Irresponsible use of antimicrobials, including antibiotics, is accelerating the rise of ‘superbugs’. These superbugs are causing infections that were once easily treatable by antimicrobials but are now becoming increasingly difficult to treat and, in some cases, turning life-threatening. Unnecessary use of antimicrobials coupled with poor infection prevention measures and lack of new antimicrobials has resulted in a full-blown global health crisis of Antimicrobial Resistance (AMR). The climate crisis is also affecting patterns of infectious diseases which may lead to an increase in the use of antimicrobial drugs and a rise in AMR.
While the problem of AMR has reached a tipping point in India, there are countless and yet, often unheard of superheroes – in research labs, hospitals, and on the ground, among communities – who are working very hard to stop the rise of these deadly superbugs. In our SaS AMR Champions Series commemorating the World Antimicrobial Awareness Week (WAAW2021), we bring to you conversations with some of these ‘Superheroes Against Superbugs’ that we hope would inform, inspire, and encourage us all to act against AMR to ensure a healthy future for all.
Pranav Johri is a patient-turned-entrepreneur who founded Vitalis Phage Therapy to help patients with bacterial infections access Phage Therapy. Phage Therapy utilises bacteria-eating viruses called ‘bacteriophages’ that kill infections caused by pathogenic bacteria. In this interview, Pranav shares with us his lived experience with multi-pathogenic antibiotic-resistant infection and how it was treated by Phage Therapy. Pranav tells us how this experience with an untreatable infection and new biomedical intervention was the motivation behind establishing Vitalis Phage Therapy that has provided much-needed support to a large number of patients. Dive into this interview to learn more about his gruelling yet inspiring journey of surviving a deadly infection and how he turned adversity into opportunity.
You fought a long and hard battle with an antibiotic-resistant infection. What was your first reaction to learning about these types of infections and how did you make sense of it?
Pranav: I learnt about antibiotic-resistant infections through my own lived experience with them. I suffered from chronic prostatitis in 2016, and the treating doctor was extremely confident of treating the infection with antibiotics. He empirically put me on one course of antibiotics after the other. However, as each course of antibiotics finished, and there was no improvement in my symptoms, the confidence that the doctor had about being able to treat my infection with antibiotics seemed to drain away. By the time I was put on my fifth and the last course of oral and IV antibiotics administered in combination, the treating doctor was talking of this being the heaviest artillery he could use against my infection, the “last throw of the dice”. Ten days later when that course finished and there was no improvement in my symptoms, he had no answers to explain my persistent infection. He discussed with me a regimen of medicines that would enable me to manage my symptoms to try and live with the condition. What I didn’t know then was that I was suffering from a multi-pathogenic antibiotic-resistant infection. In the subsequent weeks, I did a lot of research into infections that don’t respond to antibiotics, and I learned about the growing problem of AMR infections and the magnitude of this crisis.
When I came across the concept of antibiotic resistance and started to understand the scale of the problem, I felt a deep sense of helplessness and despair. The experience of going through multiple courses of antibiotics with no improvements in symptoms was extremely frustrating. Seeing the confidence drain away from my treating doctor after each failed course of antibiotic treatment was scary.
“It seemed incredible to me that a medical-scientific system that was being celebrated around the world for the giant strides of progress it had made in areas like gene therapy, cloning, DNA based diagnostics in the last few decades, did not have an answer to my simple bacterial infection! The medical system had left behind people suffering from antibiotic-resistant infections.”
You are the first Indian to receive phage therapy for an antibiotic-resistant infection. How did you learn about phage therapy and what gave you the confidence to undergo this treatment? Please tell us about your overall experience.
Pranav: After five failed antibiotic courses, and after my treating doctor had declared my infection to be one that would not be treated with antibiotics, I knew I would have to look elsewhere for a solution to my problem. I first came across “bacteriophage therapy” while I was researching alternative methods of treating bacterial infections. Since I knew nothing about it, I started researching it and gradually began to understand the science of it. Through a network of family, friends and professional acquaintances, I was able to get in touch with phage researchers and scientists in the US, UK, France, Poland, Georgia and India. I reached out to them seeking a greater understanding of phages and how they might be applied therapeutically to treat my condition. I read every phage therapy case study, report and research paper that I could find in scientific journals. Developing a fairly deep understanding of the science behind phage therapy, and learning about the almost 100-year old history of phage therapy being used to treat bacterial infections at the Eliava Institute, gave me the confidence to travel to Tbilisi and undergo treatment at the Eliava clinic.
My overall treatment experience with phage therapy was extremely positive. Over three courses of phage therapy, my multi-pathogenic antibiotic-resistant infection was treated successfully. It has been three and a half years since I finished my third and final course of treatment. Ever since then, I have had no relapse of symptoms and my diagnostic tests show no presence of pathogenic bacteria anymore in my samples.
