The problem with phage therapy is partly economic, partly regulatory, and partly practical.
Unlike antibiotics, phages are entirely natural, and so can't be patented; in a bacterial broth they multiply at an astonishing rate (about a thousandfold every hour IIRC); and they're obtained from stuff which we have so much of that a large part of our infrastructure has been built just to get rid of it (raw sewage). So there's no money to be made out of phage therapy, and it threatens whatever money pharmaceutical companies make out of selling antibiotics. So, it's no surprise they were a big success in communist countries and a failure in capitalist ones. After the fall of communism, they continue to be used in Georgia, but every attempt to make money out of them has failed.
Also, they're treated as a drug by regulatory bodies (which were established with pharmaceutical companies in mind), and so every phage strain, and every phage cocktail, would need extensive trials before approval is granted, despite their being completely safe and impossible to overdose on.
The practical reason for not using them is that antibiotics are trivial to administer compared to bacteriophage, you don't need to identify the exact strain, and antibiotics are less of a problem to store.
However, when bacteria develop resistance to a particular phage, the phage can and will evolve to kill the new strain of bacteria. Also, with phage therapy, dosage is not an issue as the phage multiplies on contact with its target bacteria. Phage doesn't mess with your gut flora. And finally, nobody is allergic to phage.
The NHS and other health services should follow Georgia's lead and develop stocks of phage (which are used at present to identify bacterial strains), as well as the expertise required to identify and administer them; fast-track them for use; and ignore any objections from pharmaceutical companies: the purpose is to cure people, not to make a profit.
Having worked in this area the problem is even worse as phage will be regulated as a biologic which is way worse than your typical small molecule drug.
I should point out that you can become allergic to phage just like anything.
Indeed, regulations will have to change before phage therapy is used. This should be done.
Re allergy: cite? It's of course possible to be allergic to other components of phage preparation, but I don't think anyone is allergic to the phages themselves. Many people are allergic to antibiotics, particularly those in the penicillin group.
While I agree the regulations should change I can't see the likes of the FDA changing anytime soon.
You can create anti-phage antibodies (here is a paper from 1933 on doing this [1], there are hundreds more) - if you can create antibodies to something then you can create an allergy to that thing.
I think the issue is less that you can't legally patent them and more that because of the relatively high mutation rate in both phage and bacteria, patenting is too slow to be practically useful. Patents are good if the thing you're selling will still be useful in a year or two, but I don't think that's the case for phage therapy.
Unlike antibiotics, phages are entirely natural, and so can't be patented; in a bacterial broth they multiply at an astonishing rate (about a thousandfold every hour IIRC); and they're obtained from stuff which we have so much of that a large part of our infrastructure has been built just to get rid of it (raw sewage). So there's no money to be made out of phage therapy, and it threatens whatever money pharmaceutical companies make out of selling antibiotics. So, it's no surprise they were a big success in communist countries and a failure in capitalist ones. After the fall of communism, they continue to be used in Georgia, but every attempt to make money out of them has failed.
Also, they're treated as a drug by regulatory bodies (which were established with pharmaceutical companies in mind), and so every phage strain, and every phage cocktail, would need extensive trials before approval is granted, despite their being completely safe and impossible to overdose on.
The practical reason for not using them is that antibiotics are trivial to administer compared to bacteriophage, you don't need to identify the exact strain, and antibiotics are less of a problem to store.
However, when bacteria develop resistance to a particular phage, the phage can and will evolve to kill the new strain of bacteria. Also, with phage therapy, dosage is not an issue as the phage multiplies on contact with its target bacteria. Phage doesn't mess with your gut flora. And finally, nobody is allergic to phage.
The NHS and other health services should follow Georgia's lead and develop stocks of phage (which are used at present to identify bacterial strains), as well as the expertise required to identify and administer them; fast-track them for use; and ignore any objections from pharmaceutical companies: the purpose is to cure people, not to make a profit.