Table 1.
Human case reports and case series of phage therapy for drug-resistant bacterial pulmonary infections.
| Patient(s) | Underlying pulmonary disease | Pathogen (resistance phenotype) | Phage composition | Route | Dose | Duration | Concomitant antibiotics | Microbiological outcome | Clinical outcome | Resistance emergence | Immune neutralization | Adverse events | Evidence type |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1 (15-y girl with CF, status post bilateral lung transplant) | Disseminated M. abscessus infection with pulmonary involvement (post-transplant immunosuppression) | M. abscessus (resistant to all antibiotics tested) | Muddy + BPsΔ33HTH_HRM10 + ZoeJΔ45 (one natural and two engineered phages) | Intravenous every 12 h + topical application to sternal wound and skin lesions | ~1 × 109 PFU per phage per dose | 32 weeks | Not reported (prior multidrug regimens had failed) | No phage-resistant isolates detected in serial specimens | Sternal wound closure, improved liver function, substantial resolution of skin nodules | None observed | Weak anti-phage antibody response without neutralizing activity | None significant; therapy well tolerated | Case report, compassionate use (Dedrick et al., 2019) |
| 2 (9 adults with CF, median age 32 y) | Cystic fibrosis with chronic P. aeruginosa infection refractory to standard antibiotics | P. aeruginosa (7 MDR, 2 pan-resistant) | Personalized cocktail of 2–3 phages (n = 6) or single phage (n = 3), including OMKO1, LPS-5, TIVP-H6 | Nebulized (jet nebulizer) | 1 × 10¹0 PFU total per day, twice daily (inpatients) or once daily (outpatients) | 7–10 days | 6 patients on intravenous antibiotics at initiation; 3 had recently completed a course | Significant decline in sputum P. aeruginosa density (P < 0.05); sputum microbiome diversity unchanged | ppFEV1 improved (median +6% at days 21–35, P = 0.004) | Yes — phage-resistant clones in all patients, associated with fitness trade-offs (restored antibiotic susceptibility or reduced virulence) | Not assessed | Well tolerated; transient low-grade fever and malaise in 4/5 outpatients on days 2–3 | Prospective single-arm case series, compassionate use, n = 9 (Chan et al., 2025) |
| 3 (83-y man) | No chronic lung disease; interstitial pneumonia with ARDS on mechanical ventilation | P. aeruginosa (carbapenem-resistant, ST260; susceptible only to colistin and tobramycin) | Cocktail 1: PaSz-1_45_92k + PaZh_1 (days 1–14); cocktail 2: PaSz-1_45_92k + PaZh_1 + PAL9 (days 15–56) | Nebulized (jet nebulizer) | 6 × 109 PFU/dose twice daily (cocktail 1); 9 × 109 PFU/dose (cocktail 2) | 8 weeks (56 days) | Colistin (early course, discontinued for nephrotoxicity) | Progressive decline in sputum bacterial load without eradication (late isolates considered colonization); viable sputum phage titer up to 107 PFU/mL | Inflammatory markers normalized; oxygenation improved; pleural effusion reduced on day-90 CT; renal function recovered | Yes — sequential isolates with partial phage resistance; final isolate fully resistant but with attenuated virulence, motility, and biofilm formation | Not assessed | None attributed to phage therapy (renal impairment attributed to colistin) | Case report (Yang et al., 2025) |
| 4 (87-y woman) | COPD with severe pneumonia, ARDS, and renal failure on mechanical ventilation | A. baumannii (XDR; susceptible only to polymyxin B) | Single novel lytic Caudoviricetes phage (isolated from hospital sewage) | Nebulized | 5 × 109 PFU/mL twice daily | 9 days (reported assessment period) | Fosfomycin 8 g q8h + amikacin 0.2 g q12h + polymyxin B 500,000 U q12h, all intravenous | Sputum cultures negative from day 4; mNGS pathogen burden reduced ~52-fold; ARGs reduced from 29 to 4 | Hypercapnia resolved by day 4; CRP, ESR, and renal function improved | Not monitored in vivo (rapid tolerance to phage alone observed in vitro) | Not assessed | None; therapy well tolerated | Case report, compassionate use (Zhang et al., 2026b) |
Preclinical (animal and in vitro) evidence is described separately in the text and is not presented as clinical cases. Fields not reported in the primary sources are labeled “Not reported” or “Not assessed” rather than inferred.
ARDS, acute respiratory distress syndrome; ARG, antimicrobial resistance gene; CF, cystic fibrosis; COPD, chronic obstructive pulmonary disease; CRP, C-reactive protein; CT, computed tomography; ESR, erythrocyte sedimentation rate; FEV1, forced expiratory volume in 1 second; IV, intravenous; MDR, multidrug-resistant; mNGS, metagenomic next-generation sequencing; PFU, plaque-forming unit; ppFEV1, percent predicted FEV1; q8h/q12h, every 8/12 hours; XDR, extensively drug-resistant.
Primary sources: Dedrick et al., Nat Med 2019;25:730–733 (doi: 10.1038/s41591-019-0437-z). Chan et al., Nat Med 2025;31:1494–1501 (doi: 10.1038/s41591-025-03678-8). Yang et al., Sci Rep 2025;15:33512 (doi: 10.1038/s41598-025-17510-3). Zhang et al., Front Cell Infect Microbiol 2026 (doi: 10.3389/fcimb.2026.1851410).