Aim: The aim of this investigation is to look at a specific, possible, solution to the increasing issue of bacteria acquiring resistance which is bacteriophage and to find out if this solution can work. Reason: This topic was chosen, for this assignment was because this is a subject which is interesting. It is also a very relevant issue for society, as the situation of bacterial resistance to many of the current antibiotics is increasing it is becoming a greater threat and danger to our health. This will at some time in many lives affect us, as in the very near future, if this is not dealt with now and many may need a vital operation you will be at greater risk of infection. Introduction: Antibiotic resistance is a serious problem for society since bacteria have increased resistant to multiple antibiotics. This problem means that our current treatments for fighting infections have become nearly impossible for patients in hospitals with a severe case of infection, as a result many people are dying every day due to untreatable infections. The problem is so severe that the bacteria are becoming resistant to the drugs faster than we can develop them, so an alternative therapy is required to fight infections. A suggested therapy that is under research which is using bacteriophage’s (a virus that targets bacteria as its host) and it minimally affect the flora in the patient, meaning the person’s microbiome is not being removed of the good bacteria, unlike conventional chemical antibiotics. A big contribution to this problem is the presence of antibiotics in our food such as meat, another contributor is the excessive use by doctors in minor cases due to the patient’s concern and therefore the doctor has to prescribe them, so this combination of overuse and presence in our food means the bacteria in our microbiome are becoming resistant and by the time we really need the antibiotics in severe cases they cannot be used. Facts about the Science and technology of bacterial resistance and bacteriophage’s: Figure 1: They are two cycles for bacteriophage’s when it infects its host cell, the bacterium, The lysogenic and the lytic cycle. The lysogenic cycle is when the bacteriophage attaches to the cell membrane of the bacterium. It inserts its genetic code into the plasmids (its genome) and remains inactive, therefore the bacterium passes its altered genetic code onto its daughter cells without damaging the cell but altering its physical characteristic (phenotype). The lytic cycle is when the bacteriophage attaches to the cell membrane of the bacterium. Figure 2: What this diagram shows is that a species of bacteria can acquire resistance rapidly, after the discovery of an antibiotic to combat that bacteria. The shortest time period of acquired resistance was Fluoroquinolones which was resistant with in that year of discovery. The bacteria that to the longest to acquire resistance was penicillin, the average duration between discovery and resistance acquired was 15.5 years for an antibiotic drug to become ineffective. This is an issue for healthcare as it shows when a new antibiotic is widely used it can become ineffective within a short period of time of use, which can affect the ability of treating a class of bacteria a patient may be infected with. Figure 3 : What this table shows is that the number of antibacterial drugs being discovered is decreasing over the period of 1980 to 2014 although the decline is not constant the exception to the decline is between 2010-2014 where the number discovered was greater than 2005-2009 and between 1985-1999 the numbers for each four year period was the same. Figure 4: This diagram shows that the amount of antibiotics has increased in the population by 6.5 percent between the period of 2011-2014 this diagram is relevant as it shows an issue with the increased use/prescription of antibiotics which may be ineffective as approximately 50 percent of patients prescribed antibiotics are inappropriately prescribed as viral infection can explain many infections and this increase can explain why antibiotic resistance is increasing. Figure 5: What this bar graph shows is that between the placebo group with dysentery (An intestinal infection) had significant incidences than the patients receiving phage treatment this is also true for culture- confirmed dysentery and diarrhoea. The group of patients that was most effective in the phage treatment was the age range of 6 months to 1 years old. The age range that was less responsive was the age range of 5 to 7 years. Figure 6: Plaque forming units (PFU) Firstly, what this graph shows is with a control group (normal blood and brain) of mice when injected with the phage’s the number of phages declined dramatically as there is no bacteria for the specific phages to multiply. Secondly it shows an optimum phage units in the infected brain meaning that all of the bacteria within the brain have been destroyed. The phage units decrease dramatically as there are no bacterial cells to infect and replicate. It also show with the infected blood it reaches a peak of phage units indicating all bacterial cells have been infected and after reaches a sharp decline. Finally it shows that between the infected and control group of mice the time when phage levels have reached a minimum is relatively close to 30 hours of a difference. This indicates that the phages are a great way of treating infections rapidly, around 6 days, of which antibiotics could not possibly treat. Effects on the society: In society what is effected the most by this problem is the patients themselves. The increase of multiple resistant bacteria, over the few decades, has also been destructive. This has brought patient afflictions, such as mental as well as physical. This means the patient will have to take time off work, maybe for a long duration of time, meaning the person is affected economically. This is more of an issue for people that live in countries that do not have a healthcare system paid by tax the patient can be left with crippling medical bills. Another effect on society which is the economy. For example, one NHS hospital had an outbreak of (CPE) Carbapenemase-producing Enterobacteriaceae the duration of this outbreak lasted ten-month period and this was “This time frame was not unusual”- Dr Jon Otter (1.1), It costed the NHS approximately £980,000, estimated by scientist from the Imperial college London. This was only one outbreak, in one hospital, in one country. If this keeps occurring, which