TERAPIA FÁGICA: UMA ABORDAGEM INOVADORA NO TRATAMENTO DE INFECÇÕES POR BACTÉRIAS RESISTENTES

Resumo

Dentre as problemáticas da infectologia, na atualidade, a resistência bacteriana a antibióticos se apresenta como uma ameaça expressiva à saúde populacional, principalmente no quesito de tratamento de infecções. Assim, em uma era de resistência antibiótica, os bacteriófagos se tornam um produto terapêutico em potencial contra infecções. Os bacteriófagos são vírus que infectam bactérias com alta especificidade e também podem ser projetados utilizando engenharia genética para exterminar cepas resistentes a antibióticos. No mínimo 1 milhão de pessoas por ano são acometidas por infecções resistentes no Brasil, as bactérias mais preocupantes são Klebsiella pneumoniae, Escherichia coli e Acinetobacter baumanii. A terapia com fagos pode ser dividida em duas principais abordagens: a personalizada e a não personalizada, sendo que a primeira possui melhores resultados. Os fagos demonstraram ser bem tolerados e seguros, independentemente da via utilizada. Contudo, os ensaios clínicos ainda carecem de sistematização completa da metodologia, sendo crucial promover e investir em ensaios clínicos bem estruturados para garantir melhores resultados aos pacientes.

Biografia do Autor

Jaqueline Corrêa de Souza

Discente do curso de Bacharelado em Biomedicina pela Faculdade UNITERP-FACTERP, São José do Rio Preto, São Paulo. 

Mateus Alexandre Maestrella Basilio

Mestrando em Microbiologia pela Universidade Estadual Paulista (UNESP), MBA em Gestão de Saúde pelo Centro Universitário São Camilo. Docente do curso de Biomedicina da Faculdade UNITERP-FACTERP, São Josè do Rio Preto, São Paulo.

Mayara Gambellini Gonçalves

Mestre em Microbiologia pela Universidade Estadual Paulista (UNESP). Especialista em Saúde Pública. Coordenadora e docente do curso de Biomedicina da Faculdade UNITERP-FACTERP, São José do Rio Preto, São Paulo 

 

Referências

ABEDON, S. T. Information Phage Therapy Research Should Report. Pharmaceuticals, [S. l.], v. 10, n. 2, abr. 2017. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5490400/ Acesso em: 06 set. 2024 DOI: https://doi.org/10.3390/ph10020043 DOI: https://doi.org/10.3390/ph10020043

ADVOCATING for phage therapy. Nature Microbiology, [S. l.], v. 9, p.1397–1398, jun. 2024. DOI: https://doi.org/10.1038/s41564-024-01733-7 Disponível em: https://www.nature.com/articles/s41564-024-01733-7#article-info Acesso em 20 set. 2024. DOI: https://doi.org/10.1038/s41564-024-01733-7

ALEKSHUN, M. N.; LEVY, S. B. Molecular Mechanisms of Antibacterial Multidrug Resistance. Cell, [S. l.], v. 23, n.128, p.1037-1050, mai. 2007. Disponível em: https://www.cell.com/action/showPdf?pii=S0092-8674%2807%2900311-X Acesso em: 2024 DOI: https://doi.org/10.1016/j.cell.2007.03.004 DOI: https://doi.org/10.1016/j.cell.2007.03.004

ANTIMICROBIAL RESISTANCE COLLABORATORS. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. Lancet, [S. l.], v. 399, p. 629-655, fev. 2022. Disponível em: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)02724-0/fulltext Acesso em: 26 ago. 2024 DOI: https://doi.org/10.1016/S0140-6736(21)02724-0

ANVISA - AGÊNCIA NACIONAL DE VIGILÂNCIA SANITÁRIA. Confira dados mundiais sobre resistência microbiana. Brasilia: ANVISA, 23 nov. 2021. Disponível em: https://www.gov.br/anvisa/pt-br/assuntos/noticias-anvisa/2021/confira-dados-mundiais-sobre-resistencia-microbiana Acesso em: 17 mar. 2024.

