Alarming Decline in the Effectiveness of Antibiotics for Common Childhood Diseases: What Can Be Done

Urgent action needed to update guidelines and improve antibiotic stewardship globally.

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A ticking time bomb—that’s how experts describe the alarming decline in effectiveness of common childhood antibiotics revealed in a new study.

Led by University of Sydney researchers, the findings suggest many go-to antibiotics doctors rely on to treat serious infections like pneumonia and meningitis in kids are not working in a significant number of cases, putting young lives at risk, especially in South-East Asia and Pacific regions.

With antibiotic resistance rising globally, the study highlights the urgent need to update outdated prescribing guidelines before it’s too late.

Some Major Antibiotics Now Less Than 50 Percent Effective

To understand the scale of antimicrobial resistance, researchers analyzed existing studies on resistance rates in children across 11 countries from 2011-2021. They compiled data on bacteria resistance to various antibiotics and used modeling to determine resistance rates in Southeast Asia and the Pacific.

The most recent antibiotic use guideline from the World Health Organization (WHO) was published in 2013 and recommends antibiotics that the researchers analyzed. The findings, published in the journal Lancet South East Asia, suggest that many of the antibiotics recommended by the WHO for common childhood infections like pneumonia, sepsis, and meningitis were less than 50 percent effective. The findings also highlight the need for the WHO to consider different antibiotics tailored to specific local bacteria and resistance patterns.

Some antibiotics were particularly ineffective.

The widely used ceftriaxone was likely effective in just one in three cases of neonatal sepsis or meningitis.

Gentamicin, often prescribed with aminopenicillins, a group of antibiotics in the penicillin family, treated less than half of all pediatric sepsis and meningitis cases, while aminopenicillins also showed low efficacy against childhood bloodstream infections.

How Bad Is the Problem in the U.S.?

In the U.S., antibiotic resistance has risen to dangerously high levels in recent years.

Antibiotic-resistant bacteria cause more than 2.8 million infections and 35,000 deaths in the United States each year, according to the U.S. Centers for Disease Control and Prevention.

The U.S. Food and Drug Administration plays a role in the U.S. government’s coordinated response to antimicrobial resistance. Multiple FDA centers work to preserve current antimicrobial effectiveness and promote new products to combat antimicrobial resistance bacteria.

According to the CDC’s 2019 Antibiotic Resistance Threats Report, nationwide investments in prevention led to an 18 percent decrease in deaths from antimicrobial-resistant infections between 2012 and 2017. CDC data indicates this downward trend continued until 2020.

However, the COVID-19 pandemic resulted in setbacks, with more resistant infections emerging, increased antibiotic use, and less surveillance data and prevention efforts overall. In fact, there was a 15 percent increase in infections and deaths from drug-resistance bacteria in the first year of the pandemic. Antibiotics were often being given to patients even though they don’t treat viral infections.

What Causes Antibiotic Resistance?

Antibiotic resistance can occur when bacteria are treated with antibiotics. A few bacteria may survive and evolve to resist the drug’s effects in various ways, like stopping the antibiotic from working, flushing it out of their system, or mutating to make it ineffective.

These resistant strains can then spread, causing difficult to treat infections and transferring resistance to other bacteria. One study found that in areas where particular antibiotics are used more frequently, resistance to those antibiotics is higher.

Inappropriate antibiotic selection for pharyngitis (sore throat) and sinus infections increased adverse events in adults compared to penicillin-based antibiotics, a study published in March found.

In a separate study, the use of non-first-line antibiotics to treat either of those two infections was associated with increased risk of adverse drug events, compared to using a penicillin-based antibiotic. Using non-first-line antibiotics was associated with nearly triple the risk of Clostridioides difficile (C. diff), a bacterium that causes diarrhea.

When C. diff bacteria exist in your gut, they coexist with beneficial bacteria that prevent harm. However, when you take antibiotics for another infection, the medication might eliminate the beneficial bacteria, enabling C. diff bacteria to thrive and multiply.

Can Antibiotics Resistance Be Stopped?

Antibiotic resistance is a “fact of life” because antibiotics are simply overused, Dr. Theodore Strange, chair of medicine, Staten Island University Hospital, part of Northwell Health in New York, told The Epoch Times.

“We have seen antibiotic resistance in probably almost every antibiotic that has ever been developed and known to man,” he added. “Every time we use a new one, the bugs are smart enough to know how to get around and cause antibiotic resistance again.”

Antibiotic stewardship is the key to dealing with this issue, according to Dr. Strange.

“We need to treat the appropriate patient with the appropriate antibiotic and not shotgun and treat with more antibiotics than we should be using,” he said. “That’s the root of the problem.”

The only way the problem with antibiotic resistance will be fixed is antibiotic stewardship—treating patients with the right antibiotic at the right dose, not over-prescribing, Dr. Strange added. The solution is changing prescription habits and culture, not just developing new antibiotics.

The other problem is how people perceive the effectiveness of these powerful, at times life-saving drugs. A systematic review showed that the prevalence of self-medication with antibiotics is roughly 50 percent in the southeast Asian region, and antibiotics are frequently supplied without prescription in many countries.

“Patients think of antibiotics sometimes as, you know, they’re cure-alls, right? They’re not cure-alls,” Dr. Strange said. “They don’t treat the common cold. They don’t treat the allergic rhinitis. They don’t treat most upper respiratory symptoms that occur when they walk into your office.”