Despite the potential of replacing antibiotics with phages for certain types of bacterial pathogens, there is a middle road that recognizes the potential of phages, but also that antibiotics should not be abandoned. We argue below that in many situations the combined use of phages with antibiotics will result in greater success than either separately, both in terms of treatment success and in curtailing the evolution of resistance. Additionally, the development of highly successful specific pairs or cocktails of antibiotics and phages could attract pharmaceutical interest to the field, avoiding some of the extra regulatory problems and polemics of genetically modified phages [21].
尽管噬菌体有可能取代抗生素来治疗某些类型的细菌病原体，但也有一条中间道路，即承认噬菌体的潜力，但也不应放弃抗生素。我们在下文中将论证，在许多情况下，噬菌体与抗生素的联合使用将比单独使用抗生素取得更大的成功，无论是在治疗成功率方面，还是在遏制抗药性的进化方面。此外，成功开发出抗生素与噬菌体的特异性配对或组合，可以吸引制药公司对这一领域的兴趣，避免转基因噬菌体带来的一些额外的监管问题和争论[21]。
Advantages of Combining Phages and Antibiotics
噬菌体与抗生素结合的优势
The logic of combining phages and antibiotics stems from an evolutionary understanding that two sufficiently different selective pressures are likely to be more effective than either alone.
将噬菌体和抗生素结合起来的逻辑源于进化论的一种认识，即两种充分不同的选择压力可能比单独使用其中一种更有效。
Table 1. Examples of Studies Showing Antibiotic–Phage Positive Effects against Problematic or Model Bacteria
表 1.显示抗生素-噬菌体对问题细菌或模式细菌有积极作用的研究实例
| Bacteria 细菌 | Phage Family 噬菌体家族 | Antibiotic 抗生素 | Effects 效果 | Refs 参考文献 |
| Burkholderia cepacia 伯克霍尔德氏菌 | Myoviridae 肌病毒科 | Meropenem, ciprofloxacin, tetracycline 美罗培南、环丙沙星、四环素 | • PASa •Increased survival of larvae -提高幼虫的存活率 | [40] |
| Escherichia coli 大肠杆菌 | Not described 未说明 | Enrofloxacin 恩诺沙星 | – Total protection of birds – 全面保护鸟类 | [17] |
| Escherichia coli 大肠杆菌 | Myoviridae 肌病毒科 | Cefotaxime 头孢他啶 | • PAS – 考绩制度 •Eradication of bacterial biofilms -根除细菌生物膜 | [37] |
| Klebsiella pneumoniae 肺炎克雷伯氏菌 | Podoviridae (T7-like)短尾噬菌体科 | Ciprofloxacin 环丙沙星 | • Eradication of bacteria – 消灭细菌 •Prevention of resistant variants -预防抗药性变体 | [27] |
| Pseudomonas aeruginosa 铜绿假单胞菌 | Podoviridae短尾噬菌体科 | Streptomycin 链霉素 | • Decreased bacterial density – 细菌密度降低 •Limited antibiotic resistance -抗生素耐药性有限 | [32] |
| Pseudomonas aeruginosa 铜绿假单胞菌 | Siphoviridae 虹吸病毒科 | Ceftriaxone 头孢曲松 | – Synergistic reduction of bacterial growth – 协同减少细菌生长 | [41] |
| Pseudomonas fluorescens 荧光假单胞菌 | Podoviridae短尾噬菌体科 | Kanamycin 卡那霉素 | • Decreased bacterial survival – 细菌存活率降低 •Limited antibiotic resistance -抗生素耐药性有限 | [29] |
| Staphylococcus aureus 金黄色葡萄球菌 | Myoviridae 肌病毒科 | Linezolid 利奈唑胺 | • Stopped MRSA hind paw foot infection – 阻止 MRSA 后爪足感染 •Decreased bacterial density -细菌密度降低 | [28] |
| Staphylococcus aureus 金黄色葡萄球菌 | Myoviridae 肌病毒科 | Gentamicin 庆大霉素 | • Decreased bacterial density – 细菌密度降低 •Prevention of phage-resistant variants -预防噬菌体抗性变种 | [30] |
aPhage–antibiotic synergy.
a 噬菌体-抗生素协同作用。