Antibiotic resistance in children is on the rise globally and will worsen over the next decade, threatening the effectiveness of life-saving antibiotics, according to the world’s first surveillance platform.
The study, led by the Murdoch Children’s Research Institute (MCRI) in collaboration with the University of Sydney, the Clinton Health Access Initiative (CHAI) and the Chinese University of Hong Kong, analyzed more than 106,000 infected samples from children up to the age of 18 across 82 countries and found that antibiotic resistance increased in all regions between 2004 and 2022. most influenced.
Published in JAMA Pediatrics, The study found that the main cause of this increase was Gram-negative bacteria, which can cause serious infections such as sepsis and pneumonia. The steepest rise in resistance has been to important “surveillance” and “backup” antibiotics, which the World Health Organization (WHO) classifies to limit overuse and maintain effectiveness when first-line treatments fail.
MCRI Associate Professor Penelope Bryant said the findings highlight the widening gap between recommended antibiotic use and real-world effectiveness, reinforcing the urgent need for improved surveillance, targeted antimicrobial stewardship and better access to effective antibiotics for children.
The research team’s new AMR in Kids website allows clinicians, researchers, and policy makers to explore antibiotic resistance by country, bacteria, and antibiotic class. It also provides region- and pathogen-specific forecasts through 2035 to help researchers identify emerging threats, inform treatment decisions, and guide public health planning.
Dr Yanhong Jessika Hu from MCRI and the University of Sydney said that by combining nearly 20 years of global data and predictions, the platform can identify where resistance is likely to emerge before it becomes a greater clinical challenge.
Antimicrobial resistance occurs when bacteria evolve to resist treatment with antibiotics. As resistant bacteria emerge and spread through communities, it becomes difficult to treat infections. Children are particularly vulnerable because they have higher rates of bacterial infections and fewer antibiotic options than adults. In 2021, approximately 840,000 children under the age of 5 died related to antimicrobial resistance.
Antimicrobial resistance is one of the biggest threats to children’s health worldwide, but until now it has not been possible to clearly understand how it changes specifically in children. The AMR in Kids platform addresses a major gap by developing region- and pathogen-specific forecasts for the next 10 years. ”
Dr Yanhong Jessika Hu, MCRI, University of Sydney
Predictive modeling from this platform suggests that by 2035, some of the most dangerous pathogens could become highly resistant to last-ditch treatments.
Associate Professor Joseph Harwell, Senior Clinical Director at CHAI, said: “Better data is essential, but children cannot wait for perfect data. We need to use the best available evidence to guide action now.”
The study found that two types of Gram-negative bacteria are causing antibiotic resistance around the world. Acinetobacter baumannii, which commonly causes nosocomial infections and pneumonia, showed the highest overall resistance. Klebsiella bacteria, which cause urinary tract infections and liver abscesses, recorded the fastest increases, particularly in Southeast Asia, Eastern Europe, and the Western Pacific. Alarmingly, resistance to the last-line carbapenem antibiotics is predicted to rise significantly by 2035, reaching 82 percent and 35 percent for each superbug, respectively.
Associate Professor Bryant said children had been ignored in global antibiotic resistance surveillance, despite facing unique treatment challenges.
“Increasing resistance to first-line and now second-line drugs is a clinical reality in children,” she says. “Visibility of antibiotic resistance in children through pediatric AMR is the first step to changing that trajectory. By understanding where resistance is occurring and how it is changing, we can better protect children today and maintain antibiotic effectiveness into the future.”
But Associate Professor Bryant said more action was needed on the global stage and measures aimed specifically at children.
“Low-income countries need to address unregulated antibiotic use and poor sanitation,” she said. “These countries need better access to diagnostic technology and first-line antibiotics. Encouraged by this, Australia’s Department of Foreign Affairs and Trade has brought together experts from the University of Melbourne and the WHO to develop solutions in the Western Pacific.”
“While infection control remains important in high-income countries, antibiotic overuse must be tackled across agricultural, veterinary, primary care and hospital settings.
“We also need child-friendly antibiotic prescribing, clearer dosing guidance and funding for trials to safely reduce antibiotic use. Consumers can help by talking to their GP about the risks of antibiotic overprescription.”
Harry, 13, was born with kidney failure and has taken antibiotics for most of his life to prevent and treat infections. Harry started dialysis when he was six months old and received a kidney transplant from his father when he was four years old. This means that you are dependent on immunosuppressants.
His mother, Eileen, said that while undergoing treatment as a child, doctors discovered that the bacteria causing the infection was resistant to some commonly used antibiotics.
She said the AMR in Kids website could help transform the way antibiotics are prescribed and improve our understanding of antimicrobial resistance.
“Antibiotic resistance is very worrying, especially for people like Harry who are dependent on immunosuppressants and therefore have a lot of infections,” she says. “That means there are a lot of unexpected things going on for him in terms of treatment.
“This website could be a game-changer in challenging the perception that antibiotics are always the best option. People are already starting to understand the long-term effects of antibiotics, but there is a long way to go in education about resistance.”
Researchers from the Royal Children’s Hospital, Brown University and the University of Melbourne also contributed to the study.
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Murdoch Children’s Research Institute
Reference magazines:
Hu, Y.J. Others. (2026) Antimicrobial resistance in children and global projections. JAMA Pediatrics. DOI: 10.1001/jamapediatrics.2026.2808. https://jamanetwork.com/journals/jamapediatrics/fullarticle/2851769
