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AMR Guardians of Tomorrow

A Slide Deck for AMR Awareness Workshop for Undergraduate Pharmacy Students (2025)

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About SaS

Superheroes Against Superbugs (SaS) is an educational and public engagement initiative to raise awareness and promote public and policy action on Antimicrobial Resistance (AMR) in India. Visit our website to learn more, sasuperbugs.org

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General notes for the users of this deck

This deck, developed by Superheroes Against Superbugs (SaS), provides a basic outline for conducting a day-long, interactive workshop for UG/PG students enrolled in pharmacy and allied fields, including suggested activities and potential guest speakers. To maximise engagement and learning, keep the workshop dynamic and participatory. Each slide has notes for the workshop facilitator. Refer to the agenda and activities provided on the SaS website to understand the optimal use of this deck.

Setting the tone for the session/workshop:

Begin by clearly explaining the objectives of the workshop, emphasizing the importance of understanding and tackling AMR.
Clarify that while AMR includes a broad range of microbes, including bacteria, viruses, fungi, and parasites, this workshop will specifically focus on bacterial resistance and antibiotics, unless you plan to cover other types of microbes.
At the start of workshop, clearly introduce key terms like Antimicrobial Resistance, AMR, Superbugs, Antibiotics, Stewardship, etc. to ensure everyone understands these concepts before diving deeper. See activities.
Establish ground rules for respectful communication and active participation to create a safe and inclusive learning environment.
Encourage students to ask questions and share their experiences to enhance collaborative learning.

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General notes for the users of this deck

Interactive format:

Incorporate ice-breakers and short group discussions to make students comfortable and encourage interaction. Examples of these have been provided in this deck.
Use a mix of case studies, role-plays, and problem-solving exercises to stimulate critical thinking and practical application of knowledge.
Facilitate Q&A sessions with invited experts to provide up-to-date insights and real-world perspectives on AMR.

Managing the workshop:

Keep sessions interactive by frequently inviting feedback and reflections from participants.
Time management is crucial – stick to the agenda but allow flexibility for meaningful discussions.
Summarize key learnings at the end of each session and the workshop to reinforce understanding and encourage reflection.
Share relevant resources and reading materials to help them explore AMR in more depth.

We thank Dr Vrinda Nampoothiri for her inputs for this deck and to Centirent Pharmaceutical for supporting this work. Contents of this presentation are for non-commercial, educational purposes only. Please write to sasindia2018@gmail.com with any inputs/feedback.

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Workshop at a glance

What is Antimicrobial Resistance (AMR)?

How bugs become resistant to antibiotics — a look at bacteria, antibiotics, and superbugs.

Why has AMR become a public health challenge?

Key drivers of AMR and why it’s a growing threat to global health.

Expert Talks

Learning through Case Studies

Fun Games and

Group Activities

The role of Pharmacists in addressing AMR

How pharmacists can promote responsible antibiotic use and community awareness.

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5

BREAK THE

TABOO

7

AMR EDITION

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Let’s Play TABOO!

Group 1

Group 2

Group 4

Group 3

Each group nominates one member as a hint-giver for Round 1. The hint-giver from the first group comes forward and draws an AMR-related cue card.

The hint-giver provides verbal descriptions to help the team guess the word within 15 seconds. Saying the word, its exact meaning in native language, gestures, sounds, or rhyming hints is strictly TABOO!

If the team guesses the correct word within the given time frame, they get a balloon which represents 10 points. If they fail to do so, they get zero points and the game proceeds with the next group.

The game proceeds for three rounds and the team with the maximum number of balloons wins.

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	GROUP 1	GROUP 2	GROUP 3	GROUP 4
ROUND 1
ROUND 2
ROUND 3
TOTAL

TABOO Score Board!

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Understanding Bugs, Drugs and Superbugs

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How many of us have scraped our knees while playing outdoor games?

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Year 1928, an incident leads to the serendipitous discovery of a special compound.

Compound: Penicillin

Discoverer: Sir Alexander Fleming

Year 1944, first case of infection caused by Penicillin Resistant bacteria was reported.

https://www.sciencedirect.com/science/article/abs/pii/B9780323045797001659

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The Antibiotic Timeline: From Discovery to AMR Crisis

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Source: ReAct

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What is AMR and why you should care?

