A new study in Frontiers in Medicine brings hospital-adapted phage therapy into focus as an adjunct to antibiotic treatment for complex respiratory infections.

The collaboration between the Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology and the Micromir Research and Production Center examined chronically critically ill patients with lower respiratory tract infections—a population in which antibiotic resistance makes additional treatment options particularly important.

This secondary analysis of randomized trial data included 96 patients. Its defining feature was a hospital-adapted phage cocktail, regularly updated to target bacterial strains identified through local microbiological surveillance.

The study demonstrated the feasibility of integrating inhaled phages into intensive care treatment. No treatment-limiting adverse events were reported during the 21-day follow-up. Among patients initially receiving Watch-group antibiotics, escalation to Reserve antibiotics was less frequent by day 14 in those receiving adjunctive phage therapy.

The work connects adaptive phage selection with a practical clinical objective: supporting the rational use of antibiotics. It also highlights the importance of evaluating phage therapy beyond microbiological outcomes alone, including its potential contribution to antibiotic stewardship. These findings provide a foundation for larger, multicenter studies.

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