Posted: November 15th, 2023

Resistance of Antibiotics in Children

# Resistance of Antibiotics in Children

Antibiotics are medicines that can kill or stop the growth of bacteria, which are the cause of many infections. However, antibiotics do not work against viruses, such as those that cause the flu, colds, or most sore throats. When antibiotics are used too often or incorrectly, some bacteria can become resistant to them. This means that the antibiotics cannot kill or stop these bacteria anymore. Antibiotic resistance is a serious threat to public health, especially for children, who are more vulnerable to infections and have fewer treatment options.

## Global Emerging Threats

According to the World Health Organization (WHO), antibiotic resistance causes about 700,000 deaths across all ages every year, of which around 200,000 are newborns . Some of the most common and dangerous bacteria that are resistant to antibiotics include:

– **Methicillin-resistant Staphylococcus aureus (MRSA)**: This is a type of staph infection that can cause skin infections, pneumonia, bloodstream infections, and sepsis. MRSA is resistant to many antibiotics, including penicillins and cephalosporins. MRSA can spread easily in hospitals and communities, especially among children who share toys, clothes, or personal items .
– **Vancomycin-resistant Staphylococcus aureus (VRSA)**: This is a rare but very dangerous type of staph infection that is resistant to vancomycin, one of the last-resort antibiotics for MRSA. VRSA can cause severe and life-threatening infections in the skin, bones, heart, and blood. VRSA can occur in people who have had previous MRSA infections or who have been exposed to vancomycin for a long time .
– **Extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae**: These are a group of bacteria that include Escherichia coli (E. coli) and Klebsiella pneumoniae, which can cause urinary tract infections, wound infections, meningitis, and sepsis. ESBL-producing bacteria can break down many antibiotics, such as penicillins and cephalosporins. They can also be resistant to other antibiotics, such as fluoroquinolones and aminoglycosides. ESBL-producing bacteria can spread through contaminated food, water, or contact with infected people or animals .
– **Carbapenem-resistant Enterobacteriaceae (CRE)**: These are a subset of ESBL-producing bacteria that are also resistant to carbapenems, which are powerful antibiotics used to treat severe infections. CRE can cause fatal infections in the lungs, blood, urinary tract, and surgical sites. CRE can spread through contact with infected people or contaminated medical devices, such as ventilators or catheters .
– **Colistin-resistant bacteria**: Colistin is an old antibiotic that is rarely used because of its toxicity. However, it has been revived as a last-resort treatment for some multidrug-resistant bacteria, such as CRE. Recently, some bacteria have developed resistance to colistin through a gene called mcr-1, which can be transferred between different bacteria. Colistin-resistant bacteria can cause untreatable infections in various organs and tissues .

## Predicting the Near Future

The emergence and spread of antibiotic resistance in children is driven by multiple factors that are specific to the pediatric age group. Some of these factors are:

– **Overuse and misuse of antibiotics**: Many children receive antibiotics unnecessarily or incorrectly for viral infections or mild bacterial infections that can resolve on their own. This exposes them to the risk of developing resistant bacteria and reduces the effectiveness of antibiotics for future infections. Some reasons for the inappropriate use of antibiotics in children include lack of diagnostic tests, parental pressure, lack of guidelines, and poor adherence .
– **Lack of pediatric-specific data and trials**: Many antibiotics are not tested or approved for children, which leads to uncertainty about the optimal dose, duration, safety, and efficacy of these drugs in this population. This also limits the availability and accessibility of new and effective antibiotics for children with resistant infections .
– **Age-dependent changes in pharmacokinetics**: Children are not small adults; they have different physiological characteristics that affect how they absorb, distribute, metabolize, and excrete drugs. These characteristics change with age and development, creating a heterogeneous population that requires individualized dosing based on weight or body surface area. However, many pediatric dosing recommendations are based on extrapolation from adult data or empirical evidence .
– **Contraindications of some antibiotics**: Some antibiotics, such as tetracyclines and fluoroquinolones, are not recommended for children because of their potential adverse effects on bone and cartilage development, teeth discoloration, and tendon rupture. This reduces the therapeutic options for children with resistant infections caused by bacteria that are susceptible to these antibiotics .
– **Congenital malformations and chronic conditions**: Some children are born with or develop conditions that increase their risk of acquiring resistant infections, such as cystic fibrosis, congenital heart disease, immunodeficiency, or cancer. These conditions often require repeated hospitalizations and invasive procedures, such as surgery or catheterization, which expose them to resistant bacteria in the health care setting. These children also need long-term or frequent use of antibiotics, which selects for resistant bacteria in their bodies .