BALASUBRAMANIAN R. et al. Global incidence in hospital-associated infections resistant to antibiotics: An analysis of point prevalence surveys from 99 countries. PLoS Medicine, [S. l.], v. 20, n. 6, jun. 2023. DOI: doi.org/10.1371/journal.pmed.1004178. Disponível em: https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1004178 Acesso em: 30 ago. 2024. DOI: https://doi.org/10.1371/journal.pmed.1004178

BANCO MUNDIAL. Drug-Resistant Infections: A Threat to Our Economic Future. Washington, DC: World Bank, 2017. Disponível em: https://www.worldbank.org/en/topic/health/publication/drug-resistant-infections-a-threat-to-our-economic-future Acesso em: 06 set. 2024.

BRAGG, R. et al. First International Conference, Advances in Experimental Medicine and Biology. Bacteriophages as potential treatment option for antibiotic resistant bactéria, New Delhi, v. 807, p. 97-110, 2014. Disponível em: https://pubmed.ncbi.nlm.nih.gov/24619620/ Acesso em: 04 mar. 2024 DOI: https://doi.org/10.1007/978-81-322-1777-0_7 DOI: https://doi.org/10.1007/978-81-322-1777-0_7

BRIVES, C.; POURRAZ, J. Phage therapy as a potential solution in the fight against AMR: obstacles and possible futures. Palgrave Commun, [S. l.], v. 6, n. 100, p. 1-11, 2020. DOI: https://doi.org/10.1057/s41599-020-0478-4 Disponível em: https://www.nature.com/articles/s41599-020-0478-4#citeas Acesso em: 25 jun. 2024. DOI: https://doi.org/10.1057/s41599-020-0478-4

CDC - CENTERS FOR DISEASE CONTROL AND PREVENTION. Antibiotic resistance threats in the United States. Atlanta, GA: U.S. Department of Health and Human Services, CDC; 2019. Disponível em: http://dx.do.i.org/10.15620/cdc:82532 Acesso em: 30 ago. 2024.

CHEVALLEREAU, A. et al. Interactions between bacterial and phage communities in natural environments. Nat. Rev. Microbiol, [S. l.], v. 20, n. 1, p. 49-62, jan. 2022. Disponível em: https://pubmed.ncbi.nlm.nih.gov/34373631/ Acesso em: 18 maio 2024 DOI: https://doi.org/10.1038/s41579-021-00602-y DOI: https://doi.org/10.1038/s41579-021-00602-y

CLOKIE, M. R. et al. Phages in nature. Bacteriophage, [S. l.], v. 1, n. 1, p. 31-45, jan. 2011. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3109452/ Acesso em: 01 mai. 2024 DOI: https://doi.org/10.4161/bact.1.1.14942 DOI: https://doi.org/10.4161/bact.1.1.14942

COHEN, N. Antibiotic resistance: a battle of wits versus natural selection. [S. l.], Harvard University, 2011. Disponível em: https://sitn.hms.harvard.edu/flash/2011/issue103/ Acesso em: 28 maio 2024.

CONLY, J.; JOHNSTON, B. Where are all the new antibiotics? The new antibiotic paradox. Canadian Journal of Infectious Diseases and Medical Microbiology, [s.l.], v. 16, n.3, p. 159-160, mai. 2005. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2095020/ Acesso em: 04 mar. 2024 DOI: https://doi.org/10.1155/2005/892058 DOI: https://doi.org/10.1155/2005/892058

DEDRICK, R. M. et al. Engineered bacteriophages for treatment of a patient with a disseminated drug-resistant Mycobacterium abscessus. Nature Medicine, [S. l.], v. 25, n. 5, p. 730-733, mai. 2019. Disponível em: https://www.nature.com/articles/s41591-019-0437-z Acesso em: 26 ago. 2024 DOI: https://doi.org/10.1038/s41591-019-0437-z DOI: https://doi.org/10.1038/s41591-019-0437-z

D'HERELLE, F. Bacteriophage as a Treatment in Acute Medical and Surgical Infections. Bull New York Academy of Medicine. New York, v. 7, n. 5, p. 329-348, mao 1931. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2095997/?page=1 Acesso em: 06 ago. 2024.

