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More than 3 million children died from antimicrobial resistance (AMR)-related infections in 2022, with South-East Asia and Africa among the hardest-hit regions, according to new research shared at ESCMID Global 2025 in Vienna.
The study reveals that over 752,000 deaths in South-East Asia and 659,000 in Africa were linked to AMR complications. Many were associated with ‘Watch’ and ‘Reserve’ antibiotics – powerful treatments intended only for severe or multidrug-resistant infections. Their use is rising rapidly, often without adequate oversight, contributing to the development of resistance and limiting future treatment options.
Between 2019 and 2021, the use of Watch antibiotics surged by 160% in South-East Asia and 126% in Africa. Reserve antibiotic use rose by 45% and 125% respectively in the same regions.
Children are especially vulnerable to resistant infections, and access to age-appropriate antibiotic formulations is limited due to development delays. In low- and middle-income countries, the issue is made worse by overcrowded hospitals, poor sanitation, and a lack of diagnostics and stewardship programmes.
Professor Joseph Harwell, a co-author of the study, emphasised the urgent need for action:
“The rising use of Watch and Reserve antibiotics without proper oversight poses serious long-term risks. We must implement coordinated national and global strategies to protect the effectiveness of these last-line treatments.”
The researchers are calling for:
- Mandatory stewardship programmes in paediatric healthcare facilities
- Improved age classifications in surveillance data
- National guidelines to ensure surveillance informs antibiotic use
Without stronger global efforts, AMR will continue to claim young lives and undermine the future of infectious disease treatment.
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