RAYAT- BAHRA INSTITUTE OF PHARMACY, HOSHIARPUR

PROJECT REPORT OF

PRACTICE SCHOOL (BP706PS)

ON

( HARNESSING AI TO COMBAT THE THREAT OF ANTIBIOTIC RESISTANCE )

SUBMITTED BY

HARJOT SINGH, B.PHARMACY ( 7th Sem )

( ENROLLMENT NO. 2117141 )

UNDER THE GUIDANCE OF

Dr. AMIT SHARMA, M.PHARM, PHD

( PROFESSOR IN PHARMACOLOGY)

Ms. SHRUTI, M.PHARM

(ASSISTANT PROFESSOR IN PHARMACOLOGY)

IN

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 CERTIFICATE

This is to certify that the project entitled “Harnessing AI To Combat The Threat Of Antibiotic
Resistance” which is submitted in the partial fulfillment of the requirement for the degree of Bachelor of
Pharmacy, embodies the work carried out by Harjot Singh (Reg no.-2117141) himself under the guidance
of Dr. Amit Sharma and co-supervision of Ms. Shruti at Rayat Bahra Institute of Pharmacy, Hoshiarpur,
Bohan-146001.

Supervised by:
Dr. Amit Kumar Sharma
(Professor in Pharmacology)
(Rayat Bahra Institute Of Pharmacy, Hoshiarpur)

Co-Supervised by :
Ms. Shruti
(Associate Professor Of Pharmacology)
(Rayat Bahra Institute Of Pharmacy, Hoshiarpur)
Date:- ______________.
 DECLARATION

I declare that the project titled “Harnessing AI to Combat the Threat of Antibiotic Resistance” is a record
of original research work carried out by me under the supervision of Dr. Amit Kumar Sharma and co-
supervision of Ms. Shruti . This work is submitted in partial fulfillment of the requirements for Bachelor’s
Of Pharmacy at Rayat Bahra Institute Of Pharmacy.

I affirm that this project is the result of my own work, and it has not been submitted previously, in whole or
in part, for any other degree or examination. Proper acknowledgment has been given where external sources
have been used.

Student Name: Harjot Singh

University Roll no.:- 2117141

Supervisor: Dr. Amit Kumar Sharma

Co-Supervisor: Ms. Shruti

Date:- ________________.
 ACKNOWLEDGEMENT

With profound gratitude, I wholeheartedly acknowledge that the successful completion of this work is one of
the many blessings from “GOD,” who has continuously bestowed blessings upon me since before I could
even realize or acknowledge them. It is truly challenging to find words eloquent enough to express my
gratitude to my Creator.

I sincerely acknowledge and deeply appreciate the academic guidance and continuous intellectual support of
my supervisor. Without his profound expertise and insightful understanding of the subject, this work would
not have been possible. I am profoundly grateful for his unwavering commitment to helping me achieve this
goal.

I must also express my ineffable indebtedness towards Dr. Chandar Mohan, Chairman, and Dr.
Maninder Pal Singh, Director Principal of Rayat Bahra Institute of Pharmacy, Hoshiarpur, whose
consistent encouragement, keen observations, understanding, and thoughtful guidance helped me overcome
various challenges throughout this journey.

My heartfelt thanks go to my esteemed teachers, especially Ms. Shruti and the Head of the Department,
Dr. Amit Sharma, for their assistance in helping me comprehend the complexities of the urinary tract
system. I am also grateful to Ms. Priyanka Rani for her valuable guidance and assistance during my
experimental work.

Finally, I extend my deepest gratitude to those who mean the most to me—my parents, Mr. Labh Singh and
Mrs. Mandeep Kaur. Their faith in me and their support in allowing me the freedom to pursue my desires
have been invaluable. I am forever indebted to them for their selfless love, care, and sacrifices, which have
shaped my life.

I also thank a very special person, my friend, who has always been by my side, offering continuous support
and encouragement. I greatly value his contribution and deeply appreciate his belief in me.

Though I may not mention every individual by name, please know that none of your contributions are
forgotten.
 TABLE OF CONTENTS

Sr.no. Contents Pg.no.

1. A Review on Harnessing AI To Combat The Threat Of Antibiotic 6-25
Resistance
2. To study introduction Of pharmacy practice in India 26-27

3. Clinical pharmacy international prospective 28-29

4. To study ADR 29-37

5. To study LAB Interpretation 37-43

6. Case study 44 - 44

7. References 45-46
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INTRODUCTION

Antibiotic resistance has emerged as a critical global health issue, leading to significant morbidity, mortality,
and economic burden. As bacteria evolve mechanisms to evade existing treatments, the effectiveness of
available antibiotics diminishes, prompting the urgent need for innovative solutions. One such solution is the
integration of Artificial Intelligence (AI) into healthcare systems. AI, with its ability to analyze vast datasets
and identify patterns, is now being leveraged to address this crisis by optimizing diagnostics, predicting
resistance trends, and supporting drug discovery efforts.[1]

Key aspects of this AI-driven approach include:

Enhanced Diagnostics: Traditional methods for identifying antibiotic-resistant infections are often slow and
reliant on lab cultures. AI-driven diagnostics enable faster detection of resistant pathogens by analyzing
clinical data, offering near real-time results. This helps healthcare providers make more informed treatment
decisions, reducing the risk of ineffective antibiotic use.

