Comment by XorNot
19 hours ago
"simple, obvious and wrong".
Phages are intensely species specific to bacterial species, so they don't work unless you identify exactly what you're targeting. Also, even if they can penetrate biofilms, that doesn't mean you can successfully deliver them to the biofilm in the human body, since they have to survive the whole blood stream and the normal human immune response to "not self" things.
Adding to this: a chief advantage of antibiotics (particularly the early ones) is that they were both broad-spectrum (controlling a vast array of bacteria) and sparing of non-bacterial cells (e.g., those of our own bodies).
Evolved resistance is changing at least the first part of that relationship.
Phages as you note are far more tailored, and may (if I understand correctly) need to be targeted to a patient's specific infection's genetic line. It's as if you had to select ammunition based on the specific type of target you were hunting, if not specific individuals. In the early days of antibiotics it was far more a case of "fire and forget" with a single magic bullet. (Not literally always, but for the overwhelming majority of bacterial infections.)
I guess specific (custom-made) IV phages might work. We „just“ need tech that makes the whole process affordable.
The problem is, you need to gather information about the specific bacterial composition of the biofilm. Unless Star Trek style transporter technology (which, iirc, is also used in their tricorders) is invented, we're stuck with invasive procedures to acquire a sample, and that kind of invasive procedure is pretty dangerous!