Spot-on phage therapy: stable formulations, smarter dosing for topical phage application
Summary: This 2026 review addresses key barriers to clinical adoption of topical bacteriophage therapy for wound and burn infections amid rising antimicrobial resistance. It synthesizes data on phage titers (typically 10^7–10^9 PFU/mL), multiplicity of infection (MOI), formulation stability (hydrogels, cetomacrogol creams, polymer sprays, chitosan films), and delivery via wound dressings. Mature biofilms require higher/repeated dosing or combination with depolymerase-armed phages and antibiotics for effective clearance. The authors emphasize standardized PK/PD frameworks, rigorous stability testing (e.g., creams stable up to 90 days at 4°C), and precise dosing protocols to translate phage therapy from lab to bedside for biofilm-related wound infections.
Key Highlights:
- Therapeutic phage concentrations and MOI guidance for planktonic vs. biofilm bacteria
- Stable formulations (hydrogels, creams, sprays) preserve activity and enable controlled release
- Strategies for mature biofilms: repeated dosing, cocktails, or enzymatic combinations
- Authors: Sandhu JS, Parida A
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Keywords: phage therapy wounds, topical phage application, biofilm wound infections, Sandhu JS