FEDOROV, E. et al. Short-Term Outcomes of Phage-Antibiotic Combination Treatment in Adult Patients with Periprosthetic Hip Joint Infection. Viruses, [S. l.], v, 15, n. 2, p. 499, fev. 2023. Disponível em: https://pubmed.ncbi.nlm.nih.gov/36851713/ Acesso em: 14 out. 2024 DOI: https://doi.org/10.3390/v15020499 DOI: https://doi.org/10.3390/v15020499

FLEMING, A. Chemotherapy: Yesterday, To-Day, and To-Morrow. Cambridge: Cambridge University Press, 1946. p. 39.

FRIEDEN, T. Centers for Disease Control and Prevention. Antibiotic resistance threats. United States: Department of Health and Human Services; 2013. Disponível em: https://www.cdc.gov/antimicrobialresistance/media/pdfs/arthreats2013508.pdf?CDC_AAref_Val=https://www.cdc.gov/drugresistance/pdf/ar-threats-2013-508.pdf Acesso em:17 mar. 2024.

GENCAY, Y. E. et al. Engineered phage with antibacterial CRISPR–Cas selectively reduce E. coli burden in mice. Nature Biotechnology, [S. l.], v. 42, p. 265–274, fev. 2024. DOI: https://doi.org/10.1038/s41587-023-01759-y Disponível em: https://www.nature.com/articles/s41587-023-01759-y Acesso em: 06 set. 2024. DOI: https://doi.org/10.1038/s41587-023-01759-y

GOODRIDGE, L.; ABEDON, S. T. Bacteriophage biocontrol and bioprocessing: Application of phage therapy to industry. SIM News, [S. l.], v. 53, n. 6, p. 254-262, nov./dez. 2003. Disponível em: https://www.researchgate.net/publication/242411977_Bacteriophage_biocontrol_and_bioprocessing_Application_of_phage_therapy_to_industry Acesso em: 26 mar. 2024.

HATFULL, G. F.; DEDRICK, R. M; SCHOOLEY, R. T. Phage Therapy for Antibiotic-Resistant Bacterial Infections. Annual Review of Medicine, [S. l.], v. 73, n. 27 p.197-211, jan. 2022. Disponível em: https://www.annualreviews.org/content/journals/10.1146/annurev-med-080219-122208#right-ref-B1 Acesso em: 10 abr. 2024 DOI: https://doi.org/10.1146/annurev-med-080219-122208 DOI: https://doi.org/10.1146/annurev-med-080219-122208

HITCHCOCK, N. M. et al. Current Clinical Landscape and Global Potential of Bacteriophage Therapy. Viruses, [S. l.], v. 15, n.4: 1020, abr. 2023. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10146840/ Acesso em: 06 set. 2024 DOI: https://doi.org/10.3390/v15041020 DOI: https://doi.org/10.3390/v15041020

JASSIM, S. A.; LIMOGES, R. G. Natural solution to antibiotic resistance: bacteriophages 'The Living Drugs'. World Jounal Microbiology Biotechnology, [S. l.], v. 30, n. 8, p. 2153-2170, ago. 2014. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4072922/ Acesso em: 10 abr. 2024 DOI: https://doi.org/10.1007/s11274-014-1655-7 DOI: https://doi.org/10.1007/s11274-014-1655-7

JAULT, P. et al. Efficacy and tolerability of a cocktail of bacteriophages to treat burn wounds infected by Pseudomonas aeruginosa (PhagoBurn): a randomised, controlled, double-blind phase 1/2 trial. Lancet Infectious Disease, [S. l.], v. 19, p. 35-45, jan. 2019. Disponível em: https://pubmed.ncbi.nlm.nih.gov/30292481/ Acesso em: 20 set. 2024 DOI: https://doi.org/10.1016/S1473-3099(18)30482-1 DOI: https://doi.org/10.1016/S1473-3099(18)30482-1

KAKASIS, A.; PANITSA, G. Bacteriophage therapy as an alternative treatment for human infections. A comprehensive review. International Journal of Antimicrobial Agents, [S. l.], v. 53, n. 1, p. 16-21, jan. 2019. Disponível em: https://www.sciencedirect.com/science/article/abs/pii/S0924857918302632?via%3Dihub Acesso em: 10 abr. 2024 DOI: https://doi.org/10.1016/j.ijantimicag.2018.09.004 DOI: https://doi.org/10.1016/j.ijantimicag.2018.09.004

