Polish Research

Polish therapeutic phage research, production and treatment have taken
place primarily at the Institute of Immunology and Experimental
Therapy, Polish Academy of Sciences, Wroclaw

Contact: Director Andre Gorski and Beata Weber-Dubrowska,
gorski@iitd.pan.wroc.pl

http://surfer.iitd.pan.wroc.pl/index_en.html

Therapeutic Phage Research

Polish therapeutic phage research, production and treatment have taken
place primarily at the Institute of Immunology and Experimental
Therapy, Polish Academy of Sciences, Wroclaw, Contact: Director Andre
Gorski and Beata Weber, gorski@iitd.pan.wroc.pl http://immuno.pan.wroc.pl/

ARCHIVUM IMMUNOLOGIAE ET THERAPIAE EXPERIMENTALIS
1987, 35, 569, PL ISSN 0004-069X

RESULTS OF BACTERIOPHAGE TREATMENT OF SUPPURATIVE BACTERIAL INFECTIONS IN THE YEARS 1981 – 1986*
by STEFAN SLOPEK, BEATA WEBER-DABROWSKA, MAREK DABROWSKI and ALINA KUCHAREWICZ-KRUKOWSKA

Institute of Immunology and Experimental Therapy, Polish Academy
of Sciences, Czerska 12, 53-114 Wroclaw

In the years 1981 – 1986 bacteriophage therapy was applied in 550 cases
(100 treated in 1986) of suppurative bacterial infections. Positive
results were obtained in 508 cases (92.4%). In 38 cases (6.9%) a transient
improvement was observed and in 4 cases (0.7%) phage treatment proved
ineffective. Considering that majority of patients (518 cases, 94.2%)
were resistant to antibiotic treatment, the results of phage therapy
may be regarded as favorable
Previous reports1-6 presented the results of phage treatment
carried out in 1981 – 1984 (370 cases). Since the results obtained in the
group of further 180 cases of 1985 and 1986 did not diverge from those previously
published, it was decided to sum up the whole material in the present report.

MATERIALS AND METHODS

Bacteriophage treatment was applied in 550 patients with septic bacterial
infections caused by pyogenic Staphylococci (Staphylococcus) and Gram-negative
bacteria (Klebsiella, Escherichia, Proteus, Pseudomonas). They were either
spontaneous or postoperative complications.

Phage therapy was carried out at clinical or hospital departments, mostly
surgery departments. The clinical results of phage therapy were evaluated
by a therapeutist.

The age of patients ranged from 1 week to 86 years. Of 550 cases examined,
the group of children up to 8 years constituted 76 cases (13.8%), group
of children and teenagers in the age 9 – 21, 72 cases (13.1%), patients
aged 21 – 60 years, predominating, 343 cases-(62.4%) and the smallest
groups of patients, above 60 years, numbered 59 cases (10.7%).

The number of males-288 cases (52.4%) was slightly higher than that of
females-262 cases (47.6%).

The number of monoinfections (372 cases – 67.6%) was markedly predominating
over polyinfections (178 cases-32.4%). Most numerous were Staphylococcal
monoinfections (272 cases -73.1%), less frequent were monoinfections caused
by Gram-negative bacilli (100 cases-26.9%). In 151 polyinfection cases,
pyogenic Staphylococci (121 cases-68.0%) were predominating over Gram-negative
bacilli (57 cases – 32.0%).

Phage therapy without parallel antibiotic therapy was applied in 398
cases (72.4%) and parallel administration of bacteriophages and antibiotics
in 152 cases (27.6%). The number of cases resistant to antibiotics available
amounted to 518 (94.2%).

In phage therapy the use was made of virulent bacteriophages, i.e. inducing
a complete lysis of bacterial strains isolated from patients. Bacteriophages
were administered orally 3 times daily in the dose of 10 ml before the
meal, after previous neutralization of gastric juice. Phages were also
used locally as moist applications to pleural, peritoneal, cavities, urinary
bladder and as eye, ear and nose drops. In the course of treatment, sensitivity
of isolated bacteria to phages applied was under control; in the case
of confirmed resistance, bacteriophages were changed.

