A groundbreaking investigation unveiled at ESCMID Global 2025 has drawn attention to a staggering statistic: over three million children perished in 2022 due to infections linked to antimicrobial resistance (AMR). This study emphasizes the pressing requirement for strategic measures, both regionally and globally, to manage pediatric AMR, particularly in areas heavily affected such as South-East Asia and Africa. The vulnerability of children to infections places them at significant risk when faced with AMR.

In 2022 alone, Southeast Asia witnessed the loss of more than 752,000 young lives, while Africa experienced the death of approximately 659,000 children due to complications tied to AMR. A substantial portion of these fatalities were attributed to the application of high-risk antibiotics and last-resort treatments. These medications are not designed for primary treatment but should be reserved for those who genuinely need them, underscoring the importance of preserving their efficacy. Conversely, accessible antibiotics, which are less likely to promote resistance, are typically utilized for common infections.

The alarming rise in the use of specific antibiotic classes highlights an urgent global concern. Between 2019 and 2021, there was a dramatic increase in the utilization of high-risk antibiotics by 160% in Southeast Asia and 126% in Africa. During this same timeframe, the usage of last-resort treatments surged by 45% in Southeast Asia and 125% in Africa. Globally, two million child deaths were associated with the increased reliance on these antibiotics. Professor Joseph Harwell warns that while this increase might be necessary due to rising drug-resistant infections, it introduces severe long-term risks, primarily the development of resistance and the consequent limitation of future treatment options.

Addressing the escalating challenge of AMR necessitates immediate and coordinated action across all levels. Factors exacerbating the situation in low- and middle-income countries include overcrowded medical facilities, inadequate sanitation, and insufficient infection prevention strategies. Overuse and misuse of antibiotics further compound the problem due to a lack of diagnostic tools and fears of misdiagnosis. Effective national surveillance and antimicrobial stewardship programs are crucial yet often absent in these regions. Implementing 'One Health' approaches in global and national surveillance can inform treatment guidelines and measure the impact of control measures. On a regional scale, mandating hospital-based stewardship programs in pediatric healthcare settings is vital. Enhanced age classifications in data collection will deepen our understanding of resistance patterns across different age groups and mechanisms specific to pediatric cases. National guidelines ensuring routine surveillance informs antibiotic use are also essential steps forward.

Through concerted efforts and comprehensive strategies, we can safeguard the health of future generations and ensure effective treatments remain available. It is imperative that we act now to prevent further tragedies and protect the most vulnerable populations from the devastating effects of AMR.