A global analysis spanning 82 countries has found that antibiotic resistance in children is increasing in every region, leaving young patients vulnerable to common infections. The study, led by Murdoch Children's Research Institute (MCRI) in collaboration with the University of Sydney, analysed 106,581 infection samples from children up to 18 years old collected between 2004 and 2022.
Rising resistance across all regions
The research, published in the Journal of the American Medical Association, revealed that resistance to antibiotics increased in all regions over the study period. Babies and children in intensive care, as well as those in countries with fewer healthcare resources, are most affected. Severe infections such as sepsis and pneumonia are driving the increase, particularly caused by Acinetobacter baumannii, a bacterium with a tough double-membrane that showed the highest level of drug resistance.
Fastest-growing resistance in Klebsiella
Another bacterium, Klebsiella, which commonly causes urinary tract infections and liver abscesses, recorded the fastest increase in resistance, especially in south-east Asia, eastern Europe, and the western Pacific. Statistical modelling by the researchers projects that resistance to last-line antibiotics will rise substantially by 2035, reaching 82% for Acinetobacter baumannii and 35% for Klebsiella.
Impact on children like Harry Booth
Harry Booth, a 13-year-old from Australia, exemplifies the challenge. Born with kidney failure, he received a kidney transplant at age four and now takes immunosuppressive medications. He has been in and out of hospital with chest and urinary tract infections that are resistant to several commonly used antibiotics. His mother, Eileen, said, 'People are already starting to understand the long-term effects of antibiotics, but there is a long way to go with education around resistance.'
Children overlooked in research
Co-author Associate Professor Penelope Bryant from MCRI, who also treats Harry, noted that children have been largely overlooked in global antibiotic resistance surveillance and research. 'We are finding antibiotic resistance not just in severe diseases but in more simple, uncomplicated infections such as urinary tract infections in children,' she said. The lack of child-friendly antibiotic formulations and clear dosing guidelines is partly due to reluctance to run trials on children and lower profitability for pharmaceutical companies.
New online tool to track resistance
To address this, Bryant and colleagues launched a website called AMR in Kids, providing region and pathogen-specific forecasts to 2035. The tool aims to help identify emerging threats, inform treatment decisions, and guide planning and research. Paediatrician Professor Chris Blyth, incoming president of the Australasian Society for Infectious Diseases, described the work as 'really important' and highlighted the need for global surveillance systems.
Disparities between high- and low-income countries
The study found that in low-income countries, unregulated antibiotic use and poor sanitation drive resistance, making access to diagnostics and first-line antibiotics a priority. In high-income countries, overuse in farming, veterinary care, and healthcare fuels drug resistance. While treatments for resistant infections are rare in high-income countries, drug-resistant infections are a leading cause of death in children under five in low-income nations.
WHO antibiotic classification and trends
The World Health Organization classifies antibiotics into 'access' (first-line), 'watch' (broader use, higher resistance risk), and 'reserve' (last-resort). The study found that first-line access resistance is declining or stabilising in high-income regions, but lower-resource settings are seeing a sharp rise in resistance to watch and reserve drugs. 'I'm frequently seeing children with difficult-to-treat infections resistant to first and second-line agents, where I have to reach for agents that are more difficult to get, more expensive, and potentially more toxic,' Blyth said.
