models for phage therapy: mimicking biofilms in diabetic foot ulcers using 3D models
https://pmc.ncbi.nlm.nih.gov/articles/PMC11891221
Treatment outcome after phage therapy:
Studies on chronic wounds:
Bacteriophages improve wound healing in an MRSA infection in diabetic mice
Author: Elena Kastner
Elena Kastner is an experienced specialist journalist focusing on health communication. Her focus is on evidence-based reporting and quality assurance of medical information in the digital space. With her expertise, she bridges the gap between scientific depth and practical applicability.
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