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Peer-reviewedCC BY-NCBreathe (Sheffield, England)

Phage therapy for nontuberculous mycobacterial pulmonary disease: a scoping review.

  • Mafalda Pais1,2
  • Rita Santos Martins3,2
  • Andreia Andrade4,2
  • Catarina Giesta5
  • Margarida Cruz6
  • Catarina Hilário6
  • Mariana Vieira7,8,9
  • João Pedro Ramos7,8,9
  • Raquel Duarte7,8,10,9
10 affiliations
  1. 1Serviço de Pneumologia, Unidade Local de Saúde Gaia/Espinho, Vila Nova de Gaia, Portugal.
  2. 2Equal contribution as first authors.
  3. 3Serviço de Pneumologia, Unidade Local de Saúde da Região de Leiria, Leiria, Portugal.
  4. 4Serviço de Pneumologia, Unidade Local de Saúde da Região de Aveiro, Aveiro, Portugal.
  5. 5Serviço de Pneumologia, Centro Hospitalar Médio Tejo, Torres Novas, Portugal.
  6. 6Serviço de Pneumologia, Unidade Local de Saúde de Trás-os-Montes e Alto Douro, Vila Real, Portugal.
  7. 7EPIUnit ITR, Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal.
  8. 8Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Universidade do Porto, Porto, Portugal.
  9. 9Equal contribution as last authors.
  10. 10Instituto Nacional de Saúde Dr. Ricardo Jorge (INSA Porto), Porto, Portugal.
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Abstract

Background

Nontuberculous mycobacteria (NTM) comprise a diverse group of organisms that can cause pulmonary and extrapulmonary disease. Their management is challenging, because many NTM species exhibit intrinsic antimicrobial resistance; current multidrug treatment regimens have limited efficacy and tolerability; and the number of immunocompromised individuals at risk of NTM disease is increasing. Phage therapy has recently emerged as a potential therapeutic option for refractory NTM pulmonary disease (NTM-PD). This scoping review aimed to map and critically assess the existing evidence on the clinical use of phage therapy for NTM-PD and its reported outcomes.Methods

PubMed, SCOPUS, Web of Science and Embase were searched for studies published between August 2015 and August 2025, in any language, addressing phage therapy in NTM-PD. Additional backward and forward citation searches were conducted to identify further relevant studies.Results

Five studies met the inclusion criteria: four single-patient case reports and one small case series representing 20 unique patients treated with phage therapy. Of these, 18 had pulmonary NTM disease, mostly involving drug-resistant Mycobacterium abscessus infections treated under compassionate-use protocols or individualised regimens. Reported clinical and microbiological outcomes were inconsistent: some patients showed transient improvement or culture conversion, while others had no measurable benefit. Phage resistance was uncommon but incompletely assessed, and immune-mediated neutralisation emerged as a future concern. No serious adverse events were described.Conclusions

Current evidence supports the feasibility but not the efficacy of phage therapy for NTM-PD. Published data are limited to isolated, heterogeneous cases and lack standardised definitions or controlled comparisons. Well-designed, prospective clinical trials are needed to clarify its therapeutic potential and optimise future application.

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Cite

BibTeXRIS
BibTeX
@article{pais2026phage,
  title = {{Phage therapy for nontuberculous mycobacterial pulmonary disease: a scoping review.}},
  author = {Mafalda Pais and Rita Santos Martins and Andreia Andrade and Catarina Giesta and Margarida Cruz and Catarina Hilário and Mariana Vieira and João Pedro Ramos and Raquel Duarte},
  journal = {Breathe (Sheffield, England)},
  year = {2026},
  month = oct,
  doi = {10.1183/20734735.0054-2026},
  url = {https://europepmc.org/article/MED/43011913},
  note = {CC BY-NC},
}
RIS
TY  - JOUR
TI  - Phage therapy for nontuberculous mycobacterial pulmonary disease: a scoping review.
AU  - Mafalda Pais
AU  - Rita Santos Martins
AU  - Andreia Andrade
AU  - Catarina Giesta
AU  - Margarida Cruz
AU  - Catarina Hilário
AU  - Mariana Vieira
AU  - João Pedro Ramos
AU  - Raquel Duarte
PY  - 2026
DA  - 2026/10/01
JO  - Breathe (Sheffield, England)
DO  - 10.1183/20734735.0054-2026
UR  - https://europepmc.org/article/MED/43011913
AB  - Background  Nontuberculous mycobacteria (NTM) comprise a diverse group of organisms that can cause pulmonary and extrapulmonary disease. Their management is challenging, because many NTM species exhibit intrinsic antimicrobial resistance; current multidrug treatment regimens have limited efficacy and tolerability; and the number of immunocompromised individuals at risk of NTM disease is increasing. Phage therapy has recently emerged as a potential therapeutic option for refractory NTM pulmonary disease (NTM-PD). This scoping review aimed to map and critically assess the existing evidence on the clinical use of phage therapy for NTM-PD and its reported outcomes.Methods  PubMed, SCOPUS, Web of Science and Embase were searched for studies published between August 2015 and August 2025, in any language, addressing phage therapy in NTM-PD. Additional backward and forward citation searches were conducted to identify further relevant studies.Results  Five studies met the inclusion criteria: four single-patient case reports and one small case series representing 20 unique patients treated with phage therapy. Of these, 18 had pulmonary NTM disease, mostly involving drug-resistant Mycobacterium abscessus infections treated under compassionate-use protocols or individualised regimens. Reported clinical and microbiological outcomes were inconsistent: some patients showed transient improvement or culture conversion, while others had no measurable benefit. Phage resistance was uncommon but incompletely assessed, and immune-mediated neutralisation emerged as a future concern. No serious adverse events were described.Conclusions  Current evidence supports the feasibility but not the efficacy of phage therapy for NTM-PD. Published data are limited to isolated, heterogeneous cases and lack standardised definitions or controlled comparisons. Well-designed, prospective clinical trials are needed to clarify its therapeutic potential and optimise future application.
SN  - 1810-6838
SN  - 2073-4735
ER  -