The final evaluation of the treatment results was based upon four-degree
scale:

+ + + + outstanding effect manifesting by a complete
recovery,
+ + + elimination of suppurative
process and healing of the local wounds,
+ +
marked improvement with a tendency to healing of the local lesions with
negative results of bacteriological control,
+
transient improvement,
0
no effect.

RESULTS

While evaluating the final results, it should be taken into consideration
that in 518 cases, i.e. in 94.2% the treatment preceding phage therapy
failed, among others, due to resistance of bacteria to antibiotics and
chemotherapeutics used. Thus, the application of bacteriophages was the
only way to eliminate the pyogenic process. Only in 31 cases (5.6%) bacteriophages
were used in patients not pretreated with either antibiotics or chemotherapeutics.

1. GENERAL CHARACTERISTICS OF PHAGE THERAPY
1. Age of patients and results of treatment

Detailed information is given in Table 1. Differences between the age
groups up to 60 years and the group of patients above 60 years, achieved
marked statistical significance. It is very likely that the above may
be accounted for a reduced immunity of patients above 60 years of age.

2. Sex of patients and results of phage therapy

Phage therapy results in relation to the sex of patients are illustrated
in Table 2. The differences observed were statistically significant.

3. Type of infection (monoinfections, polyinfections) and results of phage therapy

Detailed data are given in Table 3. The results obtained in both types
of infections reveal statistical significance.

4. Results of phage therapy in infections caused by pyogenic

Staphylococci and Gram-negative bacteria

The data presented in Table 4 show that in infections caused by Staphylococci
no statistical differences were observed between monoinfections and polyinfections.
However, statistically significantly better results were obtained in Gram-negative
bacteria-induced [mono- compared to poly-] infections.

5. Method of treatment and result of phage therapy

Detailed data are given in Table 5. Statistically significant differences
in favor of phage therapy in comparison to the parallelly run phage and
antibiotic therapy, were confirmed.

6. State of patients and result of phage therapy

The results presented in Table 6 suggest close relation between severity
of disease and result of treatment. This problem with particular regard
to the immunity state, advancement of the disease and results of phage
therapy, requires further elucidation.

II. DETAILED CHARACTERISTICS OF PHAGE THERAPY APPLIED
IN PARTICULAR DISEASE CATEGORIES

Classification into categories and nosologic units has been based on
the recommendations of the World Health Organization included in the publication:
Manual of the International Statistical Classification of Diseases, Injuries
and Cause of Death, Vol. 1 WHO, Geneva, 1977. Detailed data are listed
in Table 7.

Table 7. List of disorders as divided into disease categories with regard
to nosologic units, monoinfections and polyinfections

Categories and Nosologic units

I. Infections diseases
1. Infections diseases of the alimentary tract
2. Septicaemias

VI. Diseases of the nervous system and sense organs
3. Conjunctivitis, blepharoconjunctivitis, otitis media

4. Meningitis

VII. Diseases of the circulatory system
5. Varicose veins with ulcer and inflammation
6. Purulent pericarditis

VIII. Diseases of the respiratory system
7. Inflammation of the upper and lower respiratory
tract
8. Pneumonia, pneumonia abscedens, bronchopneumonia

9. Suppurative pneumonia, empyema with thoracic fistula

10. Pleuritis with fistula

IX. Diseases of the digestive system
11.Ulcerative stomatitis. Suppurative peritonitis, abscesses
of the inner organs

X. Diseases of the genitourinary tract
12. Suppurative infections of the urinary tract. Suppurative vaginitis

XII. Diseases of the skin and subcutaneous tissue
13. Furunculosis
14. Inflammation of the connective tissue and lymphatic vessels

15. Decubitus ulcer

XIII. Diseases of the musculoskeletal system
16. Pyogenic arthitis and myositis
17. Pyogenic ostitis

XVII. Injuries
18. Open wounds, laparotomy, tracheostomy, contusions, burns
19. Contusion of head, fractures of facial bones, contusion of
brain and brain stem (suppuration of postoperative wounds)
20. Injuries of spine (suppuration of postoperative wounds)
21. Posttraumatic ostitis of the lower and upper limbs (fractures)
22. Chronic suppurative fistulas

Category I – 1 Infectious diseases of the alimentary tract

Three cases of bacillary dysentery, 2 cases of colibacteriosis, 1 case
of Salmonellosis and 1 case of acute diarrhoea due to mixed infection
with Staphylococci, Klebsiella bacilli and Escherichia, were submitted
to phage therapy. In all the 7 cases oral administration of bacteriophages
for 1 to 3 weeks, resulted in a subsidence of the clinical symptoms and
elimination of the infection process.