LEITNER, L. et al. Intravesical bacteriophages for treating urinary tract infections in patients undergoing transurethral resection of the prostate: a randomised, placebo-controlled, double-blind clinical trial. Lancet Infectious Disease, [S. l.], v. 21, n. 3, p. 427-436, mar. 2021. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32949500/ Acesso em: 18 set. 2024 DOI: https://doi.org/10.1016/S1473-3099(20)30330-3 DOI: https://doi.org/10.1016/S1473-3099(20)30330-3

LUONG, T.; SALABARRIA, A.C.; ROACH, D.R. Phage Therapy in the Resistance Era: Where Do We Stand and Where Are We Going? Clinical Theraphy, [S. l.], v. 42, n. 9, p. 1659-1680, set. 2020. Disponível em: https://www.clinicaltherapeutics.com/article/S0149-2918(20)30348-9/fulltext Acesso em: 11 maio 2024 DOI: https://doi.org/10.1016/j.clinthera.2020.07.014 DOI: https://doi.org/10.1016/j.clinthera.2020.07.014

MALIK, D. J. et al. Formulation, stabilisation and encapsulation of bacteriophage for phage therapy. Advances in Colloid and Interface Science, [S. l.], v.249, p. 100-133, nov. 2017. Disponível em: https://www.sciencedirect.com/science/article/pii/S000186861630392X?via%3Dihub Acesso em: 16 dez. 2024 DOI: https://doi.org/10.1016/j.cis.2017.05.014 DOI: https://doi.org/10.1016/j.cis.2017.05.014

MARCUK, L. M. et al. Clinical studies of the use of bacteriophage in the treatment of cholera. Bulletin of the World Health Organization, [S. l.], v. 45, n. 1, p. 77-83, 1971. Disponível em: https://pubmed.ncbi.nlm.nih.gov/4946956/ Acesso em: 14 out. 2024.

MUTEEB, et al. Origin of Antibiotics and Antibiotic Resistance, and Their Impacts on Drug Development: A Narrative Review. Pharmaceuticals (Basel), [S. l.], v. 16, n. 11, p. 1615, nov. 2023. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10675245/ Acesso em: 28 ago. 2024 DOI: https://doi.org/10.3390/ph16111615 DOI: https://doi.org/10.3390/ph16111615

OMS - ORGANIZAÇÃO MUNDIAL DA SAÚDE. Global antimicrobial resistance and use surveillance systems | Country Profiles. [S. l.]: Global Health Observatory, 2019. Disponível em: https://www.who.int/data/gho/data/themes/topics/global-antimicrobial-resistance-surveillance-system-glass/glass-country-profiles Acesso em: 18 set. 2024

OMS - ORGANIZAÇÃO MUNDIAL DE SAÚDE. Antimicrobial resistance: global report on surveillance. Geneva: World Health Organization, 2014. Disponível em: https://www.who.int/publications/i/item/9789241564748 Acesso em: 04 nov. 2024.

OMS - ORGANIZAÇÃO MUNDIAL DE SAÚDE. Bacterial Priority Pathogens List, 2024: Bacterial pathogens of public health importance to guide research, development and strategies to prevent and control antimicrobial resistance. Geneva: World Health Organization; 2024. Disponível em: https://www.who.int/publications/i/item/9789240093461 Acesso em: 29 ago. 2024.

OMS - ORGANIZAÇÃO MUNDIAL DE SAÚDE. Incentivising the development of new antibacterial treatments 2023. [S. l.]: Global AMR R&D Hub & WHO, 2023. Disponível em: https://cdn.who.int/media/docs/default-source/antimicrobial-resistance/amr-gcp-irc/incentivising-development-of-new-antibacterial-treatments-2023---progress-report.pdf?sfvrsn=72e4f738_3 Acesso em: 11 mai. 2024.

