WHO has declared that AMR is one of the top 10 global public health threats facing humanity

Overview

Alexander Fleming in 1945 warned about the dangers of antibiotic resistance - “There is danger that the ignorant man may easily underdose himself, and by exposing his microbes to non-lethal quantities of the drug make them resistant.” He is referring to antibiotics, medicines we take to get cured of infections. Right antibiotic in the right dosage is the key to get rid of infections by killing bacteria that cause the infections (can also be referred to as pathogens). 

Recent estimates show that antibiotic resistance is increasing globally and is the one of the biggest healthcare challenges of today and tomorrow !!!

It is important that we understand antibiotic / antimicrobial resistance (AMR). We therefore decided to develop a FUN way of learning about it!!!!

We developed ArMoR - a game to play and learn on different concepts of AMR.

The game is strategic : if you don’t kill the pathogen with appropriate antibiotic dose, you will see more resistant pathogens and you are gonna loose the game. To win, the player needs to have a correct understanding of how antibiotics work. A chatbot (AryaBot) is integrated in the game to provide curated information on a wide range of pathogenic organisms.

The objective of ArMoR is to raise awareness of the issue of AMR by engaging wider society specially school going kids so that they can become game changer in saving us from the scourge of drug resistant bacteria and the healthcare burden associated with it !!.

Endorsed by WHO, India

Features & Learning strategy

We followed Tower Defence genre to design ArMoR... People who are not familiar with it may like to Google it !

ArMoR as of now has two worlds - Skin and Lung infections

Skin world has six levels... each level has one learning message integrated into the game mechanics

• Level 1 

  • Science learning

    • bacteria get into us through wounds

    • bacteria are bad, they try to infect us by getting into our blood

    • antibiotics kill bacteria

    • red blood cells (RBCs)

    • white blood cells (WBCs)

  • Game learning

    • basics of tower defense: 

      • enemies (bacteria), 

      • waves (bacterial attack), 

      • towers (antibiotics), 

      • path (we need to stop them to reach blood), 

      • funds (you need to buy antibiotics), 

      • wave indicator (for you to know how many more to kill before you win the level), 

      • wave countdown (to prepare you for the bacterial attack)

    • help button

Take home message: One must complete full course of antibiotics as prescribed to clear bacteria from an infectious wound. 

Level 2

• Science learning

  • Under the right conditions, when they are well-fed and warmed up, bacteria divide and can quickly reach high numbers. These quickly reproducing bacteria can cause damage and one must therefore identify infections (diagnose) in time and launch appropriate antibiotics attack 

• Game learning

  • When bacteria divide, they can overwhelm our defences. You will need to identify strategic locations to place the antibiotics to kill them early, before they divide!

Take home message: Killing bacteria early prevents them from reproducing too much

Level 3

• Science learning

  • Too much antibiotics leads to resistance - this means that antibiotics that were effective against bacteria (pathogens) earlier stop being as effective and we therefore need to be cautious and DO NOT misuse antibiotics

• Game learning

  • Bacteria become resistant when you use too much antibiotics - they start to show up in different forms (halo, different background colors, shapes)

  • A Resistance Bar is introduced in this level - beware the more the bar is full the higher the chances of leading to resistance and you loosing the game!!

Take home message: Use the right antibiotic dosage as prescribed

Level 4

• Science learning

  • Bacteria can adapt when facing antibiotics - one of the common mechanisms is that they spit out the antibiotics (efflux)

• Game learning

  • Killing bacteria faster by strategically placing antibiotics will not let them adapt.

Take home message: Quick response to infections in right dosage is key to avoid drug-resistant infections

Level 5

• Science learning

  • New antibiotics are discovered to fight drug resistant bacteria. These new antibiotics work in different ways to kill the pathogens

• Game learning

  • New antibiotics are shown as different form and the players must use the new ones to kill the resistant bacteria

  • This new antibiotic is more expensive than the earlier one but its more effective

Take home message: Discovery and development of new antibiotics is very time consuming and expensive, one must use them cautiously. 

Level 6

• Science learning

  •  Different antibiotics work in different ways

• Game learning

  • You can try a new antibiotic that only slows down the bacteria from reaching the blood vessel..you need additional antibiotics to kill them

Take home message: Not all antibiotics kill, some act by slowing growth of the bacteria

The OVERALL message is - DO NOT under dose or over dose - both these lead to drug-resistant bacteria and even a mild wound that gets infected can prove FATAL !!!

There are two additional game levels that UNLOCK only when the player has qualified Level 6 of the Skin world...

Lung world 

We demonstrate combination antibiotics in this level - A classical example of lung infection that needs treatment by several antibiotics at the same time is Tuberculosis - A recent New York times article refers to Tuberculosis as bigger monster than the ongoing COVID-19 pandemic

COVID-19 Level

In light of the ongoing pandemic, we also developed a COVID-19 level, this level conveys the message that antibiotics dont act on viruses and only bacteria can be killed by them. A healthy immune systems can keep the virus in check....

This level is critical as is has been reported that overuse of antibiotics for Covid-19 will cause more deaths - Therefore making it absolutely necessary for a larger community to understand that antibiotics misuse needs to be avoided.

We did several Playtests to seek feedback from several communities around the world to improve the game design.

Game Music

Track: Summertime Fun

Authors: Eric Matyas

https://soundimage.org/wp-content/uploads/2020/07/Summertime-Fun.mp3, https://soundimage.org/positive-upbeat/

Track: Enigmatic and Evolution

Authors: Royalty Free Music from Bensound

https://www.bensound.com/royalty-free-music/track/evolution-epic-nature

https://www.bensound.com/royalty-free-music/track/enigmatic