 Predictive Modeling: AI’s use in predictive analytics is crucial for forecasting resistance patterns.
Machine learning algorithms are trained on historical patient data, treatment outcomes, and pathogen
behaviour to predict future resistance trends.
This allows for proactive interventions, helping to prevent outbreaks and reduce the spread of resistant
strains.
 Drug Discovery and Development: AI plays a significant role in identifying new antibiotic candidates
and repurposing existing drugs. Through AI-powered drug discovery, researchers can screen thousands
of chemical compounds efficiently, narrowing down those most likely to combat resistant bacteria
This accelerates the process of finding new treatments, which is essential in the face of rapidly evolving
pathogens.
 Personalized Medicine: With AI’s ability to analyze patient-specific data, including genetic profiles and
medical histories, it paves the way for personalized medicine. By tailoring antibiotic treatments to

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individual patients based on predicted responses, AI helps avoid the overuse of broad-spectrum
antibiotics, one of the major drivers of resistance.

Overall, the combination of AI’s diagnostic, predictive, and therapeutic capabilities represents a promising
frontier in the fight against antibiotic resistance.

However, successful implementation requires overcoming challenges related to ethical concerns, data
privacy, and the integration of AI into existing healthcare infrastructures.

1. Background of Antibiotic Resistance

Antibiotic resistance (ABR) is a pressing global health concern that arises when bacteria develop the ability
to resist the effects of medications that once effectively treated them. This phenomenon is not only a result
natural

selection but also significantly influenced by human activities, including the overuse and misuse of
antibiotics in both healthcare and agriculture. Understanding the multifaceted background of antibiotic
resistance is crucial for addressing this challenge.[2]

1. Key Factors Contributing to Antibiotic Resistance

 Overprescription of Antibiotics: One of the primary drivers of ABR is the overprescription of
antibiotics by healthcare providers. Many patients demand antibiotics for viral infections, where they
are ineffective. This practice contributes to the unnecessary exposure of bacteria to these drugs,
promoting resistance.
 Agricultural Use: Antibiotics are widely used in livestock and poultry to promote growth and
prevent disease, even in healthy animals. This routine use can lead to the development of resistant
bacteria, which can then be transmitted to humans through the food chain.
 Poor Infection Control: Inadequate infection control measures in healthcare settings can lead to the
spread of resistant strains among patients. In hospitals, where vulnerable populations are treated, the
consequences of ABR can be particularly severe, resulting in longer hospital stays and increased
mortality.
 Lack of New Antibiotics: The pharmaceutical industry has seen a significant decline in the
development of new antibiotics. As resistance continues to rise, the pipeline for novel drugs has
slowed, leaving fewer treatment options available. This gap highlights the urgent need for innovation
in antibiotic development.
 Global Travel and Trade: The increase in global travel and trade facilitates the rapid spread of
resistant bacteria across borders. Infections that may have been confined to one geographic area can
quickly become a global threat, complicating efforts to control outbreaks.[3]
2. The implications of ABR are profound and far-reaching:

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 Increased Morbidity and Mortality: Infections caused by resistant bacteria can lead to higher rates
of complications and death. Patients with resistant infections often require longer hospital stays and
more expensive treatments, straining healthcare systems.
 Economic Burden: The economic impact of ABR is staggering. In the United States alone, the CDC
estimates that antibiotic-resistant infections cost the healthcare system approximately $20 billion
annually in direct healthcare expenses and an additional $35 billion in lost productivity.
 Threat to Medical Procedures: Many medical procedures, such as surgeries and chemotherapy, rely
on effective antibiotics to prevent and treat infections.

