Sunday, April 13, 2025, Vienna, Austria – A study presented today at ESCMID Global 2025 in Vienna, Austria has revealed that over 3 million children worldwide lost their lives in 2022 due to antimicrobial resistance (AMR)-related infections¹
The study underscores the urgent need for both regional and global strategies to combat pediatric AMR, particularly in high-burden areas such as South-East Asia and Africa. AMR poses a critical threat to children, who are highly vulnerable to infections.²
“While the rise in use of Watch and Reserve antibiotics may be necessary in response to the concurrent rise in drug-resistant infections, the sharp rise in use of these drugs presents several serious long-term risks”, commented Professor Joseph Harwell, study co-author and Senior Clinical Director at CHAI. “Their increased use, especially without careful oversight, elevates the risk of resistance and limits future treatment options. If bacteria develop resistance to these antibiotics, there will be few, if any, alternatives for treating multidrug-resistance infections.”
In 2022 alone, more than 752,000 children in Southeast Asia and 659,000 children in Africa, with over a million and a half more in other regions of the world died of AMR-associated complications. Many of these deaths were linked to the use of Watch antibiotics (drugs with a high risk of resistance) and Reserve antibiotics (last-resort treatments for severe, multidrug-resistant infections).¹,³
Children are consistently neglected in global health despite their disproportionate suffering and vulnerability, a cause that the Clinton Health Access Initiative (CHAI) has been a key advocate for being a founding member and a strategic partner with WHO for the Global Accelerator for Paediatric formulations (GAP-f), which focuses on improving access to pediatric medicines.
Addressing this issue requires urgent and coordinated action at both regional and global levels. Even though countries like Cote d’Ivoire, Ghana, Kenya, Malawi, South Africa and Tanzania have made strides to improve surveillance systems and national policies, more must be done to improve health outcomes for children.
Several factors contribute to the severity of AMR in low- and middle-income countries, including overcrowded hospitals, poor sanitation, and weak infection prevention measures that facilitate the spread of resistant pathogens within healthcare settings and communities. Due to a lack of diagnostic tools and concerns over misdiagnosis, overuse and misuse of antibiotics are also widespread in these regions. Additionally, many low- and middle-income countries lack effective national surveillance and antimicrobial stewardship programs, making it difficult to track resistance trends and establish effective treatment protocols.
Between 2019 and 2021, the use of Watch antibiotics increased by 160 percent in Southeast Asia and 126 percent in Africa. During the same period, the use of Reserve antibiotics rose by 45 percent in Southeast Asia and 125 percent in Africa.
“Global and national surveillance on AMR must adopt a ‘One Health’ approach, linking human health programs to animal and environmental factors, with cost-effective systems that can inform treatment guidelines and measure the impact of control interventions” said Professor Harwell. “On a regional level, we urge policymakers to mandate hospital-based antimicrobial stewardship programs in all pediatric healthcare facilities. Improved age classifications will also enhance our understanding of important differences in resistance rates across the age categories, as well as pediatric-specific resistance mechanisms. Additionally, we urge the implementation of national guidelines to ensure routine surveillance informs antibiotic use.”
ENDS
Notes to Editors
For more information or to arrange an expert interview, please contact
Clinton Health Access Initiative: sibraheem@clintonhealthaccess.org
ESCMID Press Office: communication@escmid.org
Table 1: Children’s Access, Watch and Reserve resistance death burden in WHO regions in 2022 – associated death counts (1000)¹
Table 2: Children’s Access, Watch and Reserve resistance death burden in WHO regions in 2022 – associated death counts (per 100k)¹
About Access, Watch and Reserve antibiotics²
- Access antibiotics are antibiotics with a narrow spectrum of activity, generally with less side-effects, a lower potential for the selection of antimicrobial resistance and of lower cost. They are recommended for the empiric treatment of most common infections and should be widely available.
- Watch antibiotics generally have a higher potential for the selection of antimicrobial resistance and are more commonly used in sicker patients in the hospital facility setting. Their use should be carefully monitored to avoid overuse.
- Reserve antibiotics are last-resort antibiotics that should only be used to treat severe infections caused by multidrug-resistant pathogens.
About the study authors
Professor Joseph Harwell is a Senior Clinical Director at Clinton Health Access Initiative, and Associate Clinical Professor of Medicine and Pediatrics at the Warren Alpert Medical School of Brown University, United States.
Doctor Yanhong Jessika Hu is Honorary Senior Research Fellow at Murdoch Children’s Research Institute, Royal Children’s Hospital and Department of Paediatrics, University of Melbourne, Australia.
About the partners
About Clinton Health Access Initiative
The Clinton Health Access Initiative, Inc. (CHAI) is a global health organization committed to saving lives and improving health outcomes in low- and middle-income countries by enabling the government and private sector to strengthen and sustain quality health systems. For more information, please visit: www.clintonhealthaccess.org
About the European Society of Clinical Microbiology and Infectious Diseases
The European Society of Clinical Microbiology and Infectious Diseases (ESCMID) is the leading Society for Clinical Microbiology and Infectious Diseases in Europe. ESCMID is proud to unite 12,000 members as well as 45,000 affiliated members through 77 national and international affiliated societies. In the wake of the COVID-19 pandemic, ESCMID now plays an important role in emerging infectious diseases and antimicrobial resistance education and research. Website: www.escmid.org/
References
- Hu, Y., Harwell, J. (2025). Global Trends and Impact of Antimicrobial Resistance in Paediatric Populations: An Analysis Using WHO AWaRe Classification and Priority Pathogens. Oral presentation. ESCMID Global 2025.
- UNICEF UK. (n.d.). Antimicrobial Resistance: A Crisis for Children Everywhere. Available at: http://unicef.org.uk/campaign-with-us/futures-at-risk/antimicrobial-resistance-a-crisis-for-children-everywhere/
- National Library of Medicine. (2023). The WHO AWaRe (Access, Watch, Reserve) antibiotic book and prevention of antimicrobial resistance. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC10042089/