“I first came across “bacteriophage therapy” while I was researching alternative methods of treating bacterial infections. Since I knew nothing about it, I started researching it and gradually began to understand the science of it.”
Through Vitalis Phage Therapy, you are providing support to other patients who may want to undergo this treatment. How far away do you think we are from routinely using phage therapy to treat antibiotic-resistant infections in India? What kind of regulations need to be in place for using them safely?
Pranav: After my successful treatment experience with phage therapy, my wife and I founded Vitalis Phage Therapy in January 2018 with the aim of raising awareness about antibiotic resistance and enabling phage therapy for patients suffering from antibiotic-resistant infections in India. Through my experience of struggling with these types of infections and then finding a cure through phage therapy, I realized that there are a large number of people in a situation similar to mine – struggling with antibiotic-resistant, persistent or recurrent infections, and the medical system did not really have an answer for them. That led us to create Vitalis. In the four years, we have been in existence, we have been contacted by more than 700 people with a variety of AMR related conditions, ranging from UTIs to chronic bronchitis, from recurrent folliculitis to chronic prostatitis.
The current state of regulations in India allows a patient to take phage therapy on an individual, compassionate treatment basis. For the foreseeable future, I do not expect phage therapy to become a first-line treatment for bacterial infections. I expect it to remain a treatment that people will seek if they are unable to treat their infections with antibiotics, which will remain the first-line, mainstay treatment for bacterial infections. However, with greater awareness of alternatives like phage therapy amongst the medical community, doctors will be able to guide patients towards this treatment option when they come across cases of antibiotic-resistant infections. This will enable patients to access the treatment with greater confidence.
Some countries around the world have already started to recognize the limitations of antibiotics and regulate the therapeutic use of phages to address antibiotic-resistant infections. India can consider emulating frameworks already set up in different countries to regulate phages for therapeutic use. Notable examples of this are Georgia, where phage use has been regulated for nearly 100 years, and Belgium, where the Magistral Phage framework was adopted in 2018.
“For the foreseeable future, I do not expect phage therapy to become a first-line treatment for bacterial infections. I expect it to remain a treatment that people will seek if they are unable to treat their infections with antibiotics, which will remain the first-line, mainstay treatment for bacterial infections.”
In addition to providing information and support to patients with drug-resistant infections through your organization, you are passionate about bringing out their stories. Please tell us more about this.
Pranav: I feel that sharing human stories is extremely important to help people understand the scope of the problem of AMR, and empathize with people suffering from it at an individual, institutional and systemic level. When I decided to share my lived experience with chronic prostatitis, my struggle with antibiotic resistance and the success of my treatment, I had no idea what kind of an impact it would have. To even be able to help one more person suffering from an antibiotic-resistant infection would have made it worth the effort. However, the way our initiative has snowballed, with a constantly increasing number of patients that contact us for support in dealing with their AMR related conditions, has been overwhelming! It really brings into focus the immense power of sharing a lived experience, and that is why we encourage other AMR survivors to share their stories.
We have created different channels for sharing these stories of lived experiences in an effective and impactful way. We have created a Patient Experiences section on our website, where patients are able to share their experiences in their own words, which in our experience is a powerful tool to bring out the reality of their struggle. We are authoring case reports for medical and scientific journals based on the treatment experience of the people we are working with, to make the message of phage therapy reach doctors and researchers with factual, data-backed experiences of patients. We are also collaborating with campaigns and organizations that are raising AMR awareness, with a focus on sharing lived experiences. We hope that this will create an exponential cycle of AMR experience sharing, leading to greater and greater awareness of this problem and possible solutions to it.
“…the way our initiative has snowballed, with a constantly increasing number of patients that contact us for support in dealing with their AMR related conditions, has been overwhelming! It really brings into focus the immense power of sharing a lived experience, and that is why we encourage other AMR survivors to share their stories.”
As someone with lived experience of AMR infection, what would be your call to action to the general public to help tackle this problem.
Pranav: The general public needs to be made aware of the problem of AMR, and how and why it propagates at personal, industrial and societal levels. A concerted and persistent effort needs to be made for this. For medical regulators and governmental bodies dealing with the health and welfare of the general public, I would prioritize the following as calls to action in dealing with the problem of AMR:
“Understanding and honest acceptance of the magnitude of the problem of AMR; advocating responsible use of antibiotics and other antimicrobials; raising awareness for alternative treatments to the problem of AMR like Phage Therapy; increasing funding, and allocating resources for ramping up alternative treatments; and creating regulatory-logistics-commercial frameworks that makes it easy for patients to seek alternative treatments for AMR infections.”
Interview by Moneca Kaul and Team SaS; Moneca Kaul is a PhD researcher based at CCMB, Hyderabad. She is studying the bacterial cell wall and proteins that break this wall to accommodate new cell wall material as the bacterial cells grow and divides.
Cover Art by Mrunal Kulkarni
Learn more about AMR and what you can do to stop the rise of superbugs here.