Antimicrobial resistance in children is rising globally and will worsen over the next decade, threatening the effectiveness of life-saving antibiotics, according to a world-first monitoring platform.

The findings, led by Murdoch Children’s Research Institute (MCRI) in collaboration with the University of Sydney, Clinton Health Access Initiative (CHAI) and The Chinese University of Hong Kong, analyzed more than 106,000 infection samples from children up to 18 years old across 82 countries, finding that antibiotic resistance increased in every region between 2004 and 2022. Babies and children in intensive care, and those in countries with fewer healthcare resources, were the most affected.

Published in JAMA Pediatrics, the research found the increase is being driven largely by Gram-negative bacteria responsible for severe infections such as sepsis and pneumonia. Resistance rose most sharply to critical “Watch” and “Reserve” antibiotics, which the World Health Organization classifies to limit overuse and help preserve their effectiveness when first-line treatments fail.

MCRI Associate Professor Penelope Bryant said the findings “highlighted a widening gap between recommended antibiotic use and real-world effectiveness, reinforcing the urgent need for improved surveillance, targeted antimicrobial stewardship.”

The newly launched AMR in Kids website, created by the study team, allows clinicians, researchers and policymakers to explore antibiotic resistance by country, bacteria and antibiotic class, and provides region- and pathogen-specific forecasts to 2035. MCRI and University of Sydney’s Dr. Yanhong Jessika Hu said that by combining almost two decades of global data with forecasting, the platform could identify where resistance was likely to emerge before it becomes an even greater clinical challenge.

“Antimicrobial resistance is one of the biggest threats to children’s health globally, but until now we haven’t had a clear picture of how it’s changing specifically in children,” Hu said. “The AMR in Kids platform addresses a major gap by developing region and pathogen-specific forecasts for the next decade.” In 2021, about 840,000 deaths in children under five years were associated with antimicrobial resistance.

Forecast modelling by the platform suggests that by 2035, some of the most dangerous pathogens could become highly resistant to last-line treatments. CHAI Senior Clinical Director Associate Professor Joseph Harwell said, “Better data is essential, but children can’t wait for perfect data. We need to use the best available evidence to guide action now.”

The research found two types of Gram-negative bacteria driving antimicrobial resistance globally: Acinetobacter baumannii, which commonly causes hospital-acquired bloodstream infections and pneumonia and showed the highest overall resistance, and Klebsiella, which causes urinary tract infections and liver abscesses and recorded the fastest increase, particularly in Southeast Asia, Eastern Europe and the Western Pacific. Resistance to last-line carbapenem antibiotics is projected to rise substantially by 2035, reaching 82% and 35% for each superbug, respectively.

Bryant said that despite facing unique treatment challenges, children had been overlooked in global antibiotic resistance surveillance. “Rising resistance to first- and now second-line drugs is the clinical reality for children,” she said. “Making antibiotic resistance in children visible, through AMR in Kids, is the first step towards changing its trajectory. By understanding where resistance is emerging and how it’s changing, we can better protect children now and preserve the effectiveness of antibiotics into the future.” More action was needed globally, she said: low-income countries need to address unregulated antibiotic use and poor sanitation and gain better access to diagnostic techniques and first-line antibiotics, while high-income countries must tackle antibiotic overuse across farming, veterinary, primary care and hospital settings and keep infection control a priority. “We also need child-friendly antibiotic formulations, clearer dosing guidance and funding for trials on safely reducing antibiotic use,” she said.

Harry, 13, who was born with kidney failure, has taken antibiotics for much of his life to prevent and treat infections. He began dialysis at six months old and received a kidney transplant from his father at age four, meaning he relies on immunosuppressant medication. His mother, Eileen, said that while he was receiving treatment as a young child, doctors found that the bacteria causing his infections were resistant to several commonly used antibiotics. “Antibiotic resistance is quite alarming, especially for someone like Harry who gets a lot of infections because he’s reliant on immunosuppressants,” she said. “It means there are a lot of things that are off the table for him in terms of treatment. The website could be a game changer, helping to challenge the perception that antibiotics are always the best option.”

Researchers from The Royal Children’s Hospital, Brown University and the University of Melbourne also contributed to the study.

Journal: JAMA Pediatrics
DOI: 10.1001/jamapediatrics.2026.2808
Article Title: Childhood Antimicrobial Resistance with Global Forecasts
Publication Date: 20-Jul-2026

Source: EurekAlert