Antimicrobial resistance in children is increasing globally and is expected to worsen over the next decade, threatening the effectiveness of life-saving antibiotics, according to a new monitoring platform announced on July 20.
The findings come from research led by Murdoch Children's Research Institute in collaboration with the University of Sydney, Clinton Health Access Initiative, and The Chinese University of Hong Kong. The study analyzed more than 106,000 infection samples from children up to 18 years old across 82 countries and found that antibiotic resistance increased in every region between 2004 and 2022. Babies and children in intensive care, as well as those living in countries with fewer healthcare resources, were most affected.
Published in JAMA Pediatrics, the research identified Gram-negative bacteria responsible for severe infections such as sepsis and pneumonia as major drivers of this trend. Resistance rose most sharply to critical 'Watch' and 'Reserve' antibiotics—categories classified by the World Health Organization to limit overuse when first-line treatments fail. Associate Professor Penelope Bryant said these findings highlight "a widening gap between recommended antibiotic use and real-world effectiveness," emphasizing an urgent need for improved surveillance, targeted antimicrobial stewardship, and better access to effective antibiotics for children.
The newly launched AMR in Kids website allows clinicians, researchers, and policymakers to explore antibiotic resistance data by country, bacteria type, or antibiotic class. It also provides forecasts through 2035 intended to help identify emerging threats and inform public health planning. Dr. Yanhong Jessika Hu said combining nearly two decades of global data with forecasting enables identification of where resistance may emerge before it becomes a greater clinical challenge.
The research found that Acinetobacter baumannii showed the highest overall resistance among Gram-negative bacteria globally while Klebsiella recorded the fastest increase—particularly in Southeast Asia, Eastern Europe, and the Western Pacific—with projections indicating substantial rises in carbapenem antibiotic resistance by 2035. Associate Professor Joseph Harwell said, "Better data is essential, but children can't wait for perfect data. We need to use the best available evidence to guide action now." Bryant also noted that despite unique treatment challenges faced by children, they have been overlooked in global surveillance efforts: "Making antibiotic resistance in children visible...is the first step towards changing its trajectory." She called for more targeted action both globally and specifically toward pediatric populations.
A case highlighted was Harry—a child born with kidney failure who has relied on antibiotics much of his life—whose mother Eileen said: "Antibiotic resistance is quite alarming...it means there are a lot of things that are off the table for him." She added that tools like AMR in Kids could help transform prescribing practices and improve understanding about antimicrobial resistance.
