Alarming Rise: Over 3 Million Children Succumb to Infections from Antimicrobial Resistance in 2022

A recent study highlighted at the ESCMID Global 2025 conference has revealed a staggering statistic: more than 3 million children died globally in 2022 due to infections linked to antimicrobial resistance (AMR). This alarming figure emphasizes the pressing need for both regional and global strategies aimed at tackling pediatric AMR, particularly in high-burden regions like South-East Asia and Africa.

Children are particularly vulnerable to infections, and the availability of new antibiotic formulations is often severely limited due to delays in product development. The research indicates that in 2022, over 752,000 children in Southeast Asia and 659,000 in Africa lost their lives as a result of AMR-related complications. A significant number of these fatalities were associated with the misuse of 'Watch' antibiotics, which are at a high risk of inducing resistance, and 'Reserve' antibiotics, which are considered last-resort options for treating severe, multidrug-resistant infections.

Watch and Reserve antibiotics should not be employed as first-line treatments; their use needs to be restricted to preserve their efficacy and prevent the emergence of resistance. In stark contrast, 'Access' antibiotics are readily available for treating common infections because they have a lower potential for contributing to resistance.

The period from 2019 to 2021 saw a dramatic increase in the use of Watch antibiotics, which surged by 160% in Southeast Asia and 126% in Africa. Similarly, the utilization of Reserve antibiotics rose by 45% in Southeast Asia and 125% in Africa during the same time frame. Out of the over 3 million deaths among children, around 2 million were directly linked to the inappropriate use of Watch and Reserve antibiotics.

Professor Joseph Harwell, a co-author of the study, expressed concern over the increasing reliance on these antibiotics. He noted that while their usage may be necessary in response to the rise of drug-resistant infections, this increase poses significant long-term risks. The unchecked use of these antibiotics heightens the risk of resistance, thereby limiting future treatment options. If bacteria develop resistance to these crucial medications, the options for treating multidrug-resistant infections will dwindle.

Several factors exacerbate the AMR crisis in low- and middle-income countries, including overcrowded healthcare facilities, inadequate sanitation, and weak infection prevention measures that foster the spread of resistant pathogens within hospitals and communities. Additionally, the lack of diagnostic tools and fears of misdiagnosis contribute to the widespread overuse and misuse of antibiotics in these regions.

The absence of effective national surveillance and antimicrobial stewardship programs in many low- and middle-income countries further complicates the issue, making it challenging to monitor resistance trends and develop effective treatment protocols.

Professor Harwell warned that the rising resistance to Watch and Reserve antibiotics will inevitably lead to increased treatment failures. Mortality rates, which are already alarmingly high, are likely to rise even further, particularly in low- and middle-income nations where access to alternative treatments and advanced medical interventions remains limited.

He emphasized the need for immediate and coordinated action at both regional and global levels to address this crisis. Implementing a 'One Health' approach to global and national AMR surveillance is crucial, with effective systems capable of informing treatment guidelines and evaluating the impact of control measures.

On a regional basis, policymakers are urged to establish antimicrobial stewardship programs in all pediatric healthcare facilities. Enhancing age classifications in surveillance data will also improve understanding of resistance rates across different age groups and pediatric-specific resistance mechanisms. Furthermore, the development of national guidelines to ensure that routine surveillance informs antibiotic usage is imperative.