Bacteriophage therapy and antimicrobial resistance: a scoping review using the "One Health" framework.

purposeAntimicrobial resistance (AMR) represents a growing challenge across human, animal, and environmental health sectors. Bacteriophage therapy is a potential strategy against methicillin-resistant Staphylococcus aureus (MRSA), one of the most significant contributors to AMR-associated morbidity and mortality globally. One Health promotes coordinated action across sectors to address AMR. This scoping review directly compares the therapeutic potential of bacteriophage therapy to antibiotic treatment for MRSA infections using bacterial load as the primary outcome measure and examines the implications of these findings within a One Health framework for combatting AMR.

methodsPubMed, CINAHL, and Scopus were searched for articles published from 2010 to 2026. Inclusion criteria were studies comparing bacteriophage therapy with antibiotics regimens for MRSA infections and reporting quantifiable bacterial load outcomes.

resultsOut of 2,160 articles identified, 29 met the inclusion criteria. Nine studies demonstrated significant bacterial load reduction with phages compared to antibiotics alone; 20 did not demonstrate phage superiority, and 19 demonstrated possible synergistic and/or additive bacterial load reduction when phages were combined with antibiotics.

conclusionPhages show promise as both monotherapy and adjunctive treatment for resistant MRSA infections, with phage-antibiotic combination therapy demonstrating superior outcomes in the majority of studies. Heterogeneity in infection models and phage selection limits direct comparisons across studies. No included studies explicitly addressed One Health. This highlights an important gap in the literature. While integration using a One Health framework is theoretically promising, further clinical investigations are needed to clarify the role of phage therapy within One Health strategies addressing AMR.