Introduction: Antimicrobial resistance (AMR) is a global problem. Its important to create awareness of the rational use of antibiotics to curb AMR. Objective: To improve the awareness of the rational use of antibiotics through innovative games for High School Students. Design: Prospective interventional study Setting: Twelve High Schools in the city of Mysuru, South India. Participants: 2195 Students between 13 and 16 years. Intervention: Innovative gamified interventions to educate on the rational use of antibiotics. Use of antibiotics only in bacterial infections of the respiratory tract, gut, urinary tract and skin was introduced through black blackboard. An animated video was shown on the effects of irrational antibiotic use. Situations in which antibiotics can be avoided in respiratory infections and gastroenteritis were taught through Bucketing the Ball and Monkeying with Donkey games. Pre-test and Post-test questionnaires were administered and evaluated. Main outcome measures: To assess the improvement in awareness of the rational use of antibiotics. Results: After the intervention, knowledge of the use of antibiotics only for bacterial infections improved from 11.5% to 82.5% and ill-effects of antibiotics improved from 2.5% to 82.5%. Awareness of when not to use and when to use antibiotics for respiratory infections and gastroenteritis improved from 5.1% to 96.77%, awareness of better use of antibiotics for urinary and skin infections improved from 19.6% to 90.38% and not buying antibiotics directly from the pharmacy without prescription, and completing the antibiotic course improved from 20.3% to 91.92%. p-value < 0.05 for all components. Conclusions: Awareness of the rational use of antibiotics is very poor among the general public. The need of the hour is to create awareness not only among healthcare providers but also among the general public. Innovative gamified interventions create better and long-lasting awareness of this.

The authors have declared no competing interest.

We thank JSS Academy of Higher Education and Research, Mysuru for providing us with the funds to prepare the material for games. Grant number is not applicable.

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Name of Ethical Committee: Institutional Ethical Committee, JSS Medical College, JSSAHER. This study involves human participants but an Ethics Committee(s) or Institutional Board(s) exempted this study because the study did not involve any diagnostic or therapeutic intervention program involving any human subjects. The awareness program was conducted to high school students to educate about rational use of antibiotics and informed consent from each school was taken prior to the scientific awareness program.

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