The laboratory, with its faded white walls and the smell of yeast in the air, seems an unlikely battleground for one of the most urgent fights facing modern medicine.
But the Eliava Institute – housed in a Stalin-era building overlooking the Mtkvari river in Tbilisi, Georgia – has come to global attention as antibiotic resistance increases and once treatable diseases are left without a ready cure.
The centre has been producing an alternative to antibiotics since the early Soviet period – tiny viruses called bacteriophages, or simply “phages,” that invade bacteria and multiply until they burst out and destroy their host.
Phages are the most abundant organisms on the planet and are used to treat bacterial diseases in humans on the principle that “my enemy’s enemy is my friend”.
The therapy has been common in Georgia for almost a century but now hundreds of foreign patients are coming to Tbilisi every year for treatment. The majority are from mainland Europe but the centre also sees patients from the UK, US and Asia.
Is it just another false hope, an unregulated money making exercise? Or might phages really have a role to play in modern medicine, especially as antibiotics start to fail?
Taking to the lab and its patients, it does feel a bit Heath Robinson, a bit too good to be true.
“Most people who are coming here, they are taking antibiotics for many, many years and they have not been treated completely,” says Dr Nina Chanishvili, the head of research and development at Eliava. Common complaints from visitors include skin infections, chronic prostatitis, chronic cystitis, bronchiectasis and complications arising from cystic fibrosis.
Patients either drink the phages cultivated in the lab or have them applied topically as a liquid or cream.
Roy Schnauss, an estate agent from Florida who heard about Eliava online, had taken multiple rounds of antibiotic treatments over several years for flu-like symptoms and fatigue linked to a bacterial infection.
In Tbilisi he underwent blood, urine and other tests to pinpoint the bacteria behind the symptoms and allow doctors to find a phage that could attack the strain.
“Since I’ve been here I’ve noticed a difference in my activity level,” the 45-year-old says, after more than a week of taking phage orally, twice a day. “When I got here I was just tired and sleeping and staying in the hotel. But as I continue I’m going out and enjoying the city.”