Table 2.

Comparison of the prophylactic and/or therapeutic use of phages and antibiotics

BacteriophagesAntibioticsComments
Very specific (i.e., usually affect only the targeted bacterial species); therefore, dysbiosis and chances of developing secondary infections are avoided (15).Antibiotics target both pathogenic microorganisms and normal microflora. This affects the microbial balance in the patient, which may lead to serious secondary infections.High specificity may be considered to be a disadvantage of phages because the disease-causing bacterium must be identified before phage therapy can be successfully initiated. Antibiotics have a higher probability of being effective than phages when the identity of the etiologic agent has not been determined.
Replicate at the site of infection and are thus available where they are most needed (59).They are metabolized and eliminated from the body and do not necessarily concentrate at the site of infection.The “exponential growth” of phages at the site of infection may require less frequent phage administration in order to achieve the optimal therapeutic effect.
No serious side effects have been described.Multiple side effects, including intestinal disorders, allergies, and secondary infections (e.g., yeast infections) have been reported (76).A few minor side effects reported (17, 58) for therapeutic phages may have been due to the liberation of endotoxins from bacteria lysed in vivo by the phages. Such effects also may be observed when antibiotics are used (42).
Phage-resistant bacteria remain susceptible to other phages having a similar target range.Resistance to antibiotics is not limited to targeted bacteria.Because of their more broad-spectrum activity, antibiotics select for many resistant bacterial species, not just for resistant mutants of the targeted bacteria (47).
Selecting new phages (e.g., against phage-resistant bacteria) is a relatively rapid process that can frequently be accomplished in days or weeks.Developing a new antibiotic (e.g., against antibiotic-resistant bacteria) is a time-consuming process and may take several years (16, 51).Evolutionary arguments support the idea that active phages can be selected against every antibiotic-resistant or phage-resistant bacterium by the ever-ongoing process of natural selection.