Bacteriophage Treatment for Chronic Rhinosinusitis in EPOS-2020

The European Rhinologic Society updated the guidelines for the treatment of acute and chronic rhinosinusitis and nasal polyps – EPOS-2020.
Bacteriophage treatment was also mentioned here.

Excerpt from EPOS-2020

“As antibiotic treatment may not be effective or may lead to resistance of the pathogens, alternative therapeutic strategies against S. aureus and other common pathogens in the nose and paranasal sinuses may be useful. Theoretically, viruses that target and kill pathogens (called bacteriophages) have been proposed to kill even multidrug-resistant S. aureus (368). Furthermore, a cocktail of bacteriophages could potentially reduce biofilm formation in vitro (369, 370). This approach could be implemented by specifically influencing the iron metabolism vital for bacterial growth, survival, and pathogenesis (371). An ex vivo experiment with nasal polyp mucosa showed that an S. aureus bacteriophage could kill naturally occurring nasal S. aureus and reduce S. aureus-driven IL-5 synthesis (372). However, no clinical studies on respiratory tract disease in humans have been conducted to date, and potential safety concerns must first be addressed.”

368: 368. Zhang G, Zhao Y, Paramasivan S, et al. Bacteriophage effectively kills multidrug resistant Staphylococcus aureus clinical isolates from chronic rhinosinusitis patients. Int Forum Allergy. Rhinol. 2018;8:406-14.https://www.ncbi.nlm.nih.gov/pubmed/29240296

371. Richter K, Ramezanpour M, Thomas N, Prestidge CA, Wormald PJ, Vreugde S. Mind “De GaPP”: in vitro efficacy of deferiprone and galliumprotoporphyrin against Staphylococcus aureus biofilms. Int Forum Allergy. Rhinol. 2016;6:737-43.