62 Commonwealth Health Partnerships 2014 Infections, such as pneumonia, diarrhoea and malaria, account for over 30 per cent of under-five child deaths in the world (Walker et al., 2013). When under-nutrition, a known predictor of mortality, affects over half of under-five children, the contribution of antimicrobial resistance (AMR) to infection-related clinical outcomes becomes difficult to tease apart (Black et al., 2013). The impact of AMR is highest in poorer countries, where the infectious disease burden is large (due to poor hygiene, polluted water supplies, malnutrition and sub-optimal vaccination) and inappropriate antibiotic use is unchecked. Even in the highest-income countries, in the face of a dry new-antibiotic pipeline and rising resistance among nosocomial pathogens, continued efforts to contain AMR are essential. A global co-ordinated effort is now imperative and networks such as the Commonwealth of Nations, through which sovereign states can associate, and share resources and efforts towards common goals, can be useful conduits. This article deals with AMR trends reported among common childhood pathogens, case examples of successful containment strategies, and gaps in recommendations and ground realities in Commonwealth countries. AMR trends and childhood diseases Newborn sepsis Recent studies reporting on aetiology and resistance trends in early and late onset newborn sepsis within Commonwealth Asia and Africa show similar gram-negative preponderance and resistance trends reported earlier in developing countries (Waters et al, 2011; Zaidi et al., 2009). 1 The use of Group B streptococci prophylaxis in the Americas has been linked to the increase in ampicillin resistant E. coli from 1988 to 2000. 2 Pneumonia/meningitis Epidemiologic data suggests that asymptomatic nasopharyngeal carriage of Streptococcus pneumonia may represent an important reservoir of resistant strains in the community. Most of the 156 million new pneumococcal pneumonia episodes each year occur in India (43 million), China (21 million), Pakistan (ten million) and Bangladesh, Indonesia and Nigeria (six million each; Rudan et al., 2008). 3 Diarrhoeal and enteric pathogens Vibrio cholerae, Salmonella sp., Shigella sp., Escherichia coli and Campylobacter sp. are endemic in Sub-Saharan Africa and South Asia with high rates of antimicrobial resistance. Increasing V. cholerae resistance to not only the World Health Organization (WHO) recommended ciprofloxacin, but also other antibiotics including tetracycline, ampicillin, chloramphenicol, azithromycin and third generation cephalosporins, increases disease severity and complexity in addition to treatment costs. Resistance to ciprofloxacin, among campylobacter jejuni, has been linked to injudicious use of floroquinolones in poultry (reservoir of organism; Laxminarayan et al., 2013). Rates from five to 38 per cent have been reported from Bangladesh, India and Ethiopia. Almost 60 per cent of Salmonella enterica serovar Typhi and Paratyphi isolates, from regions of highest disease burden (South/Central Asia and Africa) are multi-drug resistant (Kariuki et al., 2010; Ochiai et al., 2008). The global increase in multidrug resistance (resistance to ampicillin, chloramphenicol and co- trimaxazole) against S. enterica ser. Typhi is associated with greater severity and higher case-fatality rates (World Health Organization, 2009). Improving and measuring antibiotic use WHO recommends surveillance as a key strategy to address the growing global problems associated with AMR and extends systems support in the form of recommendations. Supranational and national surveillance networks Active supranational networks include Integrated Disease Surveillance and Response (IDSR), co-ordinated by the WHO regional office for Africa; the Red Latinoamericana de Vigilancia de la Resistencia a los Antimicrobianos (ReLAVRA), co-ordinated by the Pan American Health Organization; and the European Antimicrobial Resistance Surveillance Network. These systems help inform appropriate indicators (scientific, population and systems data) for an antibiotic resistance information database. Microsoft Windows-based software (WHO Surveillance Software – WHONET) can be used to enter AMR data and, for countries with Laboratory Information Systems (LIS), import data from LIS through a WHO-developed BacLink data conversion facility. WHONET is currently used in over a hundred countries worldwide. Programmes like SENTRY, The Surveillance Network (TSN), CIPARS, CNISP, the Canadian National Centre for Streptococcus and the Canadian Tuberculosis Laboratory Surveillance System are electronic surveillance databases that collect qualitative and quantitative AMR test results from participating clinical laboratories and co-ordinated surveillance studies. Antimicrobial resistance: A Commonwealth perspective Fatima Mir, Farah Naz Qamar and Zulfiqar A. Bhutta