Superbug Killers.(bacteriophages)

Alfred Gertler had never been so ill. In 1997 the 45-year-old jazz musician was hiking in Costa Rica when he fell and broke his ankle. He contracted a staphylococcus infection so severe that flare-ups kept him in bed for weeks at a time. Antibiotics were of no use: the circulation in his ankle was too poor to transport the medicine to its target. When doctors told him that they might have to amputate his foot,

Gertler buried himself in books and magazines, looking for a solution. He found one: bacteriophage therapy, a little-known medical treatment that doctors in the former Soviet Union had been using for decades. Last February, Gertler flew to the Eliava Institute in Tbilisi, Georgia. He found doctors laboring by the light of kerosene lanterns in poorly heated buildings with just one hour of running water per day. They applied a solution of bacteriophages--tiny viruses that destroy bacteria--directly to his ankle. It worked. "The infection was completely gone in three days," says Gertler. He plans to have foot- saving surgery early next year.

Soon it won't be necessary to fly to Tbilisi. Many scientists believe bacteriophages will be an important new weapon in the fight against antibiotic-resistant infections. In the past decade, chronic overprescribing of antibiotics has weaned new strains of superbugs, and pharmaceutical firms have begun to run out of drugs to fight them. Fortunately, biotech start-ups from Baltimore to Bangalore are developing phage treatments that fight infectious diseases such as tuberculosis and salmonella, as well as anthrax and other bioweapons. Even though the treatment has logged eight decades of use in eastern Europe, its success has been largely anecdotal. "[Soviet scientists] took for granted that phages work," says Nina Chanishvili, a senior microbiologist at the Eliava Institute. "They didn't feel they needed to justify how safe it was, and nobody bothered to build up any data on them."

That's what scientists are doing now, more than 80 years after phages were first administered in Paris to four patients with severe dysentery. (All four recovered.) The treatment was first popularized in Sinclair Lewis's 1925 novel "Arrowsmith," about a young doctor who stumbles upon a bacteria-eating virus. "You may have hit on the supreme way to kill pathogenic bacteria!" exclaims one character. At one time German and Red Army soldiers carried vials of phages in their medical kits, and the U.S. firm Eli Lilly marketed seven different phage preparations to fight staph, streptococcus and E. coli. Antibiotics, which proved more effective and simpler to use, eclipsed them in the 1940s, but now phages are undergoing a renaissance. "I call it 'back to the future'," says Alexander Sulakvelidze, cofounder of Intralytix, a Baltimore biotech firm.

Scientists still have some hurdles to overcome. One is political: the lingering distrust of Soviet medicine. Some doctors are also reluctant to administer live viruses for fear they'll make patients ill. (Experts are quick to point out that phages target bacterial--not human--cells.) And phages, like laser-guided missiles, are very specific: one phage kills only a specific subgroup of bacteria. (Salmonella, for example, has more than 2,400 subgroups.) Whereas antibiotics, medicine's weapons of mass destruction, kill many different types of bacteria in one go, a physician would need to make a very specific diagnosis before prescribing a phage treatment. To make it easier, scientists at Intralytix are developing phage "cocktails," and Phage Therapeutics in Seattle has genetically engineered superphages that attack bacteria across subgroups and species.