PARDO-FREIRE, M.; DOMINGO-CALAP, P. Phages and Nanotechnology: New Insights against Multidrug-Resistant Bacteria. Biodesingn Research, [S. l.], v.5, p. 1-13, jan, 2023. Disponível em: https://pmc.ncbi.nlm.nih.gov/articles/PMC10521656/ Acesso em: 16 dez. 2024 DOI: https://doi.org/10.34133/bdr.0004 DOI: https://doi.org/10.34133/bdr.0004

PELFRENE, E. et al. Bacteriophage therapy: a regulatory perspective. Journal of Antimicrobial Chemotherapy, [S. l.], v. 71, n. 8, p. 2071-2074, ago.2016. DOI: https://doi.org/10.1093/jac/dkw083 Disponível em: https://academic.oup.com/jac/article/71/8/2071/2237822?login=false Acesso em: 20 set. 2024. DOI: https://doi.org/10.1093/jac/dkw083

PIRNAY, J. et al. Personalized bacteriophage therapy outcomes for 100 consecutive cases: a multicentre, multinational, retrospective observational study. Nature Microbiology, [S. l.], v. 9, p. 1434-1453, jun. 2024. DOi: https://doi.org/10.1038/s41564-024-01705-x Disponível em: https://www.nature.com/articles/s41564-024-01705-x Acesso em: 20 set. 2024.

PIRNAY, J. Phage Therapy in the Year 2035. Frontiers Microbiology, [S. l.], v. 11, n. 1171, jun. 2020. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7284012/ Acesso em: 14 out. 2024 DOI: https://doi.org/10.3389/fmicb.2020.01171 DOI: https://doi.org/10.3389/fmicb.2020.01171

RODRIGUEZ, J. M. et al. Case Report: successful use of phage therapy in refractory MRSA chronic rhinosinusitis. International Journal of Infectious Diseases, [S. l.], v. 121, p. 14-16, ago. 2022. Disponível em: https://www.ijidonline.com/article/S1201-9712(22)00247-8/fulltext Acesso em: 18 set. 2024 DOI: https://doi.org/10.1016/j.ijid.2022.04.049 DOI: https://doi.org/10.1016/j.ijid.2022.04.049

RUBALSKII, E. et al. Bacteriophage Therapy for Critical Infections Related to Cardiothoracic Surgery. Antibiotics (Basel), [S. l.], v.9, n. 5:232, mai. 2020. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7277081/ Acesso em: 28 ago. 2024 DOI: https://doi.org/10.3390/antibiotics9050232 DOI: https://doi.org/10.3390/antibiotics9050232

SABINO, Y. N. V. et al. Characterization of antibiotic resistance genes in the species of the rumen microbiota. Nature Comumunications, [S. l.], v. 10, n. 5252, p. 1-11, nov. 2019. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6868206/ Acesso em: 01 mai. 2024 DOI: https://doi.org/10.1038/s41467-019-13118-0 DOI: https://doi.org/10.1038/s41467-019-13118-0

SARKER, S. A. et al. Oral Phage Therapy of Acute Bacterial Diarrhea With Two Coliphage Preparations: A Randomized Trial in Children From Bangladesh. eBioMedicine, [S. l.], v. 4, p. 124-137, feb. 2016. Disponível em: https://pubmed.ncbi.nlm.nih.gov/26981577/ Acesso em: 20 set. 2024 DOI: https://doi.org/10.1016/j.ebiom.2015.12.023 DOI: https://doi.org/10.1016/j.ebiom.2015.12.023

SARKER, S. A. et al. Oral T4-like phage cocktail application to healthy adult volunteers from Bangladesh. Virology, [S. l.], v 434, n. 2, p. 222-232, jan. 2012. Disponível em: https://www.sciencedirect.com/science/article/pii/S0042682212004436?pes=vor Acesso em: 20 set. 2024 DOI: https://doi.org/10.1016/j.virol.2012.09.002 DOI: https://doi.org/10.1016/j.virol.2012.09.002

SLOPEK, S. et al. Results of bacteriophage treatment of suppurative bacterial infections. III. Detailed evaluation of the results obtained in further 150 cases. Archivum Immunologiae et Therapiae Experimentalis (Warsz), [S. l.], v. 32, n. 3, p. 317-335, 1984. Disponível em: https://pubmed.ncbi.nlm.nih.gov/6395825/ Acesso em: 14 out. 2024.

SLOPEK, S. et al. Results of bacteriophage treatment of suppurative bacterial infections. IV. Evaluation of the results obtained in 370 cases Archivum Immunologiae et Therapiae Experimentalis (Warsz), [S. l.], v. 33, n. 2, p. 219-240, 1985. Disponível em: https://pubmed.ncbi.nlm.nih.gov/2935115/ Acesso em: 14 out. 2024.

