“Alarming” rates of babies with infections resistant to common antibiotics in the Asia-Pacific region should prompt urgent investment into new drugs for treating childhood diseases, findings from a new study suggest.
The misuse and overuse of antibiotics is driving bugs to mutate so that common drugs are no longer effective to kill them, known as antimicrobial resistance. Dr Phoebe Williams, an infectious diseases paediatrician and antimicrobial resistance researcher with the University of Sydney, said she regularly travelled to work in hospitals in the south-east Asia and Pacific region where she found “entire wards of babies that have multi-drug resistant infections, and there is nothing left to treat them with”.
“In the Philippines, for example, you might see wards where there are two babies to one cot, they’re just so overcrowded and staff are doing their best to keep these premature babies alive,” she said.
“Once an antibiotic-resistant bug gets in and infects one baby, it spreads like wildfire. You might see one nurse doing their best to look after 20 babies on a shift and they might not have time to wash their hands between each of those critically unwell babies, and on top of that, they often don’t have the laboratory facilities and range of drugs available that other wealthier countries do.”
To better understand the scale of antimicrobial resistance in the region, Williams and her colleagues analysed all of the existing reliable research on rates of antimicrobial resistance in children across 11 countries in the decade to 2021. They then compiled data on the resistance of each of the bacteria identified to different antibiotics, doing so for individual strains of each bacteria.
They then applied sophisticated mathematical modelling to the data to determine resistance rates in the south-east Asia and Pacific region.
“We have revealed some really alarming rates of antimicrobial resistance that are much worse than we even anticipated,” Williams said.
Many antibiotics recommended by the World Health Organization (WHO) had less than 50% effectiveness in treating childhood infections such as pneumonia, sepsis (bloodstream infections) and meningitis, the study, published in the journal Lancet South East Asia, found.
The antibiotic Ceftriaxone was found likely to be effective in treating just one-third of cases of sepsis in newborns and one-third of cases of meningitis in newborns. Another antibiotic, gentamicin, was found likely to be effective in treating just 45% of newborn sepsis and meningitis cases.
The WHO guidelines for treating serious antimicrobial infections in children were last updated a decade ago. “We need to update the guidelines, but one of the biggest problems is we’re just not getting new drugs licensed for use in children and babies so there isn’t really much new to recommend,” Williams said.
Since the year 2000, more than 14 new antibiotics have been licensed for adults, but only four of them have been licensed for use in babies because drug companies are reluctant to do research on babies and children, she said.
“Where there are new options, sometimes it’s only the rich countries that can afford them.”
Williams said well-resourced countries such as Australia must dedicate enough funding to researching new drugs and international guidelines should ensure less wealthy countries also have access these treatments.
It is estimated that around 700,000 people die from antimicrobial-resistant infections globally each year, more than annual deaths from malaria, Dr Sanjaya Senanayake, an infectious diseases specialist and associate professor of medicine with the Australian National University, said.
“If the current tide is not turned, it is estimated that up to 10 million people a year will die from such infections by 2050, a number equivalent to the annual deaths from cancer,” he said.
Williams’ findings have implications for Australia, he said. “Australian tourists regularly visit those regions and vice versa, which is why every infectious diseases physician in Australia takes a travel history from an acutely unwell child or adult in hospital.
“The ease of global travel has made the world of infections and antimicrobial resistance a much smaller space.”
