Combining Phages with Antibiotics as a Therapeutic Strategy for Managing Pseudomonas aeruginosa Pulmonary Infections: A Narrative Review of Preclinical and Clinical Evidence

Pseudomonas aeruginosa is an opportunistic Gram-negative bacillus responsible for several infectious conditions, including ventilator-associated pneumonia, acute pneumonia, and chronic pulmonary infections. The emergence and spread of antibiotic-resistant strains represent a major public health concern, particularly in severe and difficult-to-treat infections. Phage therapy combined with antibiotics has shown promising results against antibiotic-resistant strains of P. aeruginosa. In this review, we searched four databases (Academic Search Premier, Medline/PubMed, Scopus, and Web of Science) for preclinical and clinical in vivo studies that evaluated combined phage–antibiotic therapy for the treatment of P. aeruginosa pulmonary infections. The evidence suggests enhanced antimicrobial effects, greater efficacy in reducing bacterial loads and reversal of antibiotic resistance. However, substantial methodological heterogeneity limits direct comparisons across studies. The lack of standardized protocols and guidelines are significant obstacles to the clinical translation of combined phage–antibiotic therapy. Therefore, the development of standardized methodologies and guidelines that could be applied to the biological specificities of bacteriophages are essential to strengthen this therapeutic strategy and facilitate its broader adoption in clinical practice.