In the past 20 years, an increasing number of bacterial infections caught by children have become resistant to antibiotics, a massive new global study has found. Consequently, experts are warning that this silent pandemic could cause even more deaths among young children if urgent action is not taken.
The research, published in July in the prestigious journal JAMA Pediatrics, looked back at the past two decades and also looked forward to predict how resistance rates might change in the next decade. By 2035, some critical antibiotics will face “steep increases” in resistance among common bacteria such as Acinetobacter baumannii and Klebsiella, the analysis found.
How Big Is The Threat For Children?
Antibiotic resistance contributed to an estimated 840,000 deaths among children under 5 in 2021 alone, according to global estimates. Therefore, if resistance continues to increase at its current pace, that devastating number could grow significantly higher in the coming years.
“These forecasts are warning scenarios, not inevitable outcomes,” said study co-author Dr. Yanhong Jessika Hu, a clinical epidemiologist at Murdoch Children’s Research Institute in Australia. “The projections broadly assume that historical patterns continue without a major change in direction,” Hu told Live Science. If significant global action is taken now, that dangerous trajectory could still be altered, she emphasized.
Why Has This Crisis in Children Been Hidden?
Antibiotic resistance is sometimes called “a silent pandemic” because it poses a formidable threat without stirring as much public concern as viral outbreaks. However, resistance has gained attention recently, but data on how it has specifically affected children remains patchy, said co-author Dr. Penelope Bryant.
“It’s perceived as being a lesser problem in children,” Bryant told Live Science. “It’s not a theoretical problem; it’s real, and it’s happening. But I think the visibility is just substantially less than in adults.”
That lack of visibility exists partly because many resistance-tracking efforts combine adult and pediatric data, and adult data ends up obscuring specific trends in children. Adult findings cannot simply be applied to children because children have different infection patterns, antibiotic exposure, and treatment options. Meanwhile, studies aimed only at children tend to vary widely in age groups and clinical settings, making direct comparisons difficult. Children also have far fewer antibiotic options than adults at baseline, which makes preserving those existing options even more critical for survival.
How Was This Massive Global Study Conducted?
To help fill this critical data gap, researchers turned to the Antimicrobial Testing Leadership and Surveillance database, which contains clinical samples from children and teens ages 0 to 18 across 82 countries. These bacterial samples were collected between 2004 and 2022 from hospital wards, intensive care units, and outpatient clinics.
The analysis included over 106,000 bacterial samples and assessed which antibiotics these germs were resistant to. The antibiotics were grouped using the World Health Organization’s AWaRe system: Access, Watch, and Reserve. Access antibiotics target few bacteria and are recommended as first choice for most infections. Watch antibiotics have broader effects and should be used selectively for more resistant infections. Reserve antibiotics are considered last-resort options when all alternatives have failed.
“Resistance increased across all regions, showing that this is not only a problem in lower-income countries,” Hu said. “However, the highest resistance levels and some of the steepest increases were seen in lower-resource settings.”
What Did The Study Find About Access, Watch and Reserve Drugs?
Part of the analysis zoomed in on eight bacteria that are considered “critical” or “high” priority by the WHO. Across these germs, resistance rates were similar across high and low-income countries in 2004, but those trends diverged sharply by 2022.
Overall, resistance to Access antibiotics declined across the study period, but that improvement was not equal everywhere. In high-resource countries, resistance to Access drugs fell from 48% to 29% among the eight bacteria, while it rose slightly from 44% to 47% in low-income settings.
The decline seen in wealthy nations is “almost certainly because of the large investment that high-income countries have put into controlling MRSA,” Bryant said, referencing methicillin-resistant Staphylococcus aureus.
However, the news was far worse for stronger antibiotics. Resistance to Watch antibiotics rose from 14% to 24% in high-income countries and from 16% to 48% in low-income nations between 2004 and 2022. Resistance to last-resort Reserve drugs also increased dramatically, rising from 9% to 25% in high-income countries and from 4% to 37% in low-income ones.
Modeling future trends, the team predicts that Watch resistance will continue to see steep increases by 2035, driven largely by low-income settings, but high-income settings will not be spared.
Analysis: Why Are Low-Income Countries Hit Hardest?
“With low-income countries, the problem is amplified because of poor sanitation and because of unregulated access to antibiotics,” Bryant noted. Easy access to over-the-counter antibiotics makes misuse more likely, which ultimately pressures more bacteria to evolve resistance.
The analysis gives the first truly large-scale snapshot of how antibiotic resistance is affecting kids now and how it might evolve. However, the data has limitations, as samples came from only certain medical centers and are not fully representative of entire nations.
“But it’s the first large dataset, really, to look specifically at children,” Bryant said. “And it gives us an idea that things are getting worse.”
The team has made their analysis freely available to other researchers on the website AMR in Kids.
Q&A
Q: How many children die from antibiotic resistance each year?
A: Global estimates suggest antibiotic resistance contributed to 840,000 deaths among children under 5 in 2021 alone, making it a leading hidden killer of young children worldwide.
Q: Which bacteria are becoming most resistant in kids?
A: The study predicts steep increases by 2035 in resistance among WHO critical priority bacteria like Acinetobacter baumannii and Klebsiella, which cause severe hospital infections.
Frequently Asked Questions [FAQ]
1. What is antibiotic resistance in children?
Antibiotic resistance occurs when bacteria evolve to survive antibiotics, making common childhood bacterial infections harder to treat and increasing the risk of severe complications and death.
2. Why is antibiotic resistance rising faster in low-income countries?
It rises faster due to poor sanitation, overcrowded hospitals, lack of clean water, and unregulated over-the-counter sales of antibiotics that lead to overuse and misuse in children.
3. What are Access, Watch, and Reserve antibiotics?
The WHO classifies antibiotics into Access (first-line, low resistance risk), Watch (broader, use selectively), and Reserve (last-resort for highly resistant infections) to guide responsible use.
4. How can parents help prevent antibiotic resistance in kids?
Parents should avoid demanding antibiotics for viral colds, complete prescribed courses as directed, practice good hygiene, ensure vaccinations are up to date, and never use leftover antibiotics.
Final Word: This massive 20-year study is a wake-up call that antibiotic resistance is not just an adult problem. Without coordinated global action, the antibiotics we rely on to save children today may fail them tomorrow.
Disclaimer: This article is for informational purposes only and does not constitute medical advice. Consult a healthcare professional for diagnosis and treatment.