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What is AMR and why you should care?

AMR occurs when disease-causing microorganisms like bacteria, viruses, fungi, and parasites develop resistance to the drugs that were once effective against them, thus making the infections harder to treat.

Antimicrobial-resistant infections are on the rise due to the irresponsible human use and disposal of antimicrobials such as antibiotics, as well as a lack of new drugs to fight drug-resistant strains.

AMR or drug-resistant infections know no boundaries. Everyone is affected, everyone needs to act!

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What is AMR and why you should care?

Global Threat

causing 700,000 deaths annually worldwide and predicted to increase by 70% by 2050 if no action is taken.

More deaths than even malaria or HIV/AIDS in 2019.

The Silent Pandemic

Despite this, AMR remains an overlooked crisis with low public awareness

Economic burden

could cost the global economy USD 100 trillion by 2050.

LMICs will bear the heaviest burden due to weaker healthcare systems and limited access to new antibiotics.

Compromised public health

limits effectiveness of life-saving treatments & undermines medical advances.

Disproportionately affects vulnerable populations, increasing disparities in healthcare access.

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AMR in India

🔴 297,000 deaths directly caused by AMR in 2019.�🛑 1.04 million deaths linked to AMR the same year (GRAM study)

🦠 India accounts for nearly 27% of global TB cases, with over 1.2 lakh drug-resistant TB (DR-TB) cases in 2022, posing a major AMR challenge (WHO)

�💊 50%+ of global antibiotic prescriptions are inappropriate (WHO)�⚠️ ⅔ of antibiotics at pharmacies are used for self-medication (WHO)

�🌍 India = World's Largest Antibiotic Consumer 📈�🏭 20,000 tons of pharmaceuticals (including antibiotics) produced annually in India (CIDRAP)

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What’s fueling AMR?

Pharma waste pollution

Antibiotics Misuse in Agriculture and Animal Farming

New drug-resistant microbes

Limited healthcare access & low health awareness

Over-the-counter drug misuse

Challenges

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The Making of Superbugs:

How AMR Happens

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AMR is an evolutionary phenomenon...

Source: CDC

Facilitator's note: Use this slide to explain how AMR is an evolutionary phenomenon driven by the principle of "survival of the fittest”. In any population of bacteria, a few are naturally resistant to antibiotics. When antibiotics are used, they kill the bacteria causing illness as well as the beneficial bacteria protecting our body. However, the resistant bacteria survive and, without competition from non-resistant bacteria, they multiply rapidly. These drug-resistant bacteria can then pass on their resistance genes to other bacteria, making the problem worse.

This slide illustrates how human actions, like overusing or misusing antibiotics, accelerate this natural process. By not completing antibiotic courses, using antibiotics unnecessarily, or misusing them in livestock, we create an environment where only resistant bacteria survive and thrive. It is crucial to understand that while resistance is a natural process, responsible antibiotic use can slow down its spread.

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Survival Hack:

How Bacteria Outsmart Threats at the Cellular Level

Source: NIAID, NIH

Facilitator's note: Diagram showing that when bacteria multiply some will mutate. Some of those mutations can make the bacteria resistance to drug treatment. In the presence of the drugs, only the resistant bacteria survive and then multiply and thrive. This slide illustrates how bacteria evolve to resist antibiotics through genetic mutations. Use this visual to help participants grasp the concept of natural selection in microbes��Key points to highlight through this slide: �Bacteria multiply rapidly, increasing the chances of genetic mutations.�Some mutations make bacteria drug-resistant, allowing them to survive in the presence of antibiotics.�Resistant bacteria multiply and thrive, outcompeting non-resistant ones.�Overuse and misuse of antibiotics accelerate this process, making once-effective drugs obsolete.

Discussion prompt: Ask participants: can you think of ways we can slow down this process?��Image source: https://www.niaid.nih.gov/research/antimicrobial-resistance-causes

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Survival Hack:

How Bacteria Outsmart Threats at the Cellular Level

Source: NIAID, NIH

Facilitator's note: How does a bacterial outsmart antibiotics? For that we need to zoom into a bacterial cell. AMR can be acquired at the cellular level through a process known as Horizontal Gene Transfer (HGT). Unlike vertical gene transfer, where genetic material is passed from parent to offspring, HGT allows bacteria to share genes directly with one another, even between different species. This enables rapid spread of resistance traits across bacterial populations. This slide illustrates three main mechanisms of HGT: Transformation, Conjugation, and Transduction.