 The rise of ABR threatens the safety of these procedures, potentially leading to increased risks for
patients undergoing such treatments.
3. Global Response to Antibiotic Resistance
Efforts to combat antibiotic resistance are gaining momentum internationally. Various organizations,
including the World Health Organization (WHO) and the Centres for Disease Control and Prevention
(CDC), advocate for comprehensive strategies to address this crisis. Key strategies include:
 Antimicrobial Stewardship Programs: These programs aim to optimize the use of antibiotics
through evidence-based guidelines, ensuring that antibiotics are prescribed only when necessary.
 Public Awareness Campaigns: Educating the public about the risks associated with antibiotic
misuse is essential in changing prescribing practices and reducing demand for unnecessary
antibiotics.
 Research and Development Initiatives: Increased investment in research for new antibiotics and
alternative therapies is critical. Innovative approaches, such as bacteriophage therapy and vaccine
development, are being explored as potential solutions.[3]

2. Role of Artificial Intelligence in Combating Antibiotic Resistance

The increasing threat of antibiotic resistance (ABR) has catalyzed a search for innovative solutions, and
artificial intelligence (AI) has emerged as a transformative tool in this arena. AI encompasses various
technologies, including machine learning and data analytics, which can significantly enhance our ability to
combat ABR through improved diagnostics, predictive modeling, drug discovery, and personalized treatment
strategies.

1. Enhanced Diagnostics

AI-driven diagnostic tools facilitate rapid and accurate identification of antibiotic-resistant pathogens.
Traditional microbiological methods often require time-consuming laboratory processes to determine
resistance patterns. In contrast, AI algorithms can analyze patient data, including electronic health records
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and laboratory results, to provide real-time insights into resistance profiles. For instance, researchers have
developed machine learning models that can predict the susceptibility of pathogens to specific antibiotics
based on genomic data. This rapid identification can lead to timely and appropriate antibiotic prescriptions,
minimizing the risk of resistance development.[4]

2. Predictive Modeling

AI plays a critical role in predicting antibiotic resistance trends by analyzing large datasets from various
sources, including hospitals and public health databases. By employing machine learning techniques,
researchers can identify patterns and factors contributing to resistance, enabling proactive public health
responses.

For example, predictive models can forecast outbreaks of resistant infections and inform antibiotic
stewardship programs, helping healthcare systems allocate resources effectively.

3. Drug Discovery and Development

The drug discovery process has traditionally been lengthy and costly, often taking over a decade to develop
new antibiotics. AI accelerates this process by utilizing algorithms to screen vast libraries of chemical
compounds and predict their effectiveness against resistant bacteria. Machine learning can identify
promising candidates for further development, significantly shortening the time frame for new drug
discovery. Recent studies have demonstrated that AI can also aid in repurposing existing drugs for new
indications, potentially providing effective treatments for resistant infections without starting from scratch.

4. Personalized Treatment Strategies

AI’s ability to analyze individual patient data allows for the development of personalized treatment
strategies tailored to the specific characteristics of a patient’s infection. By integrating genomic data and
clinical history,

AI can recommend the most effective antibiotics for a particular patient, reducing the likelihood of
prescribing broad-spectrum antibiotics that contribute to resistance. This precision medicine approach not
only improves treatment outcomes but also helps in preserving the efficacy of existing antibiotics.[4]

5. Challenges and Ethical Considerations

While the potential of AI in combating ABR is significant, several challenges must be addressed. Data
privacy concerns, the need for high-quality datasets, and the integration of AI systems into existing
healthcare infrastructures pose barriers to implementation. Furthermore, the ethical implications of using AI,
particularly in decision-making processes, require careful consideration to ensure accountability and
transparency.

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PROJECT SCOPE AND OBJECTIVES
PROJECT SCOPE

The scope of this project encompasses a comprehensive exploration of the role of artificial intelligence (AI)
in combating antibiotic resistance (ABR). Given the urgent and escalating nature of ABR as a global health
crisis, this project will analyze various dimensions where AI can make a significant impact. It will involve:

1. Literature Review: Conducting a thorough review of existing research on antibiotic resistance, its
causes, and the current landscape of AI applications in healthcare. This will include academic papers,
case studies, and reports from reputable health organizations like the World Health Organization
(WHO) and the Centers for Disease Control and Prevention (CDC).[5]

2. Technological Assessment: Evaluating the different AI technologies that are being applied in the
context of antibiotic resistance. This will include machine learning, natural language processing, and
predictive analytics, as well as the latest advancements in AI algorithms that enhance diagnostic
capabilities and drug discovery processes.
3. Case Studies: Analyzing real-world applications of AI in combating ABR. This will involve
studying successful implementations in hospitals and research institutions, examining how AI has
been utilized to improve patient outcomes, optimize antibiotic prescribing practices, and support
antimicrobial stewardship initiatives.[5]
4. Data Analysis: Exploring the datasets used in AI applications, including patient data, microbial
genomic sequences, and clinical outcomes. Understanding data quality, availability, and ethical
considerations related to data usage in healthcare will also be a critical aspect of this analysis.
5. Stakeholder Engagement: Engaging with healthcare professionals, researchers, and policymakers
to gather insights and opinions on the current state and future potential of AI in addressing antibiotic
resistance. This will include interviews, surveys, and participation in relevant conferences or
workshops.
6. Recommendations and Strategies: Developing actionable recommendations for healthcare
providers, researchers, and policymakers on effectively integrating AI into existing systems to
combat antibiotic resistance. This will also include suggestions for future research areas and
technological developments that could further enhance the fight against ABR.[6]

