The use of viruses infecting bacteria (bacteriophages or phages) to treat bacterial infections has been ongoing clinically for approximately 100 years. Despite that long history, the growing international crisis of resistance to standard antibiotics, abundant anecdotal evidence of efficacy, and one successful modern clinical trial of efficacy, this phage therapy is not yet a mainstream approach in medicine. One explanation for why phage therapy has not been subject to more widespread implementation is that phage therapy research, both preclinical and clinical, can be insufficiently pharmacologically aware. Consequently, here we consider the pharmacological obstacles to phage therapy effectiveness, with phages in phage therapy explicitly being considered to serve as drug equivalents. The study of pharmacology has traditionally been differentiated into pharmacokinetic and pharmacodynamic aspects. We therefore separately consider the difficulties that phages as virions can have in traveling through body compartments toward reaching their target bacteria (pharmacokinetics) and the difficulties that phages can have in exerting antibacterial activity once they have reached those bacteria (pharmacodynamics). The latter difficulties, at least in part, are functions of phage host range and bacterial resistance to phages. Given the apparently low toxicity of phages and the minimal side effects of phage therapy as practiced, phage therapy should be successful so long as phages can reach the targeted bacteria in sufficiently high numbers, adsorb, and then kill those bacteria. Greater awareness of what obstacles to this success generally or specifically can exist, as documented in this review, should aid in the further development of phage therapy toward wider use.

中文翻译：

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药理学感知噬菌体疗法：噬菌体在动物和人体中抗菌作用的药效学和药代动力学障碍。

使用感染细菌的病毒（噬菌体或噬菌体）来治疗细菌感染在临床上已经持续了大约 100 年。尽管有着悠久的历史、日益严重的国际标准抗生素耐药性危机、丰富的疗效轶事证据以及一项成功的现代疗效临床试验，但这种噬菌体疗法尚未成为医学的主流方法。噬菌体疗法尚未得到更广泛实施的一种解释是，噬菌体疗法研究（无论是临床前还是临床）的药理学认识不足。因此，在这里我们考虑噬菌体治疗有效性的药理学障碍，噬菌体治疗中的噬菌体明确被视为药物等效物。药理学研究传统上分为药代动力学和药效学两个方面。因此，我们分别考虑噬菌体作为病毒颗粒在穿过身体隔室到达目标细菌（药代动力学）时可能遇到的困难，以及噬菌体一旦到达这些细菌（药效动力学）在发挥抗菌活性方面可能遇到的困难。后者的困难，至少部分是由于噬菌体宿主范围和细菌对噬菌体的抗性的作用。鉴于噬菌体的毒性明显较低，并且噬菌体疗法的副作用最小，只要噬菌体能够以足够多的数量到达目标细菌，吸附并杀死这些细菌，噬菌体疗法就应该是成功的。如本综述所述，更好地认识到一般或具体可能存在的成功障碍可能有助于噬菌体疗法的进一步发展，以实现更广泛的应用。