The Potential Role of Bacteriophages in the Treatment of Recalcitrant Chronic Rhinosinusitis

Abstract

Chronic rhinosinusitis is a common condition affecting 5-12% of the general population worldwide. In a limited number of cases, the disease is recalcitrant to medical and surgical interventions, causing a major impact on physical, social and emotional well-being and increasing pressure on healthcare systems. Biofilm formation and dysbiosis caused by Staphylococcus aureus and Pseudomonas aeruginosa play a role in the pathogenesis of recalcitrant chronic rhinosinusitis. In these cases, a promising treatment alternative is the application of bacteriophages, which are viruses that infect and lyse bacteria. In this review, we appraise the evidence for the use of bacteriophages in the treatment of recalcitrant chronic rhinosinusitis. Additionally, (dis)advantages of bacteriophages and considerations for implementation of phage therapy in otorhinolaryngology practice will be discussed.

Keywords: bacteriophages; chronic rhinosinusitis; endolysins; phage therapy; phages; recalcitrant; refractory; therapy-resistant.

Figure 1

Schematic overview of part of the pathophysiology of recalcitrant CRS with biofilm formation, dysbiosis, overgrowth of S. aureus or P. aeruginosa and the theoretical mechanisms of action of bacteriophages in the treatment of recalcitrant CRS: (1) lysis of bacteria during the lytic phase of bacteriophage replication and (2) reduction of biofilm mass by hydrolysis of polymers by phage-derived enzymes.

Figure 2

Advantages and disadvantages of bacteriophages and antibiotics.