A detailed analysis presented at ESCMID Global 2025 revealed grim findings: well over 3 million children died in 2022 as a result of antimicrobial resistance (AMR infections). This result has sparked debate among health specialists and politicians alike, as the data highlight the devastating impact of AMR on disadvantaged paediatric populations, notably in South-East Asia and Africa.

The report portrays a bleak picture of a global crisis fuelled by failures in infection control and an overreliance on powerful antibiotic classes. With an incredible 752,000 deaths in South-East Asia and 659,000 in Africa, the report underscores an acute lack of access to paediatric-appropriate antibiotic therapies. 

According to the investigation, the majority of these deaths were caused by the usage of antibiotics labelled "Watch" or "Reserve". These categories include drugs that are not designed for routine use but rather for situations in which first-line therapy fails. Their increased use is indicative of an environment in which drug-resistant diseases have become extremely common.

Alarmingly, from 2019 to 2021, there was a substantial increase in the use of these essential antibiotic families. Watch antimicrobial deployment increased by 160% in South-East Asia and by 126% in Africa. Similarly, reserve antibiotics increased by 45% in Southeast Asia and 125% in Africa. 

The consequences of such dependency are dire: over 2 million of all confirmed paediatric fatalities attributable to AMR in 2022 were linked to these antibiotic classes. This pattern indicates a rapid change in treatment procedures, which, if not monitored, may accelerate the development of antibiotic resistance.

Professor Joseph Harwell, a co-author of the study, voiced great worry about these tendencies. "While the rise in use of watch and reserve antibiotics may be necessary in response to the concurrent rise in drug-resistant infections, the sharp rise in use of these drugs presents several serious long-term risks," according to him. Harwell's comments reflect a larger concern in the health community: that an unregulated expansion in the usage of these strong treatments could render them ineffective when truly needed. He went on: "If bacteria develop resistance to these antibiotics, there will be few, if any, alternatives for treating multidrug-resistant infections." His statements serve as a stark reminder to reevaluate current practices and enhance antibiotic stewardship across all healthcare levels.

AMR disproportionately affects low- and middle-income nations as a result of a convergence of detrimental variables. Overcrowded medical facilities, poor sanitation infrastructure, and ineffective infection prevention methods provide fertile ground for the propagation of resistant microorganisms. 

Furthermore, widespread unregulated antibiotic usage, compounded by a lack of precise diagnostic devices and diagnostic uncertainty, promotes resistance. 

The lack of effective national monitoring systems and antimicrobial stewardship programmes impedes efforts to closely monitor and respond to changing resistance patterns. This scenario greatly impairs the ability to develop effective treatment regimens, exacerbating the public health catastrophe.

To address these difficulties, Professor Harwell recommends a multifaceted, globally coordinated solution. "Addressing this situation necessitates immediate and concerted action on both the regional and global levels. Global and national AMR surveillance must take a 'One Health' approach with cost-effective technologies that can influence treatment guidelines and assess the effectiveness of control efforts," he remarked. 

The 'One Health' concept, which incorporates human, animal, and environmental health, is widely recognised as a critical method for combating the spread of resistance across sectors.

At the regional level, the paper urges authorities to implement hospital-based antimicrobial stewardship programmes in paediatric hospitals. 

There is a greater emphasis on improving surveillance data through age-specific categorisation. Improved data granularity could provide vital insights into the differential impact of AMR across paediatric age groups, allowing for more targeted intervention measures.

The findings of the ESCMID Global 2025 report are a call to action for the global health community. A new strategy for antibiotic usage, supported by coordinated surveillance systems and comprehensive stewardship programs, is required to stem the tide of AMR-related deaths among children. As health experts such as Professor Harwell point out, the window for effective intervention is closing, and the cost of inactivity could be measured in millions of young lives lost. The study emphasises that combating AMR is a moral responsibility that requires prompt and coordinated worldwide action.