Sharp rise in antimicrobial resistance among children

A steep increase in paediatric antimicrobial resistance risks sharply reducing the efficacy of life-saving antibiotics if current trends continue, according to a new study.
 
That is the finding of new research published this month in JAMA Paediatrics, which analysed bacterial data between January 2004 and December 2022 for 106,581 children aged 0–18.
 
Research led by the Murdoch Children’s Research Institute (MCRI) used the Antimicrobial Testing Leadership and Surveillance (ATLAS) database, and found resistance increased across all 82 countries covered by the data.
 
It found the trend has largely been driven by Gram-negative bacteria, which cause infections such as sepsis and pneumonia, helping provide a clearer picture of how antimicrobial resistance is changing in children.
 
The study references the Access, Watch, and Reserve (AWaRe) categories, a system designed by the World Health Organization (WHO) to curb overuse and keep antibiotics effective.
 
Researchers found while resistance is highest in the ‘Access’ group of antibiotics – generally first-line or second-line antibiotics for common infections – resistance has increased most significantly among ‘Watch’ and ‘Reserve’ antibiotics.
 
‘These trends threaten the effectiveness of empiric therapy for severe childhood infections, particularly in settings with limited alternative treatment options,’ they wrote.
 
The study team, which also included the University of Sydney, Clinton Health Access Initiative and the Chinese University of Hong Kong, has launched a new website to attempt to bridge data gaps.
 
It tracks antibiotic resistance by country, bacteria and antibiotic class, with forecasts up to 2035 to help pinpoint emerging threats and shape public health plans.
 
Rapid increases in resistance to dangerous pathogens such as Acinetobacter baumannii, which commonly causes hospital-acquired bloodstream infections and pneumonia, and Klebsiella, which causes urinary tract infections and liver abscesses, suggest they could become highly resistant to last‑line treatments.
 
MCRI Associate Professor Penelope Bryant said the research highlights the need for improved surveillance and access to effective antibiotics for children.
 
‘In low-income countries we need to address unregulated antibiotic use and poor sanitation,’ she said.
 
‘These countries need better access to diagnostic techniques and first-line antibiotics.
 
‘In high-income countries, antibiotic overuse must be tackled across farming, veterinary, primary care and hospital settings, while infection control remains critical.
 
‘We also need child-friendly antibiotic formulations, clearer dosing guidance and funding for trials on safely reducing antibiotic use.
 
‘Consumers can help by talking with their GP about the risks of overprescribing antibiotics.’
 
A separate study, published in Lancet Public Health this week, found many regions are using more antibiotics than expected, and rely too much on the ‘Watch’ class of antibiotics.
 
Researchers identified and applied a way of calculating optimal levels of antibiotic use for 186 countries according to their burden of disease, resistance, as well as the local context.
 
They showed most countries used more antibiotics overall than needed in 2019, with almost every nation showing an excessive use of Watch antibiotics, which contribute most to antibiotic resistance.
 
They also found more than half of countries with real-world data available are not using enough ‘Reserve’ antibiotics, which are generally held back to treat life-threatening drug-resistant infections.
 
Professor Mark Morgan, Chair of the RACGP Expert Committee – Quality Care, as well as a researcher on antimicrobial stewardship at Bond University, said research suggests ‘many of the things we take for granted may become much riskier in the future’.
 
‘Resistant microbes might change the balance of harm and benefit for cancer treatments or joint replacements,’ he told newsGP.
 
‘Common antibiotics are no longer as useful. We used to use trimethoprim as a first line antibiotic for UTIs, not any more.’
 
While Australian use of antibiotics is lower than in 2015, it has increased in recent years, and Professor Morgan says reducing low-value uses of antibiotics is key to addressing the spread and development of antimicrobial resistance.
 
With most antibiotics in Australia prescribed by GPs, he points to the Therapeutic Guidelines for broad guidance on antibiotic choice, while also highlighting gaps in Australian data, including for privately dispensed antibiotics and appropriateness of antibiotic use.
 
‘Better data would help to shape efforts to optimise antibiotic use,’ Professor Morgan said.
 
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