Effective treatment of many paediatric infections is threatened by “alarmingly high” rates of antibiotic resistance to commonly prescribed empirical therapies in the Asia–Pacific region, Australian research shows.

A study led by Dr Phoebe Williams from Sydney University’s School of Public Health found many antibiotics recommended by the World Health Organization (WHO) had less than 50% effectiveness in treating childhood infections such as pneumonia, sepsis and meningitis.

The findings, published in Lancet South East Asia (link here), show the most recent 2013 global guidelines on antibiotic use are outdated and need updates, according to Dr Williams, an infectious disease specialist at the Sydney Infectious Diseases Institute.

The researchers analysed data obtained from a systematic review of antibiotic susceptibility data for bacterial pathogens in the WHO SE Asia and West Pacific regions to provide local coverage estimates for aminopenicillins, gentamicin, third-generation cephalosporins and carbapenems.

Based on 6648 bacterial isolates from 11 countries, coverage provided by aminopenicillins in neonatal sepsis/meningitis was 26%, whilst gentamicin coverage was 45% . Third-generation cephalosporin coverage was only 29% in neonatal sepsis/meningitis, 51% in paediatric sepsis and 65% in paediatric meningitis.

Carbapenems were estimated to provide the highest coverage: 81% in neonatal sepsis/meningitis, 83% in paediatric sepsis and 79% in paediatric meningitis.

“In light of the growing burden of [antimicrobial resistance] in these settings, an urgent focus on improving our understanding of the available efficacious therapies that may reduce the morbidity and mortality of serious infections in children is required,” the study author said.

These data call into urgent question the adequacy of coverage currently provided by WHO-recommended first- and second-line antibiotic regimens, they added.

“Evaluation of potential alternative antibiotic regimens, targeted to local pathogen and [antimicrobial resistance] patterns, will be essential to reduce unnecessary morbidity and mortality for children in this region; whilst ensuring antimicrobial stewardship is optimised in the context of rapidly growing [antimicrobial resistance] worldwide, and ensuring antibiotic development programs promptly promote access to new agents to treat multi-drug resistant infections in children globally,” they wrote.

Dr Williams said the study findings should be a wake-up call for the whole world, including Australia, because there are increasing cases of multidrug-resistant bacterial infections in children globally.

“We are not immune to this problem – the burden of anti-microbial resistance is on our doorstep,” she said.

“Antibiotic resistance is rising more rapidly than we realise. We urgently need new solutions to stop invasive multidrug-resistant infections and the needless deaths of thousands of children each year.”

According to Dr Williams, the best way to tackle antibiotic resistance in childhood infections would be to make funding to investigate new antibiotic treatments for children and newborns a priority.

“Antibiotic clinical focus on adults and too often children and newborns are left out. That means we have very limited options and data for new treatments.”

Dr Williams is currently looking into an old antibiotic, fosfomycin, as a temporary lifeline to treat multidrug-resistant urinary tract infections in children in Australia.

She is also working with the WHO’s Paediatric Drug Optimisation Committee to ensure children have access to antibiotics to treat multidrug-resistant infections as soon as possible, to reduce deaths due to AMR among children.