Global antibiotic resistance rates in children have increased significantly from 2004 to 2022, rendering many first-line treatments ineffective and increasingly threatening second-line and last-resort options, according to a study published in JAMA Pediatrics. Researchers analyzing more than 100,000 bacterial isolates collected from children globally between 2004 and 2022 found that more than a third were resistant to at least one first-line antibiotic, highlighting a growing crisis in pediatric care.
The Scope of Pediatric Antibiotic Resistance
The study examined 106,581 bacterial isolates from pediatric patients aged zero to 18 across 82 countries. Researchers evaluated resistance trends using the World Health Organization’s Access, Watch, and Reserve classification system.
Overall, resistance peaked at 36% for Access antibiotics, which are first-line, narrow-spectrum drugs recommended for common bacterial infections. Meanwhile, 22% of the isolates showed resistance to Watch antibiotics, and 13% were resistant to Reserve antibiotics. The most frequently identified pathogens across the dataset were Staphylococcus aureus at 19%, Klebsiella species at 11%, and Escherichia coli at 10%.
High-Risk Settings and Vulnerable Groups
Antimicrobial resistance is an acute danger in specific clinical environments and among particular age groups. According to the research team—which included investigators from the Murdoch Children’s Research Institute, the University of Sydney, Brown University, and the Clinton Health Access Initiative—resistance is especially concentrated in intensive care units, among the youngest children, and in resource-limited settings.
While resistance to Access antibiotics declined in most inpatient settings over the study period, it surged for broader-spectrum options. In ICUs, resistance to Watch antibiotics jumped from 15% to 33%, while resistance to Reserve antibiotics climbed from 9% to 32%. Children aged zero to two years, patients with sepsis, and those battling respiratory infections experienced the highest levels of resistance to Watch and Reserve categories.
“There’s really no area of the world that isn’t seeing an increase,” Penelope Bryant, research clinician at the Murdoch Children’s Research Institute and corresponding author of the study, told CIDRAP News. “And it’s going to continue to increase unless we turn it around.”
Regional Disparities and Future Projections
Geographic disparities remain stark, with resistance to all World Health Organization AWaRE categories hitting highest levels in resource-limited regions, including countries in Southeast Asia, Africa, and Central America. In Africa and Southeast Asia, resistance to Reserve antibiotics in Klebsiella species climbed to 33% and 43%, respectively, according to regional data analyzed in the research.
Forecasting models looking toward 2035 indicate that resistance to certain Watch and Reserve antibiotics could worsen further in lower-resource settings if current trajectories hold. Such a shift would leave clinicians with fewer effective treatment options for children suffering from severe conditions like pneumonia, bloodstream infections, and urinary tract infections.
Researchers emphasize that these projections are not guaranteed outcomes. Improved sanitation, expanded vaccination coverage, robust hospital infection control, enhanced diagnostic testing, and responsible antibiotic stewardship can alter the expected path and preserve the efficacy of critical medicines for pediatric patients worldwide.
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