seems inevitable in this current situation, this shows the extent of how this issue affect the economy. Advantages: The advantages of using bacteriophage’s, as the treatment for bacterial infection, are when a bacteriophage infects a bacteria cell it can use the mechanisms of the bacterial cell for the virus to self-replicate. This, therefore, means that the dose required for treating a patient is significantly reduced compared to chemical antibiotics. Since the majority of bacteriophage’s have evolved to a certain species of bacteria (specialisation) therefore, the disruption of your own microbiome is minimal. Phage’s consist mostly of nucleic acids and proteins; therefore, they are inherently nontoxic this low toxicity and specificity can allow the disposal of phage to have a low impact on the environment. Bacteriophage’s infect the cell and kill it using mechanisms which are different from antibiotics, the resistance of antibiotics does not mean that it is resistant to phage’s as antibiotic-resistance does not correlate to mechanisms to prevent phage infection. Since phage’s can completely kill bacterial cultures this can prevent the horizontal gene transfer of resistant genes in the remaining bacterial cell. Disadvantages: The disadvantages when using phage’s, as treatment for bacterial infection, are not all bacteriophages are able to be used in therapeutics. For a bacteriophage to be used, in treatment, it must have a high virulence towards the bacterium. There is also the problem of it can only destroy specific hosts this is not a good treatment for presumptive treatment (treating infection before identification) so, a broad spectrum of phage’s must be administered. This is only a disadvantage if the time for a patient is limited, by a severe infection, which may need treatment before Identification. Another problem to these phage’s is when cultured they might evolve before being administered into the patient and could therefore, be useless. Regards to production there is an issue in producing a high purity, of phage serum, this is an issue as to culture the phage is requires a host to replicate. In doing so, the bacterium produces endotoxins that needs to be removed. If the endotoxins are present, in the serum, and the serum is administered intravenously it can affect the many systems and organs of the patient. Differing opinions: (Haq, et al. 2012) (1.0) – Bacteriophage’s have a range of applications from phage’s vaccines and bacterial infections of people and crops. But, the issue that it brings is it safety such as the inflammatory response when treating the patient. What also is an issue being the purification of the phage’s, by removal of endotoxins produced by the bacteria in response to increasing of the quantity of phage’s. (Nagel, et al. 2016) (2.0) – The main issue with using phage’s is the current regulatory are not suited for the regulation of bacteriophage’s. Also, the concern the public have as it could be misunderstood, as the therapy contains the word “virus” contained within, making people fear the treatment as it might be associated with deadly viruses. They both agree that upon the fact that the potential that phages possess is great. They also agree upon that this treatment needs improvement but however, they disagree on what are the issues at hand as one thinks it needs improvements medically whereas, the other thinks it is social. therefore, through deduction it appears that for this to work, the issues in terms of social and medical need investigated and resolved the public need educated on the treatment to reduce fears and more research is required to reduce harm to the patients needing treatment. Conclusion: The aim of this investigation was to look at one of the possible solution, to the increasing issue of bacterial resistance, which is bacteriophage and to find out if this solution can work. In this investigation what was found was that the use of bacteriophage’s, in the treatment of bacterial infection is promising. The effectiveness of the phage’s, medically tested, to some extent this is shown in (1) table: it shows a collection of peer-review journals in Poland and former Soviet Union. The success of these studies shows the great potential for this treatment as it is more effective than current antibiotics used. Although the phage’s maybe effective there is still some issues that need to be dealt with for instances the purification of phage serum by removal of endotoxins. What else needs to be done is the further research into this therapy to ensure that the treatment does not have an effect on the patient when administered for example there might be an inflammatory response. How society should deal with this issue is to ensure that doctors are not over prescribing antibiotics when not necessary and reduction in antibiotics used in our livestock as it introduces more antibiotics into our system. The public need to be educated on what are bacteriophage’s and how they work so ensure no misconception to prevent fear of the therapy and finally further research is needed to clarify the current research and improve the techniques to make sure that the treatment is safe for humans. This therapy has a great potential if it is perfected because the studies that have been conducted about this topic show the effectiveness even in its early stages of understanding of the phage’s it can be a great solution to the problem of antibiotic resistant bacteria that are causing death to so many. Evaluation: What went right with this assignment was the finding an adequate number of journals on this topic. Finding along with that a large amount of data (graphs, tables and figures) to show the advantages of this therapy. What went wrong with this assignment, is that alteration needed to be made to the time table as the duration of time needed to complete each section was unrealistic. Another issue with the assignment was the difficulty in finding different opinions on the issue as the majority of scientist studying this field of research all agree that it is beneficial. In the process of creating an assignment, what has been learnt is how to correctly reference the report. Also, how to structure the report with a balanced, unbiased, way when opinions are being presented to convey a conclusion. What also was learnt was how to depersonalise the report to present the report in a correct manner for this topic. That a graph/diagram/table by itself is not sufficient enough it must be analysed and stated.