Category I – 2 Septicaemia

Septicaemia was confirmed in 98 of 550, i.e. in 17.8% cases submitted
to phage therapy. The cases belonged to various disease categories. Monoinfections
were recognized in 48 cases and polyinfections in 50. In monoinfections
septicaemia was caused in the majority of cases by pyogenic Staphylococci
(32 cases), and less frequently by Gram-negative bacteria (Klebsiella-5,
Escherichia- 5, Pseudomonas-6). In polyinfections most frequent appeared
Klebsiella (37 cases), pyogenic Staphylococci (30 cases), Escherichia
(30 cases), Pseudomonas (26 cases) and less frequent were Proteus bacteria
(10 cases).

Positive therapeutic result was obtained in 87 cases (88.8%) and transient
improvement in 7 cases. In 4 cases which ended with exitus, bacteriophages
appeared ineffective (too late application at great cachexy of patients).

Category VI – 3 Blepharitis, conjunctivitis and otitis media

This group numbered 16 patients: 7 with purulent conjunctivitis, 3 with
recurrent hordeolum. 1 with dacryocystitis and 5 with otitis media. All
the cases proved resistant to antibiotics. Pyogenic Staphylococci were
isolated in monoinfections (13 cases), pyogenic Staphylococci and Klebsiella
bacteria in 3 cases of polyinfections and Pseudomonas and Proteus bacteria
in 1 case each. Application of bacteriophages as eye and ear drops and
moist applications fully eliminated the infection.

Category VI – Meningitis

This group comprised 10 cases. In 9 patients meningitis resulted from
operative infections and in 1 from septicaemia. All the cases were resistant
to antibiotic treatment. Of 3 monoinfection cases, in 1 pyogenic Staphylococci
was confirmed and in 2 Klebsiella bacilli. Klebsiella bacilli were predominating
in polyinfections (6 cases of 7 cases), also frequent were pyogenic Staphylococci
(5 cases); Escherichia and Proteus were encountered only in 2 cases each.
In 9 cases phage therapy gave way to an elimination of pyogenic process.
In 1 case due to the mixed infection with Klebsiella, Escherichia and
Pseudomonas, exitus was reported.

Category VII – 5 Varicose veins of legs

This group included 36 patients. Of 23 monoinfection cases, 15 were caused
by pyogenic Staphylococci, 7 by Pseudomonas and 1 case by Klebsiella bacteria.
Of 13 polyinfections cases, Pseudomonas were confirmed in 7 cases, pyogenic
Staphylococci in 4 cases and Escherichia in 1 case. All the cases were
resistant to antibiotics. In 27 cases phage therapy resulted in a total
elimination of the infection and in 9 marked improvement with tendency
towards healing was confirmed.

Category VII – 6 Acute purulent pericarditis

This groups comprised 7 cases of pyopericardium (complications after
operations on open heart and large vessels). In monoinfections (5 cases)
pyogenic Staphylococci was recognized as a causative factor and polyinfections
(2 cases) were caused by Pseudomonas, Escherichia and pyogenic Staphylococci.
In all the cases antibiotic treatment brought no effect. In 6 cases phage
therapy eliminated the infection and in 1 marked improvement was observed
with a tendency towards healing of the wounds.