Transformation: In this process, bacteria pick up genetic material (like resistance genes) from their surrounding environment, which may have come from dead bacteria.

Example: A non-resistant bacterium can become resistant by absorbing DNA fragments from a resistant bacterium that has died.

Conjugation: This is the direct transfer of genetic material from one bacterium to another through a connecting protein tube called a pilus.

Example: Two bacteria come into close contact, and resistance genes are transferred through this pilus, rapidly spreading resistance within a community.

Transduction: Here, bacteriophages (viruses that infect bacteria) carry resistance genes from one bacterium to another.

Example: A virus infects a resistant bacterium, picks up resistance genes, and then infects a non-resistant bacterium, thus transferring the resistance genes.

Key points to emphasise:

Horizontal Gene Transfer allows bacteria to quickly adapt to antibiotics, making AMR spread faster than traditional evolution.

It enables resistance to jump between different species of bacteria, including those that are harmless to humans to those that can cause severe infections.

Understanding HGT is crucial for developing strategies to prevent the spread of resistance genes.

Discussion prompt: Ask participants, “Why do you think it's important to understand how bacteria share resistance genes? How can this knowledge influence our antibiotic use?”

This will help link the science of HGT with practical actions, such as reducing unnecessary antibiotic use and preventing infections to minimise the spread of resistant bacteria.�

Image source: https://www.niaid.nih.gov/research/antimicrobial-resistance-causes

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Antibiotic Susceptibility Test (Disk Diffusion Method)

Facilitator's note: Antibiotic Susceptibility Test (Disk Diffusion Method). This slide shows petri dishes displaying the results of an Antibiotic Susceptibility Test using the Disk Diffusion Method, also known as the Kirby-Bauer Test. This test is used to determine the effectiveness of antibiotics against specific bacteria and to identify antibiotic resistance.

Each dish contains a nutrient agar surface on which bacteria have been spread evenly. White discs are antibiotic-impregnated discs, each containing a different antibiotic.

Zones of inhibition: Clear areas around some antibiotic discs indicate the bacteria are sensitive to that antibiotic; it has inhibited bacterial growth.

Smaller or no clear zones around certain discs suggest that the bacteria are resistant to those antibiotics.

Comparison between plates: The dish on the left shows larger zones of inhibition, indicating sensitivity to most antibiotics. The dish on the right has smaller or no zones of inhibition, suggesting the bacteria are resistant to multiple antibiotics. This illustrates multidrug resistance, a hallmark of AMR.

Key points to emphasise:

How it works? Antibiotics diffuse outward from the discs, and if the bacteria are sensitive, a clear zone (zone of inhibition) forms. If bacteria are resistant, they grow right up to the disc.

Where is this used? This test is commonly used in clinical labs to guide effective antibiotic treatment. It also helps in monitoring antibiotic resistance trends in healthcare settings.

The right dish showcases antibiotic resistance, demonstrating how bacteria can survive even in the presence of multiple antibiotics. This highlights the importance of choosing the right antibiotic based on susceptibility testing to avoid ineffective treatments and slow down the spread of resistance.

�Discussion prompts:

Ask participants, “What do you think would happen if antibiotics were given without doing such a test? Why is it important to know if bacteria are resistant before starting treatment?”

This can lead to discussions on the importance of accurate diagnosis, the dangers of empirical antibiotic use, and how misuse contributes to AMR.

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Role of Pharmacists

in Tackling AMR

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First contact for the patient

Easy to access compared to doctors

A link between patient and doctors

Key role played by

Pharmacist in Healthcare

Credit: Dr Dr Vrinda Nampoothiri

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Regulation of Antibiotics in India

Drugs and Cosmetics Act, 1940 and Drugs and Cosmetics Rules (DCR), 1945 classify all antibiotics as prescription drugs under Schedule H.
In 2014, an amendment introduced Schedule H1 to regulate second- and third-generation antibiotics.
Pharmacists' obligations for Schedule H1 drugs:

Maintain a separate register for sales.
Retain copies of prescriptions.

