Grand Round Webinar: Antimicrobial resistance in children

A Paediatric Crisis Accelerating

Antimicrobial resistance (AMR) has escalated into one of the most pressing global health threats, with recent evidence highlighting its devastating toll on children. In 2022, over 3 million children worldwide died from infections linked to AMR, according to a major analysis presented at ESCMID Global 2025. Southeast Asia recorded around 752,000 such deaths, Africa 659,000, and the remainder spread across other regions, often involving overuse of 'Watch' and 'Reserve' antibiotics reserved for severe cases.

The problem has worsened rapidly in recent years. The WHO's 2025 Global Antimicrobial Resistance and Use Surveillance System (GLASS) report, the most comprehensive since 2015, showed resistance increasing in more than 40% of tracked bacterial-antibiotic pairs from 2018 to 2023, with annual rises of 5-15%. One in six laboratory-confirmed common bacterial infections proved resistant in 2023, undermining treatments for bloodstream, urinary tract, and gastrointestinal infections that frequently affect children.

Children are especially vulnerable. Their developing immune systems make them prone to infections, while immature kidneys and livers complicate dosing, and fewer paediatric-specific antibiotics exist due to historical research gaps. In low- and middle-income countries, where most AMR deaths occur, limited diagnostics drive empirical prescribing, fuelling resistance. The COVID-19 pandemic exacerbated this in middle-income settings through higher antibiotic use, even as high-income countries saw some declines.

The stakes extend beyond immediate mortality. AMR strains healthcare systems with prolonged hospital stays, more invasive treatments, and higher costs—potentially US$1 trillion in additional healthcare expenses by 2050 and trillions in GDP losses annually by 2030. Forecasts suggest 39 million direct AMR deaths from 2025 to 2050 without intervention. In the UK and similar settings, rising resistant infections add pressure to already strained paediatric services.

Non-obvious tensions include the paediatric innovation lag: children are often excluded from early drug trials, delaying access to new options. Meanwhile, prevention through vaccination and stewardship competes with demands for broader antibiotic access in under-resourced areas. The 2024 UN General Assembly High-Level Meeting on AMR produced commitments to reduce associated deaths by 10% by 2030 and update the Global Action Plan by 2026, but implementation gaps persist, particularly for child-focused strategies.