New research data underscores an urgent need for actions against a mounting antimicrobial resistance (AMR) crisis among children. Over 3 million children tragically lost their lives to infections related to AMR in 2022. Particularly concerning is the escalating deployment of last-resort drugs, indicative of escalating resistance issues. This critical situation calls for immediate global and regional strategies to manage AMR in children.
The research spotlights Southeast Asia and Africa as regions of high concern, accounting for a significant proportion of these infections. Children and infants are especially susceptible to AMR due to their underdeveloped immune systems and limited access to new antibiotic formulations, the latter being a result of delays in the product development cycle.
Prof Joseph Harwell of Brown University’s Warren Alpert Medical School and his research team scrutinized data from Pfizer’s Antimicrobial Testing Leadership and Surveillance (ATLAS) database, along with the Institute for Health Metrics and Evaluation’s Global Burden of Disease Study. Using these sources, they charted AMR-related deaths, antibiotic resistance, clinical syndrome, and geographic region.
The study unveils startling figures for 2022: around 752,000 children in Southeast Asia and 659,000 in Africa died due to AMR-associated complications. Two-thirds of these children were treated using Watch and Reserve antibiotics, drugs notorious for their high likelihood to spur resistance. These remedies are primarily intended for severe, multi-drug-resistant cases, and are not first-line treatments.
World Health Organization guidelines advise restricting usage of such drugs to preserve their effectiveness and forestall resistance. Yet, between 2019 and 2021, recorded use of Watch antibiotics soared by 160% and 126% in Southeast Asia and Africa, respectively. Reserve antibiotics usage also rose by 45% and 125% in the corresponding regions.
Prof Harwell expressed grave concern over the increased deployment of Watch and Reserve antibiotics without stringent oversight, as it amplifies resistance risks and limits future treatment possibilities. AMR emerges as a particular peril in low- and middle-income countries, caused by a blend of overcrowded hospitals, inadequate sanitation, ineffective infection prevention measures, and a scarcity of diagnostic tests often leading to indiscriminate antibiotic usage.
The lacking in robust national surveillance and antimicrobial stewardship programs compounds the issue, making resistance tracking and formulation of effective treatment protocols challenging. In light of these threats, Prof Harwell urges for immediate and coordinated actions at both regional and global levels. Embracing a ‘One Health’ approach in global and national AMR surveillance would be critical, backed by cost-effective systems to guide treatment guidelines and monitor the success of control measures.
At a regional level, the implementation of hospital-based antimicrobial stewardship programs for all pediatric healthcare facilities could form a decisive mandate. Additionally, refining age classifications in surveillance data could enhance our grasp of resistance rates and resistance mechanisms specific to age groups. Thus, mandating national guidelines to guarantee routine surveillance’s role in guiding antibiotic usage is crucial. This compelling research was presented at the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Global meeting in Vienna, Austria.