The Red Line Initiative by Government of India (2016)

Launched to curb antibiotic misuse by marking prescription-only antibiotics with a red line on packaging.
Aimed to raise awareness about responsible antibiotic use and prevent self-medication.

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Monitoring prescription patterns, ensuring compliance with guidelines. Equipping doctors, nurses, and pharmacists with best practices to optimize antibiotic use

Conducting Antibiotic Use Audits & Quality Checks

Training Healthcare Professionals on AMR & Stewardship

Informing patients about correct antibiotic use, risks of self-medication, and adherence

Minimizing incorrect dosages, inappropriate combinations, and prescription errors

Ensuring patients complete their antibiotic courses to prevent resistance

Ensuring Proper Dispensing of Antibiotics

Dispensing only when necessary and preventing overuse or misuse of antibiotics

Providing Patient Education & Counseling

Preventing Medication Errors in Antibiotic Therapy

Encouraging Adherence to Prescribed Antibiotics

Curbing AMR, enhancing patient health, and promoting smart antibiotic use

Safe & Effective Antibiotic Use

Role of Pharmacist in improving antibiotic use

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Be Aware of AWaRe to

save Antibiotics

The AWaRe (Access, Watch, Reserve) classification by WHO helps combat AMR by categorizing antibiotics into three groups based on resistance risk, providing treatment recommendations for 21 infections, and identifying priority antibiotics for monitoring and surveillance to promote responsible antibiotic use globally.

🟢 Access Group (Essential,

Low Resistance Risk)

First-choice antibiotics for common infections
Safe, effective, and widely available
Low risk of resistance

Examples: Amoxicillin, Azithromycin, Cefalexin

🟡 Watch Group (Higher Resistance Potential)

Higher risk of resistance
Use should be monitored closely
Recommended only when first-line options are ineffective

Examples: Ciprofloxacin, Ceftriaxone, Vancomycin

🔴 Reserve Group (Last-Resort Antibiotics)

Used only for confirmed multidrug-resistant infections
Restricted use to prevent resistance spread
Often used in hospitals under strict guidelines

Examples: Colistin, Carbapenems (Meropenem, Imipenem)

Pharmacists should educate patients on responsible antibiotic use, follow AMR stewardship protocols, and advocate for rational prescribing!

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Dispensing Antibiotics:

Key Steps for Pharmacists

Dispense antibiotics only with a valid prescription

Ensure the prescription is from a licensed healthcare provider.

Verify prescription details carefully

Check the date, patient’s name, and doctor’s signature to confirm validity.

Review antibiotic details

Verify the name, dose, frequency, duration, and usage instructions.

If any details are unclear or illegible, contact the prescriber before dispensing.

Check for possible substitutions

If providing an alternate brand, ensure it is an appropriate substitute.

Explain the change to the patient to avoid confusion and ensure adherence.

Beware of look-alike and sound-alike medications

Keep a list of the common medication errors to alert all pharmacists

Credit: Dr Dr Vrinda Nampoothiri

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Effective Patient Counseling on Antibiotic Use

Pharmacists play a crucial role in educating patients about the proper use of antibiotics. Effective counseling helps prevent antimicrobial resistance (AMR), improves adherence, and ensures patient safety.

Credit: Dr Dr Vrinda Nampoothiri

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Effective Patient Counseling on Antibiotic Use

Purpose of the antibiotic (Indication): Explain why the patient is prescribed the antibiotic and what infection it treats.

Correct Usage Instructions: How to take the antibiotic (with or without food, specific timing). Importance of completing the full course even if symptoms improve.

Possible Side Effects & Adverse Reactions: Common and serious adverse drug reactions (ADRs) to watch for. When to seek medical help for severe reactions.

Drug-Drug & Drug-Food Interactions: Warn about interactions with other medications (e.g., antacids, alcohol). Explain any dietary restrictions if applicable.

Contraindications & Special Precautions: Check for pregnancy, liver/kidney conditions, or allergies. Guide patients on what to avoid while on antibiotics.

Preventing the Spread of Infections: Encourage hand hygiene and avoiding self-medication. Explain the risks of misuse and AMR.

Credit: Dr Vrinda Nampoothri

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Antimicrobial stewardship: Optimise antibiotic prescribing practices.

Patient education: Promote responsible antibiotic use and adherence in patients.