To prevent and control antibiotic resistance in children, urgent actions are needed from all stakeholders, including health care providers, parents, policy makers, researchers, and pharmaceutical companies. Some of these actions are:

– **Implementing antimicrobial stewardship programs (ASPs)**: ASPs are coordinated interventions that aim to improve the appropriate use of antibiotics by selecting the right drug, dose, duration, and route of administration for each patient. ASPs can reduce antibiotic consumption, resistance, adverse events, and costs in pediatric settings. ASPs can include various strategies, such as education, guidelines, audit and feedback, prior authorization, prospective review, de-escalation, and streamlining .
– **Promoting infection prevention and control measures**: Infection prevention and control measures can reduce the transmission of resistant bacteria in health care and community settings. These measures include hand hygiene, environmental cleaning, isolation precautions, vaccination, screening and decolonization, and rational use of personal protective equipment .
– **Enhancing surveillance and monitoring systems**: Surveillance and monitoring systems can provide timely and accurate data on the prevalence, trends, and patterns of antibiotic resistance in children at local, national, and global levels. These data can inform clinical decisions, policy interventions, research priorities, and public awareness. Surveillance and monitoring systems can also track antibiotic consumption, prescribing practices, and stewardship outcomes in pediatric settings .
– **Increasing research and innovation**: Research and innovation are essential to develop new and effective antibiotics for children with resistant infections. However, there are many challenges and barriers that hinder the discovery and development of pediatric antibiotics, such as scientific complexity, regulatory hurdles, ethical issues, market failures, and lack of incentives. Therefore, there is a need for more collaboration and coordination among academia, industry, government, and non-governmental organizations to overcome these challenges and create a conducive environment for research and innovation .
– **Raising awareness and education**: Awareness and education are key to change the behavior and attitude of health care providers, parents, and children regarding the appropriate use of antibiotics. Awareness and education campaigns can increase the knowledge and understanding of antibiotic resistance and its consequences among different audiences. They can also promote the adoption of best practices and evidence-based guidelines for antibiotic prescribing and use in pediatric settings .

## Conclusion

Antibiotic resistance is a growing problem that threatens the health and survival of children around the world. It is caused by multiple factors that are specific to the pediatric age group. It is also associated with high morbidity, mortality,
and economic burden. To prevent a post-antibiotic era where simple infections might cause infant death once again,
urgent actions are needed from all stakeholders to improve the appropriate use of antibiotics,
prevent the transmission of resistant bacteria,
enhance the surveillance and monitoring systems,
increase the research and innovation,
and raise the awareness and education about this issue.

## References

: Antibiotic resistance in children is becoming a bigger problem around the world. KGOU News. https://www.kgou.org/health/2023-11-07/antibiotic-resistance-in-children-is-becoming-a-bigger-problem-around-the-world (accessed Nov 14 2023).

: Antibiotics warning as kids dying from sepsis due to resistance to drugs. Mirror News. https://www.mirror.co.uk/news/health/kids-dying-unnecessarily-pneumonia-sepsis-31366054.amp (accessed Nov 14 2023).

: Vancomycin-resistant Staphylococcus aureus (VRSA) Infections write my dissertation thesis | HAI | CDC. Centers for Disease Control
and Prevention. https://www.cdc.gov/hai/organisms/vrsa/vrsa.html (accessed Nov 14 2023).

: Extended-spectrum beta-lactamases (ESBL) | HAI | CDC. Centers for Disease Control
and Prevention. https://www.cdc.gov/hai/organisms/ESBL.html (accessed Nov 14 2023).

: Carbapenem-resistant Enterobacteriaceae (CRE) infection