The Paediatric Subgroup of SACAR has identified major changes in antibacterial use for children. The number of prescriptions for antibacterials for children in primary care in 2000 was half that in 1996, with amoxicillin still accounting for around 50% of all antibacterial prescribing. There is a marked regional variation in prescribing rates. The UK now has paediatric antibacterial prescribing rates lower than many other European countries at around 700 prescriptions/1000 children/year. The group has been using the General Practice Research Database and Hospital Episode Statistics data to identify trends in clinical disease patterns associated with this change in prescribing practice. Data are also now available from the Health Protection Agency for all paediatric bacteraemias reported over the last decade. In 1992, around 50% of bacteraemias were due to Gram-positive bacteria, but this has increased to over 75% in 2003 with Staphylococcus aureus now becoming the leading significant bacteraemia reported in children. It may now be possible to link existing childhood data sets to develop collaborative prospective antimicrobial surveillance networks, monitoring antimicrobial prescribing, bacterial isolates and clinical outcome data, and to provide updated evidence-based prescribing advice to all prescribers. Adherence to national guidelines and clinical outcome data can then be monitored in turn to provide a continuous audit process aimed at improving prescribing advice and reducing antimicrobial resistance.