Category VIII – 7 Suppurative inflammation of the respiratory tract

Of 74 cases classified to this group, 51 patients suffered from suppurative
inflammation of the nasal cavity, rhinitis, recurrent angina and 23 patients
from mucopurulent bronchitis. Monoinfections were confirmed in 53 cases
of which the majority was caused by pyogenic Staphylococci (46 cases)
and a few cases by Escherichia (4 cases) Klebsiella bacilli (2 cases)
and Proteus (1 case). In 21 cases of polyinfections, most frequent were
pyogenic Staphylococci (15 cases), Klebsiella bacilli (14 cases), less
frequent were Escherichia (7 cases), Pseudomonas (6 cases), Proteus (2
cases) and Streptococcus viridans (1 case). Of 74 cases, in 69 antibiotic
treatment failed. In 4 cases phage therapy was not preceded by antibiotic
application. Phages appeared ineffective in 1 case, transient improvement
was obtained in 6 cases and in the remaining 67 (91.9%) the suppurative
process was fully eliminated.

Category VIII – 8 Bronchopneumonia, pneumonia abscedens

This group numbered 57 cases; 20 monoinfections and 37 polyinfections.
Monoinfections were mostly caused by pyogenic Staphylococci (9 cases),
Pseudomonas (8 cases) and Klebsiella bacilli (3 cases). In polyinfections
predominating were: Pseudomonas (25cases) Klebsiella and Escherichia (23
cases each) and pyogenic Staphylococci (22 cases), less frequent were
cases with Proteus (7 cases). In 54 cases antibiotics administration proved
to have no effect upon the course of infection. In 3 cases antibiotics
were not applied. Phage therapy eliminated the suppurative process in
47 cases (82.5%) and in the remaining 10 cases it had unfavorable influence
upon the infection. In 6 cases polyinfections resulted in exit.

Category VIII – 9 Pneumonia with thoracic empyema and fistulas

This group included 27 cases: 11 monoinfections and 16 polyinfections.
The former ones were caused by pyogenic Staphylococci (6 eases), Pseudomonas
(3 cases) and Klebsiella bacilli and Escherichia (1 case each). In polyinfections
predominating were: Pseudomonas (13 cases), Klebsiella (10 cases), pyogenic
Staphylococci (8 cases), Escherichia bacilli (8 cases) and Proteus (5
cases). Antibiotic treatment was ineffective in 23 cases. In 3 cases the
treatment terminated only in a transient improvement and 1 in exit. In
the remaining 23 cases (85.2%), suppression of the infection in the lungs
and thoracic cavity was observed.

Category VIII – 10 Thoracic empyemas with fistulas

This groups numbered 22 cases of which 13 were monoinfections caused
by pyogenic Staphylococci (6 cases), Pseudomonas (4 cases), Klebsiella
(2 cases) and Escherichia (1 case), and 9 polyinfections caused by pyogenic
Staphylococci (9 cases), Pseudomonas (7 cases), Klebsiella (5 cases) and
Escherichia (4 cases). Antibiotic therapy was ineffective in 20 cases.
In 2 cases antibiotics were not applied. Phage therapy eliminated the
suppurative process in 19 cases (86.4%) and gave way to marked improvement
in 2 cases. One case resulted in exitus.

Category IX – 11 Acute gingivitis, purulent peritonitis and
abdominal abscesses

To this category 65 cases were included: 2 cases of acute purulent gingivitis
and stomatitis and 63 cases of suppurative peritonitis due to suppurative
or gangrenous acute appendicitis, gastric resection, cholecystectomy,
suppurative pancreatitis and operations on intestines. Antibiotics proved
ineffective in 63 cases. Thirty eight cases of monoinfections were mostly
caused by Escherichia (20 cases), pyogenic Staphylococci (12 cases), Pseudomonas
(3 cases) and Klebsiella (3 cases). Polyinfections were confirmed in 27
cases and were caused by Klebsiella (18 cases), Pseudomonas (17 cases)
and Escherichia (17 cases), pyogenic Staphylococci (13 cases), and Proteus
(4 cases). Bacteriophage were applied orally and locally (for the washing
of operation field and to the fistulas); Good therapeutic result was reported
in 59 cases (90.8%). In 5 cases marked improvement with the tendency toward
fueling of the wounds was noted and in 1 phage therapy was ineffective.
Local application of bacteriophages in ulcerative gingivitis brought about
full elimination of the suppurative process within 2 weeks.