SLOPEK, S. et al. Results of bacteriophage treatment of suppurative bacterial infections. V. Evaluation of the results obtained in children. Archivum Immunologiae et Therapiae Experimentalis (Warsz), [S. l.], v. 33, n. 2, p. 219-240, 1985. Disponível em: https://pubmed.ncbi.nlm.nih.gov/2935116/ Acesso em: 14 out. 2024.

SLOPEK, S. et al. Results of bacteriophage treatment of suppurative bacterial infections. VI. Analysis of treatment of suppurative staphylococcal infections. Archivum Immunologiae et Therapiae Experimentalis (Warsz), [S. l.], v. 33, n. 2, p. 261-273, 1985. Disponível em: https://pubmed.ncbi.nlm.nih.gov/2935117/ Acesso em: 14 out. 2024.

SMOLINSKI, M. S.; HAMBURG, M. A.; LEDERBERG, J. Microbial Threats to Health: Emergence, Detection, and Response. Washington: The National Academies Press, 2003. Disponível em: https://www.ncbi.nlm.nih.gov/books/NBK221483/#ddd00042 Acesso em: 28 fev. 2024.

STRATHDEE, S. A. et al. Phage therapy: From biological mechanisms to future directions. Cell, [S. l.], v. 186, n. 1, p. 17-31, jan. 2023. Disponível em: https://www.cell.com/cell/fulltext/S00928674(22)014611?_returnURL=https%3A%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS0092867422014611%3Fshowall%3Dtrue Acesso em: 21 abr. 2024 DOI: https://doi.org/10.1016/j.cell.2022.11.017

SUH, G. A. et al. Considerations for the Use of Phage Therapy in Clinical Practice. Antimicrobial Agents and Chemotheraphy, [S. l.], v. 66, n. 3, mar. 2022. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8923208/ Acesso em: 20 set. 2024 DOI: https://doi.org/10.1128/AAC.02071-21 DOI: https://doi.org/10.1128/aac.02071-21

SUTCLIFFE, S. G; REYES, A.; MAURICE, C. F. Bacteriophages playing nice: Lysogenic bacteriophage replication stable in the human gut microbiota. IScience, [S. l.], v. 26, n. 2, p. 1-14, fev. 2023. DOI: https://doi.org/10.1016/j.isci.2023.106007 Disponível em: https://www.cell.com/iscience/fulltext/S2589-0042(23)00084-6#%20 Acesso em: 11 maio 2024. DOI: https://doi.org/10.1016/j.isci.2023.106007

VIERTEL, T. M.; RITTER, K., HORZ, H. Viruses versus bacteria—novel approaches to phage therapy as a tool against multidrug-resistant pathogens. Journal of Antimicrobial Chemotherapy, [S. l.], v. 69, p. 2326-2336, mai. 2014. Disponível em: https://academic.oup.com/jac/article/69/9/2326/2911275?login=false Acesso em: 18 maio 2024 DOI: https://doi.org/10.1093/jac/dku173 DOI: https://doi.org/10.1093/jac/dku173

WRIGHT, A. et al. A controlled clinical trial of a therapeutic bacteriophage preparation in chronic otitis due to antibiotic-resistant Pseudomonas aeruginosa; a preliminary report of efficacy. Clinical Otolaryngology, [S. l.], v. 34, n. 4 p. 349-457, ago. 2009. Disponível em: https://onlinelibrary.wiley.com/doi/10.1111/j.1749-4486.2009.01973.x Acesso em: 06 set. 2024 DOI: https://doi.org/10.1111/j.1749-4486.2009.01973.x DOI: https://doi.org/10.1111/j.1749-4486.2009.01973.x

Como Citar

Souza, J. C. de, Basilio , M. A. M., & Gonçalves, M. G. (2025). TERAPIA FÁGICA: UMA ABORDAGEM INOVADORA NO TRATAMENTO DE INFECÇÕES POR BACTÉRIAS RESISTENTES. RECIMA21 - Revista Científica Multidisciplinar - ISSN 2675-6218, 6(2), e626264. https://doi.org/10.47820/recima21.v6i2.6264