Infection prevention: Guide proper hygiene and vaccination practices.

Surveillance and reporting: Monitor antibiotic use and resistance patterns.

Collaboration: Work with healthcare teams for effective AMR management.

.

Community engagement: Raise public awareness about AMR.

Role of Pharmacists in Tackling AMR

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Resist Resistance

Learning through Expert Talks

and Discussion

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Expert Talk

Understanding AMR as a Public Health Challenge and Call for Action

Add Speaker Name & Designation

This individual can be a public health researcher or clinician or any AMR expert

Themes to cover: A detailed overview of AMR and its national and global impact, reasons why AMR is spreading and is becoming a public health priority (include Over the Counter sales as a key reason), the One Health approach to tackle AMR.

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Expert Talk

Role of Pharmacists in tackling AMR

Add Speaker Name & Designation

This individual can be a clinical or community pharmacist

Themes to cover: Antibiotic stewardship – ensuring rational use of antibiotics to reduce misuse, WHO’s AWaRe (Access, Watch, and Reserve) classification system for antibiotics. Patient education—counselling patients on proper antibiotic use and adherence, Infection Prevention—promoting hygiene and vaccination, and surveillance and reporting—participating in AMR surveillance programs. Important government policies for pharmacists.

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Expert Talk

Advances in Antibiotic Research & Drug Development

Add Speaker Name & Designation

This individual can be a pharmacologist, researcher focusing on AMR evolution, drug discovery, pharmaceutical expert

Themes to cover: Investigating how bacteria develop and spread resistance, Antibiotic research and development, new drug targets and antimicrobial compounds, optimising drug dosing to combat resistance, Enhancing the efficacy and safety of antibiotics.

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Resist Resistance:

Learning through Role Play

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Dilwale AMR ko Bhagayenge, Par Kaise?

Act 1, Scene 1

Facilitator’s Note: This role-play exercise is designed to help students reflect on antibiotic use. Assign each character to a student and allow them to enact these scenes. Following which discuss with the actors and audience the right action to take in this scenario. We have intentionally referenced a famous Indian movie (Dilwale Dulhaniya Le Jaayenge) to make the activity more engaging and fun for the audience (mostly Hindi-speaking in our case). Feel free to use similar culturally relevant references to enhance your activities, but be mindful to ensure that they are appropriate and relatable for your audience.The dialogues are in Hindi to keep them as close to the original film as possible, making the activity more relatable and fun for the audience. Ensure that you, or a medically qualified person, are available to facilitate this discussion and provide the appropriate course of action.

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Scenario 1

Simran is back from Europe and has fallen sick. Rajjo ji and Chaudharay Baldev Singh (Simran's parents) are concerned about Simran's Health. What should the parents do to make their darling daughter feel better?

Bauji: Areee Rajjo, Simran ka badan bukhar se tp raha hai. Maine toh kaha tha mt jaane do ise Europe lekin yaha toh sbko apni manmani krni hai… ab pd gayi na bachi beemar. (Oh no, Rajjo, Simran's body is burning with fever. I told you not to let her go to Europe, but no one listens here... now look, the poor girl is sick.)

Rajjo: Ohho Ji! Bematlab itna chilla rahe ho. Ruko mai Thandi Patti rkh deti hu, aur kadha Bana dungi; Dekhna 2 din me Changi ho jayegi hmari bachi… (Oh, come on! There's no need to shout so much. Wait, I'll put a cold compress on her forehead and make some herbal remedy. You'll see, she'll get better in two days...)

Bauji: Aree kaadhe se kuch nahi hoga… pichli baar ise bukhar aya tha doctor ne paracetamol aur kuch antibiotics di thi. Unme se kuch bachi hui hai wo khila dete hain theek ho jayegi…(Herbal remedies won't work... Last time she had a fever, the doctor gave her paracetamol and some antibiotics. There are some left over—let's give her those, she'll get better quickly...)

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Dilwale AMR ko Bhagayenge, Par Kaise?

Act 2, Scene 2

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Scenario 2

Raj and Simran finally get married. Simran has severe diarrhoea that has made her very weak. Help Simran get well.

Simran: Tabiyat badi kharab ho rahi hai meri. (I'm feeling really unwell.)