Category X – 12 Suppurative inflammations of the genitourinary tract

This category comprised 42 cases: 40 cases of suppurative inflammation
of the genitourinary tract and 2 cases of postoperative suppurative vaginitis.
Monoinfections caused by Pseudomonas (8 cases), Escherichia (5 cases),
pyogenic Staphylococci (3 cases), Klebsiella (1 case) and Proteus (1 case),
were confirmed in 18 cases. Polyinfections numbered 24 cases and were
caused by Pseudomonas (16 cases), Escherichia (16 cases) and pyogenic
Staphylococci (14 cases), Klebsiella (12 cases) and Proteus bacteria (4
cases). In 37 cases antibiotic therapy was without effect. Application
of phage therapy in 39 cases (92.9%) resulted in elimination of the infection
and sterilization of urine. One patient revealed marked improvement and
2 – lack of improvement.

In 2 cases of suppurative vaginitis due to infection with pyogenic Staphylococci,
the washings with the specific bacteriophages totally eliminated the inflammation.

Category XII – 13 Furunculosis

This groups included 55 cases of furunculosis of various localization.
In 50 cases monoinfections caused by pyogenic Staphylococci were confirmed.
In 5 cases of polyinfection, the presence of pyogenic Staphylococci (5
cases), Escherichia (3 cases) pyogenic Staphylococci and Pseudomonas (1
case each) was confirmed. All the cases were resistant to antibiotic treatment.
Good therapeutic result was obtained in all the cases (100%) after oral
and local application of bacteriophages.

Category XII – 14 Diseases of the connective tissue and lymphatic vessels

This group included 91 cases of skin inflammations: abscesses, phlegmone
of various localization, acne necrotica and 11 cases of abscesses mammae.
Seventy-four cases appeared to be monoinfections caused by pyogenic Staphylococci
(65 cases), Pseudomonas (5 cases), Klebsiella (3 cases), Escherichia (1
case). In 17 cases of polyinfections there were isolated pyogenic Staphylococci
(15 cases), Klebsiella (10 cases), Escherichia (7 cases), Pseudomonas
(9cases) and Proteus (4 cases). In 83 cases antibiotic treatment appeared
ineffective. Phage therapy eliminated the infection in 86 cases (94.5%).
Five cases revealed marked improvement with tendency towards healing.

Category XII – 15 Decubitus ulcer

Of 16 cases of long-term decubitus ulcer, monoinfections were confirmed
in 2. Pyogenic Staphylococci were recognized to be the causative factor.
In 14 cases of polyinfection, different bacterial flora was encountered:
pyogenic Staphylococci (11 cases), Pseudomonas (10 cases), Escherichia
and Klebsiella (9cases each) and Proteus (6 cases). All the cases were
resistant to antibiotics. Application of phage therapy, oral and local,
resulted in favorable effect in 13 cases. In 3 cases phage treatment was
ineffective.

Category XIII – 16 Purulent arthritis and myositis

This group numbered 19 cases: 15 cases of purulent arthritis and 4 cases
of myositis. Thirteen of them were monoinfections caused by pyogenic Staphylococci
(12 cases), Proteus (1case). Polyinfections numbering 6 cases were caused
by pyogenic Staphylococci (5 cases), Pseudomonas (3 cases), Proteus (4
cases), Klebsiella (2 cases) and Escherichia (2 cases). All the cases
were resistant to antibiotic treatment. Application of phage therapy eliminated
the suppurative process in 17 cases (89.5%). In 2 cases no improvement
was reported.

Category XIII – 17 Osteomyelitis of the long bones

This group included 40 cases of osteomyelitis of long bones. Monoinfections
confirmed in 29 cases were due to infection with pyogenic Staphylococci
(25 cases) in 3 cases Pseudomonas bacilli were isolated and in 1 Klebsiella
bacilli. In 11 cases mixed infections was confirmed caused by pyogenic
Staphylococci (7 cases), Pseudomonas (5 cases), Proteus, Klebsiella and
Escherichia (4 cases each).

Thirty-eight of 40 cases appeared resistant to antibiotics. Suppurative
process was eliminated due to application of phages in 38 cases (95.0%).
Two cases revealed a transient improvement.

