In a groundbreaking session at the ESCMID Global 2025 conference in Vienna, Austria, researchers revealed the startling truth that over three million children globally succumbed to infections related to antimicrobial resistance (AMR) in 2022 alone. This compelling evidence underscores an immediate need for comprehensive strategies to address pediatric AMR, especially in areas bearing the brunt of its impact, such as South-East Asia and Africa.
The data presented by researchers, including Professor Joseph Harwell, Senior Clinical Director at the Clinton Health Access Initiative (CHAI), indicates a significant and troubling trend. While the increased use of Watch and Reserve antibiotics may initially seem necessary in counteracting the rise of drug-resistant infections, this development harbors potential dangers for future treatment protocols. Careless oversight and uncontrolled use of these drugs could accelerate resistance evolution and potentially limit future treatment options.
According to the research data, in 2022, AMR-associated complications resulted in over 752,000 child fatalities in Southeast Asia, and an additional 659,000 lives were lost in Africa. Globally, more than a million and a half lives succumbed to the same cause. Many of these deaths are associated with the uses of Watch and Reserve antibiotics, drugs viewed as a high-risk or last resort against lethal, multi-drug resistant infections.
Unfortunately, children often bear the brunt of global health neglect, an issue the CHAI has championed since its inception. The organization, a founding and strategic partner with WHO for the Global Accelerator for Paediatric formulations (GAP-f), has been instrumental in pushing for improved access to pediatric medicines.
However, addressing this crisis on a regional and global scale requires urgent, coordinated action. Countries including Cote d’Ivoire, Ghana, Kenya, Malawi, South Africa, and Tanzania, have shown progress in enhancing surveillance systems and national policies, yet more needs to be accomplished to ameliorate child health outcomes.
Multiple factors contribute to the AMR severity in low- and middle-income nations, including overpopulated hospitals, inadequate sanitation, and lackluster infection prevention measures. Issues such as misuse and overuse of antibiotics, stemming from a lack of diagnostic tools and fear of misdiagnosis, are widespread. Furthermore, the absence of effective national surveillance and antimicrobial stewardship programs negatively impacts the capability to effectively track resistance trends and establish robust treatment protocols.
Over the span of three years (2019-2021), usage of Watch antibiotics rose by 160% in Southeast Asia and 126% in Africa. Similarly, usage of Reserve antibiotics rose by 45% in Southeast Asia and a staggering 125% in Africa.
Professor Harwell emphasized the importance of a ‘One Health’ approach, linking human health programs to animal and environmental factors. On a regional level, he recommended the implementation of antimicrobial stewardship programs in all pediatric healthcare facilities, improved age classifications for better understanding of resistance rates, and national guidelines to ensure routine surveillance informs antibiotic use.