ANTIMICROBIAL resistance in children is an escalating global health threat, responsible for a substantial proportion of infection-related deaths, particularly in those under 5 years of age. In Oceania, a new regional review highlights the growing burden of drug-resistant Gram-positive infections and exposes major inequities in access to effective treatments for children.
Antimicrobial Resistance in Children and Priority Pathogens
The World Health Organization identifies methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus faecium (VRE) as critical bacterial threats. The review shows that paediatric MRSA infections are common across Oceania, accounting for 13–43% of S. aureus infections, with the highest rates reported in Pacific Island Countries and Territories (PICTs). VRE infections in children remain relatively rare at 3–5%, but data from several Pacific regions are limited.
Alarmingly, First Nations children in Australia and Aotearoa New Zealand are disproportionately affected, emphasising the intersection between antimicrobial resistance, health inequity, and access to care.
Treatment Gaps in Antimicrobial Resistance in Children
Despite clear treatment guidelines, access to recommended antibiotics for antimicrobial resistance in children varies widely. In many PICTs, vancomycin is the only intravenous option available for MRSA, while newer agents used in Australia and New Zealand are often unavailable due to cost, regulatory barriers and lack of paediatric licensing.
Paediatric clinical trials have largely focused on safety rather than effectiveness. Only a small number of studies have assessed outcomes in children with MRSA infections, and none included children with VRE. As a result, clinicians often rely on adult data to guide treatment decisions, which may not translate reliably to paediatric patients.
Dosing Challenges and Clinical Implications
Pharmacokinetic and pharmacodynamic studies reveal that standard antibiotic dosing frequently fails to achieve therapeutic targets in children under 12 years. Differences in drug metabolism across age groups mean under-dosing is a real risk, potentially driving treatment failure and further resistance.
For clinicians, this highlights the need for dedicated paediatric dosing studies and clearer therapeutic drug monitoring targets, particularly for commonly used agents such as vancomycin and linezolid.
Why This Matters for Practice and Policy
The review calls for urgent investment in laboratory capacity, antimicrobial resistance surveillance and paediatric drug development, especially in the Pacific region. Advocacy for early paediatric trials, tiered pricing and regulatory support could significantly improve access to life-saving treatments. Without coordinated action, antimicrobial resistance in children will continue to widen health disparities across Oceania, placing the most vulnerable patients at greatest risk.
Reference
Gwee A et al; KIDS DOSE group. Methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus faecium infections in children in the Oceania region: review of the epidemiology, antimicrobial availability, treatment, clinical trial and pharmacokinetic data and key evidence gaps. Lancet Reg Health West Pac. 2025;65:101754.