Category XVII – 18 Open wounds, laparotomy, tracheostomy, contusions and burns

This group included 49 cases (22 monoinfections and 27 polyinfections).
The former ones were caused by pyogenic Staphylococci (11cases), Pseudomonas
(5 cases), Escherichia (4 cases) and Klebsiella (2 cases). In polyinfections
the presence of various bacterial flora was confirmed consisting madly
of Klebsiella (16 cases), Pseudomonas (14 cases), Escherichia (16 cases),
Proteus (9 cases) and pyogenic Staphylococci (15 cases). Antibiotic therapy
was ineffective in 46 cases. Oral and local application of bacteriophages
eliminated the infection in 42 cases and in 7 brought about a transient
improvement.

Category XVII – 19 Contusions of head with suppuration of wounds

This group comprised 23 cases, including 13 cases of monoinfection and
10 of polyinfection. In monoinfections the suppuration was due mostly
to pyogenic Staphylococci (10 cases), rarely Klebsiella, Escherichia and
Pseudomonas (1 case each). In polyinfections frequently met were: Pseudomonas
(9 cases), Klebsiella (7 cases), pyogenic Staphylococci (6 cases) and
Escherichia (5 cases). The remaining 22 cases, with 1 exception, were
resistant to antibiotics. Application of bacteriophages orally and locally,
eliminated the infection in 19 cases (82.6%), in 2 resulted in marked
improvement and in 4 in transient improvement.

Category XVII – 20 Injuries of spine (suppuration of wounds)

This group numbered 12 cases: 8 monoinfections and 4 polyinfections.
In the former group pyogenic Staphylococci were predominating and in the
latter they were encountered in 4 cases, Klebsiella and Escherichia bacilli
in 2 cases each, and Proteus in 1 case. All of the cases were resistant
to antibiotic treatment. Application of phage therapy allowed elimination
of the suppurative process. Marked improvement with the healing of the
wound and transient improvement were reported in 1 case each.

Category XVII – 21 Ostitis of the long bones after fracture

This group included 41 cases: 24 monoinfections and 17 polyinfections.
Monoinfections were caused mainly by pyogenic Staphylococci (21 cases),
Escherichia and Proteus (1 case each). In polyinfections predominating
were pyogenic Staphylococci (14 cases), Pseudomonas (10 cases), Klebsiella
(6 cases). Escherichia (7 cases) and Proteus (3 cases). Resistance to
antibiotics was confirmed in 37 cases. Bacteriophages applied orally and
locally eliminated the infection in 37 cases (90.2%). In 4 cases only
a transient improvement was reported.

Category XVII – 22 Chronic suppurative fistulas

This group comprised 180 cases in which the infections resulted in long-persisting
suppurative fistulas. Monoinfections (118 cases) caused by pyogenic Staphylococci
numbered 92 cases. Escherichia bacilli were recognized in 13 cases, Pseudomonas
in 6 cases and Klebsiella in 7 cases. In polyinfections (62 cases) predominating
were: pyogenic Staphylococci (38 cases), Klebsiella (33 cases), Pseudomonas
(30 cases), Escherichia (31 cases) and Proteus (15cases). In all the cases
observed antibiotics were not effective. Bacteriophages applied orally
and locally (to the fistulas) eliminated the infection in 168 cases (93.3%)
and healed the fistulas. Marked improvement with the tendency toward healing
of the wounds was reported in 12 cases.

RECAPITULATION OF THE RESULTS AND CONCLUSIONS

Detailed analysis of 550 cases of suppurative bacterial infections subjected
to phage therapy allowed the following conclusions:

1. Specific phage therapy is highly effective in the infections caused
by pyogenic Staphylococci and Gram-negative bacteria (Klebsiella, Escherichia,
Proteus, Pseudomonas). Positive therapeutic result was observed in 508
cases of 550 examined, i.e. in 92.4%. This percentage ranged from 75.9%
to 100%, in accordance with etiologic factor and type of infection.

2. Differences in positive results of phage therapy in the age group
up to 60 years achieved statistical significance as compared to the age
group above 60 years.

3. Statistically significant differences related to the sex of patients
were also confirmed.

4. Difference in effectivity of phage therapy in monoinfections and polyinfections
were statistically significant. They were most drastic in the group of
infections caused by Gram-negative bacilli. In the Staphylococcal infections
they were negligible.

