Antibiotic Resistance in Children Is Rising Globally, New Study Warns

Antibiotic resistance in children is increasing globally, with some critical bacteria projected to see steep increases in resistance by 2035. According to a study published in July in the journal JAMA Pediatrics, this trend poses a significant threat to pediatric health, as antibiotic resistance contributed to an estimated 840,000 deaths among children under 5 in 2021.

Researchers from the Murdoch Children’s Research Institute (MCRI) analyzed over 106,000 bacterial samples collected between 2004 and 2022. The data, sourced from the Antimicrobial Testing Leadership and Surveillance database, included children and teens ages 0 to 18 across 82 countries, including the U.S., U.K., Malawi, and Uganda.

The analysis found that resistance rates were highest in intensive care units, in children under 3 with the most severe infections, and in resource-limited settings. While the study describes these projections as warning scenarios rather than inevitable outcomes, Dr. Yanhong Jessika Hu, a clinical epidemiologist and public health researcher at MCRI, told Live Science that the trajectories assume historical patterns continue without major intervention.

Trends in Antibiotic Resistance by Drug Category

The study categorized antibiotics using the World Health Organization’s Access, Watch, Reserve (AWaRe) system. This system distinguishes between first-choice drugs (Access), selective treatments for resistant infections (Watch), and last-resort options (Reserve).

Resistance to Access antibiotics declined in high-income countries, dropping from 48% to 29% among eight critical bacteria between 2004 and 2022. In contrast, resistance to these same drugs rose slightly from 44% to 47% in low-income settings. Dr. Penelope Bryant, a clinician-researcher at MCRI, Royal Children’s Hospital Melbourne, and the University of Melbourne, attributed the decline in wealthier nations to significant investments in controlling methicillin-resistant Staphylococcus aureus (MRSA).

Resistance to more potent drugs showed a sharper upward trend. Between 2004 and 2022, resistance to Watch antibiotics rose from 14% to 24% in high-income countries and from 16% to 48% in low-income nations. Resistance to Reserve drugs increased from 9% to 25% in high-income countries and from 4% to 37% in low-income settings.

The research team predicts that while Access antibiotic resistance may stabilize or decline by 2035, resistance to Watch antibiotics will continue to increase.

Factors Driving Pediatric Resistance

The study highlights a lack of visibility regarding antibiotic resistance in children compared to adults. Dr. Bryant told Live Science that the problem is often perceived as lesser in children, partly because pediatric data is frequently combined with adult data, which obscures specific pediatric trends.

This data gap is critical because children have different infection patterns and fewer antibiotic treatment options than adults. Dr. Hu noted that the lack of granular data hinders the development of specific clinical protocols or policy changes to protect these limited treatment options.

In low-income regions, the crisis is amplified by poor sanitation and unregulated access to antibiotics. Dr. Bryant stated that easy over-the-counter access to these medicines leads to misuse, which pressures bacteria to evolve resistance.

Study Limitations and Future Research

The researchers acknowledged that the samples collected from each country may not be representative of entire national populations, as they came from specific participating medical centers. Dr. Hu cautioned that the results should not be interpreted as precise national prevalence estimates.

Despite these limitations, Dr. Bryant described the analysis as the first large dataset to focus specifically on children. The research team has made the analysis available via the AMR in Kids website to assist other researchers.

Future research goals include surveying resistant infections in children using more representative methods and modeling how specific intervention strategies could reduce resistance rates.

It’s not a theoretical problem; it’s real, and it’s happening. But I think the visibility is just substantially less than in adults.
Dr. Penelope Bryant