MORE than 3 million children worldwide died from antimicrobial resistance (AMR)-related infections in 2022, according to a landmark study presented at ESCMID Global 2025, highlighting the urgent need for targeted action to curb AMR in paediatric populations.
Researchers conducted a comprehensive global analysis of paediatric AMR data, examining regional usage patterns of antibiotics and associated mortality. The study evaluated antibiotic use categorised by WHO’s Access, Watch, and Reserve classifications and linked these trends to child mortality in various world regions. Special attention was given to Southeast Asia and Africa, where the burden of resistance-related deaths was highest, alongside analysis of healthcare infrastructure, antibiotic availability, and surveillance capacity.
The findings revealed that 2 million of the over 3 million paediatric AMR-related deaths were linked to Watch and Reserve antibiotics, classes of drugs intended for limited use due to their high resistance potential. Southeast Asia and Africa recorded the highest paediatric mortality, with 752,000 and 659,000 deaths respectively. Between 2019–2021, Watch antibiotic use increased by 160% in Southeast Asia and 126% in Africa, while Reserve antibiotic use rose by 45% and 125% respectively in the same regions. The African and Southeast Asian regions also showed the highest number of deaths linked to these high-risk antibiotics, surpassing all other WHO regions.
The authors warned that the expanding use of Watch and Reserve antibiotics, while sometimes necessary, poses significant risks without careful stewardship. Much of the AMR mortality burden is attributed to antibiotic overuse, poor sanitation, limited diagnostics, and underdeveloped antimicrobial surveillance systems in low- and middle-income countries. Hospitals in these settings often struggle with overcrowding and infection control, accelerating the spread of resistant pathogens.
Urgent, coordinated action is now essential to prevent further escalation of AMR-related child mortality. Improved surveillance, stewardship, and paediatric-specific treatment protocols must be prioritised globally, particularly in high-burden regions.
Reference
Hu Y et al. Global trends and impact of antimicrobial resistance in paediatric populations: an analysis using WHO AWaRe classification and priority pathogens. ESCMID Global 2025, 11-15 April, 2025.