5. Phage therapy is particularly useful in the cases where antibiotic
therapy failed. In the material studied the number of cases resistant
to antibiotics was as high as 518, i.e. 94.2%.

6. Phage therapy is recommended in the following pathological states:

a) acute infections of the alimentary tract (bacillary
dysentery, diarrhoeas caused by Salmonella, Klebsiella, Escherichia, Proteus
and Pseudomonas),
b) septicaemias irrespective of their origin,
c) postoperative infections irrespective of localization
d) suppurative skin diseases, diseases of the subcutaneous
tissue, and lymphatic vessels. Particular effectiveness should be underlined
in the treatment of furunculosis,
e) suppurative infections of the respiratory tract,
lungs and pleura,
f) infections of the urinary tract,
g) suppurative infections of joints and bones,
h) suppurative fistulas.

7. Effectivity of phage therapy as compared to the combined treatment
of phages and antibiotics revealed statistical significance.

8. Statistically significant differences related to the severity of the
disease were also observed.

9. Bacteriophage treatment may last long, up to full elimination of the
infective process. Side effects are rarely encountered.

10. The routs of bacteriophage administration depend upon a localization
of suppuration focus. Oral administration of phages is recommended in
each case. Bacteriophages easily penetrate from the alimentary tract to
the blood circulation system and are excreted with the urine. With great
effectiveness they were also applied as moist applications to the wounds,
eye, ear and nose drops, infusions to the fistulas, washings of the nasal
cavity, urinary bladder, suppurative lesions of pleura and peritoneum,
decubitus, fistulas, intravaginally intraoperatively for the washing of
peritoneal cavity and in the cases of multiple skin abscesses.

11. Bacteriophages are of great value in prophylaxis (in preparing the
patients for orthopaedic surgeries, in skin transplantations).

12. Unfavorable treatment results may be accounted, to a great extend,
to too late initiation of the treatment and also great cachexy of patients
with long course of disease.

REFERENCES

1. SLOPEK S., DURLAKOWA I., WEBER-DABROWSKA B., KUCHAREWICZ-KRUKOWSKA
A., DABROWSKI M. and BISIKIEWICZ R.: Results of bacteriophage treatment
of suppurative bacterial infections. 1. General evaluation of the results.
Arch. Immunol. Ther. Exp., 1983, 31, 267 – 291.

2. SLOPEK S., DURLAKOWA I., WEBER-DABROWSKA B., KUCHAREWICZ-KRUKOWSKA
A., DABROWSKI M. and BISIKEWICZ R.: Results of bacteriophage treatment
of suppurative bacterial infections. 11 Detailed evaluation of the results.
Arch. Immunol. Ther. EXP., 1983, 31, 293 – 327.

3. SLOPEK S., DURLAKOWA 1., WEBER-DABROWSKA B., DABROWSKI M. and KUCHAREWICZ-KRUKOWSKA
A.: Results of bacteriophage treatment of suppurative bacterial infections.
111. Detailed evaluation of the results obtained in further 150 cases.
Arch. Immunol. Ther. EXP., 1984, 32, 317-335.

4. SLOPEK S., KUCHAREWICZ-KRUKOWSKA A., WEBER-DABROWSKA B. and DABROWSKI
M.: Results of bacteriophage treatment of suppurative bacterial infections.
IV. Evaluation of the results obtained in 370 cases. Arch. Immunol. Ther.
Exp., 1985, 33, 219 – 240.

5. SLOPBK S., KUCHAREWICZ-KRUKOWSKA A., WEBER-DABROWSKA B. and DABROWSKI
M.: Results of bacteriophage treatment of suppurative bacterial infections.
V. Evaluation of the results obtained in children. Arch. Immunol. Ther.
Exp., 1985, 33, 241 – 260.

6. SLOPEK S., KUCHAREWTCZ-KRUKOWSKA A., WEBER-DABROWSKA B. and DABROWSKI
M.: Results of bacteriophage treatment of suppurative bacterial infections.
P7. Analysis of treatment of suppurative Staphylococcal infection. Arch.
Immunol. Ther. Exp., 1985, 33, 261 – 275.

Received in March 1987.