Antibiotics & children

By Tabitha Reefer

During the pandemic, there was a decrease in antibiotic prescribing, which can be contributed to a reduction in bacterial infections from COVID-19 risk-mitigation measures (social distancing, masks, and many schools holding classes virtually or a hybrid model).1 While this is great news, it is not a trend that we foresee being consistent as we have moved into a phase of the pandemic with less masking, social distancing, and most school back in full swing. For reference, shortly before the start of the pandemic, a study found that 1 in 4 kids who get antibiotics in children’s hospitals are prescribed the drugs incorrectly.2 Without further interference, this undesirable situation will likely return of its own accord.

Increased use of antibiotics leads to a further increase in antimicrobial resistance (AMR) with all its consequences. In a recent publication by The Lancet, it became clear that in 2019 a total of 4.9 million people died from the (in)direct effects of AMR.3 There is a large disparity in the death rate among children under five years of age from AMR between high and low/middle-income countries. In high-income countries, under 1,000 children each year lose their life to AMR.4 Meanwhile, in low and middle-income countries, there are almost 253,000 deaths each year.4 In addition to the loss of life, children are highly susceptible to side effects of antibiotics, such as allergic reactions, fungal infections, and diarrhea, with many being treated at the emergency department.1 This not only harms the child physically but also contributes to increased health care costs. Providers have the ability to take the lead to educate parents on watchful waiting, as well as work locally with child care centers to improve policy regarding sick-child exclusion. In addition, experts in the US can assist in increasing stewardship education and policies in the US and globally by joining efforts to engage providers.

The AMR Engagement Group is a new workgroup by and for AMR Insights Ambassadors. This group will focus on education and outreach efforts for children and students around AMR. In this group, experts will have the opportunity to learn from one another, participate in outreach efforts, and lead education with a collaborative spirit. The first focus of this group will be with kids and their caregivers with the implementation of a children’s art competition. Modeled off of an art competition developed by the Pennsylvania Department of Health, this competition will take this state-driven initiative and expand it across the world. AMR Insights will work with Ambassadors to implement the competition in their country, region, or city. Ambassadors will be offered technical and marketing assistance and be enrolled in implementation for their local competition. Provided the needed funding is obtained the local competitions can be integrated to a final global competition with attractive, appropriate prices as well as global attention for the winning children.

We welcome experts from all backgrounds to become Ambassadors with AMR Insights. Together, we can start a global movement towards education to lower the rates of unnecessary antibiotic prescribing for children, increase the awareness of AMR in caregivers, and jointly work towards a decrease of resistant bacteria. To this end a first landing page for ‘Kids and Carers’ has been made available.


  1. Kao-Ping Chua, Anna Volerman, Rena M. Conti. Prescription Drug Dispensing to US Children During the COVID-19 Pandemic. Pediatrics, 2021; e2021049972 DOI: 10.1542/peds.2021-049972
  2. Sauerwein, K. (2020, January 28). 1 in 4 kids who get antibiotics in children’s hospitals are prescribed the drugs incorrectly. Washington University School of Medicine in St. Louis.
  3. Murray, C. J., Ikuta, K. S., Sharara, F., Swetschinski, L., Aguilar, G. R., Gray, A., Han, C., Bisignano, C., Rao, P., Wool, E., Johnson, S. C., Browne, A. J., Chipeta, M. G., Fell, F., Hackett, S., Haines-Woodhouse, G., Hamadani, B. H. K., Kumaran, E. A. P., McManigal, B., … Naghavi, M. (n.d.). Global burden of bacterial antimicrobial resistance in 2019: A systematic analysis. The Lancet, 0(0).
  4.  McDonnell, A., & Klemperer, K. (2022, January 20). Drug-Resistant infections are one of the world’s biggest killers, especially for children in poorer countries. We need to act now. Center For Global Development.



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