April 14, 2025, 11:46 am | Read time: 5 minutes

Every use of antibiotics promotes the development of resistance because, while sensitive bacteria are killed, resistant ones survive and multiply. If treatment with antibiotics becomes ineffective, it can be dangerous, as some diseases become harder to treat.¹ Children are also affected, and antibiotic resistance can even be fatal. This was highlighted by a study from 2023, which was presented again at the ESCMID Global 2025.

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Research on Resistance in Children Has Been Incomplete

Antimicrobial resistance (AMR) is one of the greatest global health threats–especially for children, who are more susceptible to infections due to their immature immune systems. However, research on antimicrobial resistance in children has been incomplete. This study aimed to fill this knowledge gap and systematically capture global trends and patterns of antibiotic resistance in children.

Also interesting: By 2050, 39 million deaths are expected to be attributed to antibiotic resistance

Analysis of More Than 100,000 Child Data

The researchers conducted a retrospective data analysis using the Vivli platform–an international database of clinical study data.² The analysis was based on 858,233 bacterial isolates from 83 countries over 18 years, including 101,661 from children. Antibiotics were classified according to the WHO AWaRe system:

• “Access” antibiotics are first-line agents with low resistance potential
• “Watch” antibiotics have a higher resistance risk
• “Reserve” antibiotics are considered the last treatment option for multidrug-resistant infections.

Using scientific statistical methods, the data was then analyzed. The goal was to reveal global and regional developments, identify genetic resistances, and model potential future scenarios. The study provides a crucial basis for targeted strategies to curb antimicrobial resistance in childhood.

Dramatic Increase in Antibiotic Resistance in Children

The analysis of over 100,000 child isolates revealed alarming trends: Increasing resistance was found particularly in gram-negative bacteria such as Klebsiella pneumoniae, Escherichia coli, Enterobacter cloacae, and Acinetobacter baumannii against “Watch” and “Reserve” antibiotics. Resistance to cephalosporins also increased.

Regionally, particularly high resistance rates were observed in low- and middle-income countries, although comparatively fewer data were available from these regions. Forecasts suggest that resistance to “Watch” antibiotics in the mentioned pathogens could increase by more than 50 percent in the next ten years, and by more than 25 percent for “Reserve” antibiotics–unless countermeasures are taken.

What Do the Results Mean?

The study highlights the growing threat of antibiotic-resistant infections in children–with already dramatic consequences: In 2022, more than 3 million children worldwide died from complications related to antimicrobial resistance, including 752,000 in Southeast Asia and 659,000 in Africa. Particularly concerning is the massive increase in the use of “Watch” antibiotics:

• Increase of 160 percent in Southeast Asia
• Increase of 126 percent in Africa

A dramatic increase was also observed in “Reserve” antibiotics:

• Increase of 45 percent in Southeast Asia
• Increase of 125 percent in Africa

These reserve drugs are actually intended only for the most severe, multidrug-resistant infections. However, their excessive use promotes the development of resistant pathogens and reduces the long-term effectiveness of vital medications. Structural problems such as overcrowded hospitals, poor hygiene, and lack of monitoring systems have a particularly strong impact in low-income regions.

“The increased use of Watch-and-Reserve antibiotics may be necessary given the simultaneous increase in drug-resistant infections, but the sharp rise in these medications also poses serious long-term risks. Their increased use, especially without careful monitoring, raises the risk of resistance and limits future treatment options. If bacteria develop resistance to these antibiotics, there are few alternatives for treating multidrug-resistant infections,” emphasizes Professor Joseph Harwell, co-author of the study, highlighting the danger.³ “The already alarmingly high mortality rates will continue to rise significantly, especially in low- and middle-income countries, where access to alternative treatments and advanced medical interventions may be limited.”

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Global Forecast A Third of Children and Young People Will Be Overweight in 2050

Study shows By 2050, 39 million deaths are expected to be attributable to antibiotic resistance

Study Classification and Possible Limitations

“At the regional level, we urge policymakers to mandate hospital-based antibiotic management programs in all pediatric health facilities. Improved age classifications in surveillance data will also enhance our understanding of important differences in resistance rates between age groups and pediatric resistance mechanisms. Furthermore, we advocate for the implementation of national guidelines to ensure that routine monitoring influences antibiotic use,” concludes Professor Harwell. He emphasizes that the study has high significance due to its large data size and long duration of 18 years.

However, there are also limitations: The data from low-income countries was incomplete, making regional comparisons difficult. Additionally, this is an observational study–causal relationships cannot be derived from it. The collection of isolates was partly heterogeneous, and not all countries had national surveillance programs. Despite these limitations, the study provides crucial impetus for a realignment of the global resistance strategy in childhood.

Conclusion

This study emphatically shows that antibiotic resistance in children is an acute global health crisis–especially in poorer regions. The increase in multidrug-resistant pathogens and the overuse of critical reserve antibiotics require rapid, internationally coordinated action. This includes comprehensive monitoring systems, mandatory antibiotic programs in children’s hospitals, and age-appropriate data collection. Only through consistent measures can we prevent resistance-related child deaths from continuing to rise–and the effectiveness of life-saving medications from being permanently lost.