Antibiotic resistance in children has been climbing for two decades — and forecasts point to steep jumps by 2035. The analysis, published in JAMA Pediatrics, drew on more than 106,000 bacterial samples from children and teens across 82 countries, collected between 2004 and 2022 from hospital wards, intensive care units and outpatient clinics — spanning high-income countries like the US and UK down to Malawi and Uganda.

Resistance rose across all regions; rates were highest in ICUs, in children under 3 with the most severe infections, and in resource-limited settings. Antibiotic resistance contributed to an estimated 840,000 deaths among children under 5 in 2021 — a toll that could grow if rates keep rising.

The gap between rich and poor countries is striking: while resistance to "Access" antibiotics — the recommended first-choice drugs — fell from 48% to 29% in high-income countries, it rose slightly from 44% to 47% in low-income ones. Resistance to broader-spectrum "Watch" antibiotics climbed from 14% to 24% in high-income settings and from 16% to 48% in low-income ones; resistance to last-resort "Reserve" drugs rose from 9% to 25% and from 4% to 37%, respectively. By 2035, the models project "steep increases" in resistance among common critical-priority germs such as Acinetobacter baumannii and Klebsiella.

"These forecasts are warning scenarios, not inevitable outcomes," said study co-author Dr. Yanhong Jessika Hu. "It's real, and it's happening," added Dr. Penelope Bryant of the Murdoch Children's Research Institute — "the visibility is just substantially less than in adults." Since children already have fewer antibiotic options than adults, preserving those options matters all the more.

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