A new analysis presented at ESCMID Global 2025 has revealed a staggering toll of antimicrobial resistance (AMR) on global child health.1 In 2022 alone, more than 3 million paediatric deaths were associated with AMR-related infections worldwide. The study draws attention to the urgent necessity for comprehensive local and international strategies to combat paediatric AMR, particularly in regions such as South-East Asia and Africa, where the burden is disproportionately high.
Children are particularly susceptible to infectious diseases, yet access to newer paediatric-appropriate antibiotic formulations remains limited due to delays in pharmaceutical development. The data highlight that in 2022, over 752,000 children in South-East Asia and approximately 659,000 children in Africa succumbed to complications related to drug-resistant infections. Many of these fatalities were linked to the administration of Watch group antibiotics—agents with a higher likelihood of promoting resistance—and Reserve group antibiotics, which are considered last-line options for treating multidrug-resistant infections.2
According to the World Health Organization (WHO) AWaRe classification, Watch and Reserve antibiotics should be used sparingly to preserve their effectiveness. In contrast, Access antibiotics—those with a lower resistance potential—are recommended as first-line therapies for common infections.3
Alarmingly, the study noted that from 2019 to 2021, the use of Watch antibiotics surged by 160% in South-East Asia and 126% in Africa, while the consumption of Reserve antibiotics rose by 45% and 125% in the respective regions. These trends reflect a concerning over-reliance on critical antimicrobial agents. Of the global paediatric deaths reported in 2022, approximately two million were attributed to the use of Watch and Reserve antibiotics.
Commenting on the findings, study co-author Professor Joseph Harwell emphasized the potential long-term ramifications. "Although increased use of Watch and Reserve antibiotics may reflect the growing threat of resistant infections, unregulated or excessive use elevates the risk of further resistance development and significantly narrows future treatment options," he stated.
In low- and middle-income countries (LMICs), several systemic challenges exacerbate the AMR crisis. Overcrowded hospitals, substandard sanitation, and limited infection control resources allow resistant organisms to proliferate both in healthcare settings and the community. Diagnostic limitations and concerns about under-treatment frequently lead to antibiotic overuse and misuse in these regions.
Moreover, many LMICs lack robust antimicrobial stewardship (AMS) programs and effective national surveillance systems, impairing their ability to monitor AMR trends and guide appropriate antibiotic usage.4 Professor Harwell warned that without significant improvements in antimicrobial management and surveillance, “treatment failure rates will rise, and paediatric mortality—which is already disturbingly high—will continue to increase.”
To address this critical issue, Professor Harwell advocated for a coordinated global response. He urged governments and international stakeholders to adopt a One Health approach—an integrated strategy that considers human, animal, and environmental health—when designing surveillance and intervention programs. He also called for national policies mandating AMS programs in paediatric care facilities and improving surveillance systems with age-specific data to better understand resistance patterns in children.
“National guidelines must ensure that real-time surveillance directly informs prescribing practices,” Harwell concluded. “Without immediate and unified action, the gains of modern medicine in paediatric care may be severely undermined.”
Reference:
- Hu, Y., Harwell, J. Global Trends and Impact of Antimicrobial Resistance in Paediatric Populations: An Analysis Using WHO AWaRe Classification and Priority Pathogens. Oral presentation. ESCMID Global 2025.
- World Health Organization (WHO). (2019). AWaRe Classification Database of Antibiotics. https://www.who.int/medicines/news/2019/antibiotic-awareness-week/aware-classification/en/
- World Health Organization (WHO). (2021). Global Antimicrobial Resistance and Use Surveillance System (GLASS) Report.
- Tängdén, T., & Pulcini, C. (2020). "Antibiotic stewardship: what’s missing?" Clinical Microbiology and Infection, 26(5), 561–562.
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