More than 3 million children die of AMR-associated complications every year

Key takeaways:

• More than 3 million children died from AMR-associated complications in 2022.
• The use of watch and reserve antibiotics rose significantly from 2019 to 2021.

VIENNA — More than 3 million children died from antimicrobial resistance-associated complications in 2022 across the globe, most of whom lived in Southeast Asia and Africa, according to findings presented at ESCMID Global 2025.

Joseph Harwell, MD, Senior Clinical Director at Clinton Health Access Initiative and associate professor of medicine and pediatrics at Brown University’s Warren Alpert Medical School, told Healio he is concerned about rising rates of resistance to antibiotics for treating sepsis and respiratory infections.

Harwell and Yanhong Jessika Hu, MD, MPH, an honorary senior research fellow at Murdoch Children’s Research Institute at University of Melbourne, Australia, investigated antimicrobial resistance (AMR)-related pediatric deaths in 83 countries from 2004 to 2022. They studied 106,581 isolates from Pfizer’s ATLAS and the Global Burden of Disease study to identify patterns and estimate annual mortality rates.

Nearly half of the isolates came from children aged younger than 2 years (47%), according to the authors. They noted that most came from sputum (30%), wounds (20%), blood (16%) and urine (12%).

Harwell and colleagues estimated that more than 3 million children — including 752,000 in Southeast Asia and 659,000 in Africa — died from AMR-related complications in 2022, according to a related press release.

The researchers also categorized data based on whether the antibiotics were in the WHO’s access, watch or reserve groups.

According to WHO, “access” antibiotics typically carry a lower risk for resistance and, therefore, should be available at all times. “Watch” antibiotics are first- and second-line antibiotics that should be used sparingly because of their higher risk for developing resistance. “Reserve” antibiotics are last-resort drugs with high potential for resistance; WHO recommends using them only to treat life-threating infections caused by multidrug-resistant bacteria.

In their 2022 estimate, the researchers said 2 million AMR-related deaths were associated with watch and reserve antibiotics.

Harwell and colleagues reported that the use of watch antibiotics rose 160% in Southeast Asia and 126% in Africa from 2019 to 2021, and reserve antibiotic use increased 45% in Southeast Asia and 125% in Africa. Reserve antibiotic use also rose 44% in Europe during that time frame.

Harwell noted that although the relative increase in use seems large, the absolute increase is small. He also pointed out that global antibiotic use rose during the COVID-19 pandemic, so perhaps providers were using stronger antibiotics because antibiotics were in short supply.

“It is tempting to assume the rise in resistance is because of the rise in use, but especially because the actual volumes are so small, one would not expect that to be the case,” he said.

The researchers reported that respiratory and urinary infections were associated with the highest rates of resistance. Additionally, Escherichia coli was 30% resistant to access antibiotics, and Klebsiella pneumoniae and Enterobacter cloacae became more resistant to watch and reserve antibiotics over time.

In Africa and Southeast Asia, as well as Ukraine and Mexico, the authors found combined resistance to ampicillin and gentamicin exceeded 20%. They also reported rising resistance to ceftriaxone in Indonesia, Egypt, El Salvador and Honduras.

Harwell offered suggestions to reduce AMR-related deaths, noting that the best way to avoid AMR-related deaths is by preventing infections in the first place. He recommended, however, that improving infection prevention and control in health care facilities, enhancing diagnostics and treatment and preventing unsupervised antibiotic use could also curb the risk of AMR-related deaths.

“Providers should recognize that effective antibiotics are a precious commodity and should be used correctly,” Harwell said. “This means that the importance of using antibiotics responsibly must be highlighted before a child experiences a condition that might lead to a desire to use antibiotics.”

For more information:

Joseph Harwell, MD, can be reached at sibraheem@clintonhealthaccess.org.

References:

• Hu Y, et al. Abstract 00829. Presented at: ESCMID Global; April 11-15, 2025; Vienna.
• Over 3 million children died from AMR-related infections in 2022, major study shows. https://www.eurekalert.org/news-releases/1079367. Published April 13, 2025.