New research by the University of Sydney has found that antimicrobial resistance in children is rising globally and will worsen over the next decade, threatening the effectiveness of life-saving antibiotics. 

The findings, published in JAMA Pediatrics, was carried out by the University of Sydney in collaboration with researchers at the Murdoch Children’s Research Institute (MCRI), the Clinton Health Access Initiative (CHAI) and the Chinese University of Hong Kong. 

Dr Yanhong Jessika Hu, Research Fellow at the School of Public Health and Honorary Fellow at the MCRI, said: “Antimicrobial resistance is one of the biggest threats to children’s health globally, but until now we haven’t had a clear picture of how it’s changing.”

Antimicrobial resistance occurs when bacteria evolve to withstand antibiotic treatment. As resistant bacteria emerge and spread through communities, infections become harder to treat. Children are especially vulnerable as they experience high rates of bacterial infections and have fewer antibiotic options than adults. In 2021, approximately 840,000 deaths in children under five years were associated with antimicrobial resistance.

The study

Experts analysed more than 106,000 infection samples from children, aged up to 18 years, across 82 countries, discovering that antibiotic resistance increased in every region between 2004 and 2022. Babies and children in intensive care and countries with fewer healthcare resources were found to be the most affected.

MCRI Associate Professor Penelope Bryant said: “The findings highlight a 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.”

Resistance rose most sharply among antibiotics that the World Health Organization has classified as “last resort” or “to be closely monitored” to prevent overuse and preserve their effectiveness when first-line treatments fail. 

In particular, the researchers found that two types of Gram-negative bacteria (acinetobacter baumannii and klebisella) were driving antimicrobial resistance globally.

Acinetobacter baumannii, which commonly causes hospital acquired bloodstream infections and pneumonia, showed the highest overall resistance. Klebsiella, which causes urinary tract infections and liver abscesses, recorded the fastest increase, particularly in Southeast Asia, Eastern Europe and the Western Pacific. 

AMR in Kids

Created by the study team, a new website called AMR in Kids allows clinicians, researchers and policymakers to explore antibiotic resistance by country, bacteria and antibiotic class. It also provides region and pathogen-specific forecasts to 2035, helping researchers to identify emerging threats, inform treatment decisions and help guide public health planning.

Associate Professor Bryant said despite facing unique treatment challenges, children had been overlooked in global antibiotic resistance surveillance: 

“Making antibiotic resistance in children visible, through AMR in Kids, is the first step towards changing its trajectory. By understanding where resistance is emerging and how it’s changing, we can better protect children now and preserve the effectiveness of antibiotics into the future.”

The research team is also urging governments to take more action on the global stage. Associate Professor Bryant said:  

“In low-income countries we need to address unregulated antibiotic use and poor sanitation. 

“These countries need better access to diagnostic techniques and first-line antibiotics. Encouragingly, Australia’s Department of Foreign Affairs and Trade has brought together experts including from the University of Melbourne and the WHO to develop solutions in the Western Pacific.

“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.”

The researchers hope that the AMR in Kids website will help transform the way antibiotics are prescribed and improve understanding of antimicrobial resistance.

Researchers from The Royal Children’s Hospital, Brown University and the University of Melbourne also contributed to the study.

Research

Yanhong, Jessika Hu, et al, ‘Childhood Antimicrobial Resistance with Global Forecasts’, JAMA Pediatrics (2026)

DOI: 10.1001/jamapediatrics.2026.2808