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.

Antimicrobial resistance poses a significant threat to children's health, with up to 20% of 1.27 million deaths attributable to bacterial AMR annually, occurring in children <5 years. The WHO 2024 Bacterial Priority Pathogens List identifies methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus faecium (VRE) as critical pathogens. This review examines the epidemiology, treatment recommendations, dosing strategies, efficacy, and safety data for antibiotics targeting MRSA and VRE infections in children in Oceania. Paediatric MRSA infections are prevalent (13-43%) across Oceania, while VRE infections remain uncommon (3-5%). Disparate access to recommended treatments, particularly in Pacific Island Countries and Territories, highlights the need for paediatric licensing. Paediatric trials primarily assess safety, with efficacy data limited to vancomycin, teicoplanin, and daptomycin. Pharmacokinetic/pharmacodynamic studies show standard dosing in children under 12 years often fails to achieve therapeutic targets, highlighting the need for dedicated dosing studies. Addressing these gaps is essential to advancing paediatric access to optimal treatment for drug-resistant infections in the region.