Raj: Ghabrao nahi, senorita! Bade bade deshon mein aisi choti choti baatein hoti rehti hain. (Don't worry, Senorita! In big countries, little things like this keep happening.)

Simran: Haan, mummy kehti hai gharelu nuskhon se sab theek ho jayega. (Yes, Mom says that home remedies will cure everything.)

(But her stomach makes a grumbling sound.)

Aaaahhh, parrr mera pettttt!!!! (Aaaahhh, but my stomaachhhh!!!!)

Raj: Senorita, mai tumhare liye dawai leke aata hu (Senorita, I’ll go get you some medicine.)

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Scenario 3

Raj has decided to go to his father-in-law, Chowdhary Baldev Singh’s pharmacy shop. Raj approaches, looking worried.

Baldev Singh: Aao, aao, Raj beta. Kya hua? Chehra kyun utra hua hai? (Come, come, Raj my boy. What happened? Why do you look so worried?)

Raj: Namaste babuji. Simran ki tabiyat badi kharab hai. Pata nahi kya khaaya usne, uska pet ekdum kharab hai. (Namaste, Uncle. Simran is very unwell. I don’t know what she ate, but her stomach is really upset.)

Baldev Singh (glaringly): Zaroor fir beer party ki hogi! (Must be because of another beer party!)

Raj: Nahin, nahin. Meri aisi himmat! Ab to main aapka beta hoon. Kya aap mujhe kuch antibiotics de sakte hain, Simran ke liye? (No, no! I wouldn't dare! I’m your son now. Can you give me some antibiotics for Simran?)

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Resist Resistance

Learning through Case Studies

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Case Scenario 1

Addressing Pharmaceutical Pollution: Protecting Public Health and Environmental Sustainability

Case Scenario 2

Regulating Antibiotic Use: Patient Education and AMR Awareness

Case Scenario 3

Antibiotic Overuse in Poultry Farming: Balancing Profitability and Sustainability

Case Scenario 4

The Antibiotic Pandemic: Unveiling the Perils of Unregulated Dispensing in Rapor

Case Scenario 5

Addressing the Antibiotic Discovery Void: Exploring Alternatives in the 21st Century

Let’s Discuss!

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Resist Resistance:

Learning through Quiz

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Jeopardy Style Quiz

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Teams will compete in an interactive Jeopardy-style quiz session.
Each team will have the opportunity to answer questions.
If a team is unable to answer within the given time frame, the question will be passed on to the next team.

There will be 4 themes related to AMR.
Each theme will have 4 different score categories: 100, 200, 300, and 400 points.
Teams will select a theme and corresponding score category for each question.

Questions will appear on the screen.
Teams will have 15 seconds to provide their answer.
If the answer is incorrect, the team will receive 0 points.

Guidelines

Team Competition

Theme & Score Categories

Question Format & Timing

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Jeopardy Jamboree Platform

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Be A Superhero Against Superbugs:

Group Assignments

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Group Assignments

Assignment option 1

Draft a plan to start an AMR Club at your college/institution. Your proposal may include a catchy name and tagline briefly describing the focus of your club.

Outline the objectives, focus areas, activities the club would organize, source of funding (if required for certain activities), process of recruiting members of the club, and an action plan for the first month.
List the roles and responsibilities the members would have.

Assignment option 2

Create a visual infographic to raise awareness on issues related to AMR catered to one of the following target groups:

Local pharmacies (medical stores, retail vendors, etc)
Poultry and Agri farmers
Local public
For your college
Hospitals/Clinics

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Guidelines

What makes an infographic both informative and visually appealing?

A Catchy Title
Key information on the subject
Relevant visuals/Doodles
Clear call to action for your audience
Statistics or data
Slogan(s)

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Share 3 new things you learnt today

and 3 actions you will take to address AMR

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AMR is a global health threat. It affects everyone and everyone has a role to play in tackling this health issue.

Your role as future pharmacists: Be responsible prescribers and educators, ensuring the rational use of antibiotics.

Key actions to combat AMR:

Promote infection prevention and hygiene practices.

Educate patients on the correct use of antibiotics.

Support antimicrobial stewardship programs.

Looking ahead: Innovate and contribute to raising awareness, research in diagnostics, vaccines, and alternative therapies to combat AMR.

Here’s what we learnt today....

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Further Learning Resources

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You all are now