OBJECTIVES

The primary objectives of this project are outlined below:

1. To Analyze the Impact of Antibiotic Resistance:

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 Objective: Understand the scope and scale of antibiotic resistance as a global health threat.
 Justification: By analyzing data from the WHO and CDC, this project aims to highlight the
consequences of ABR on public health, healthcare costs, and treatment efficacy. This objective will
provide a foundational understanding of why AI interventions are necessary.
2. To Evaluate the Role of AI in Diagnostics:
 Objective: Assess how AI technologies are improving the rapid and accurate diagnosis of antibiotic-
resistant infections.
 Justification: Timely diagnostics are crucial for effective treatment and can prevent the unnecessary
use of antibiotics. By examining case studies and existing literature, the project will highlight
specific AI applications that have demonstrated success in diagnostic settings.[6]
3. To Investigate Predictive Modelling for Resistance Patterns:

 Objective: Explore how AI-driven predictive modeling can forecast resistance trends and support
public health strategies.
 Justification: Understanding future resistance patterns allows for proactive measures, enabling
healthcare systems to allocate resources effectively and develop targeted antibiotic stewardship
programs.
4. To Explore AI in Drug Discovery and Development:
 Objective: Investigate the use of AI in identifying new antibiotics and repurposing existing drugs for
resistant infections.
 Justification: With the decline in antibiotic development, leveraging AI can accelerate the discovery
of novel treatments. This objective will involve reviewing current research and identifying successful
AI-driven drug discovery platforms.
5. To Assess Ethical and Practical Challenges:
 Objective: Identify and analyze the ethical considerations and practical challenges associated with
implementing AI in combating antibiotic resistance.
 Justification: Understanding the barriers to AI implementation—such as data privacy, algorithm
transparency, and the potential for bias—will inform stakeholders about the necessary steps to
address these challenges effectively.[7]
6. To Provide Recommendations for Implementation:
 Objective: Develop a set of actionable recommendations for integrating AI solutions into healthcare
practices and policies to combat antibiotic resistance.

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 Justification: By synthesizing findings from the research and stakeholder engagement, the project
will offer practical strategies for healthcare providers, policymakers, and researchers to enhance the
effectiveness of AI in the fight against ABR.
7. To Promote Awareness and Collaboration:
 Objective: Foster awareness of the potential of AI in addressing antibiotic resistance and encourage
collaboration among stakeholders in healthcare, technology, and research.
 Justification: Engaging with various stakeholders will create a platform for sharing knowledge,
resources, and best practices, leading to more robust interventions against ABR.[7]

OVERVIEW OF ANTIBIOTIC RESISTANCE

Antibiotic resistance is a growing public health concern caused by the overuse and misuse of antibiotics,
leading to the survival and proliferation of resistant bacteria. Key factors contributing to this issue include
inappropriate prescribing practices, self-medication, and the widespread use of antibiotics in agriculture.

Bacteria can acquire resistance through genetic mutations or by gaining resistance genes from other bacteria
via horizontal gene transfer. Resistant strains, such as Methicillin-resistant Staphylococcus aureus (MRSA)
and multidrug-resistant Mycobacterium tuberculosis, are increasingly difficult to treat, leading to prolonged
illness, higher medical costs, and increased mortality.

The economic burden of antibiotic resistance is significant, with estimates suggesting that it could cost the
global economy up to $100 trillion by 2050 if not addressed. Infections caused by resistant bacteria result in
longer hospital stays and more intensive care requirements, straining healthcare resources.

Preventive measures are crucial in combating antibiotic resistance. These include promoting the judicious
use of antibiotics, enhancing infection prevention and control measures, and increasing public awareness
about

the appropriate use of these medications. Additionally, the development of rapid diagnostic tests can help
distinguish between bacterial and viral infections, reducing unnecessary antibiotic prescriptions.

Addressing antibiotic resistance requires a multifaceted approach involving healthcare providers.[8]

MECHANISM OF ANTIBIOTIC RESISTANCE

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Antibiotic resistance (ABR) mechanisms are diverse and sophisticated, reflecting bacteria's ability to evolve
rapidly in response to environmental pressures. The mechanisms of resistance are typically classified based
on how bacteria evade the action of antibiotics. Below are the primary mechanisms of antibiotic resistance :-
Antibiotic resistance occurs when bacteria evolve mechanisms to survive the effects of antibiotics. This
resistance can develop through various mechanisms, which are explained below in a simple and easy-to-
understand way:

 Efflux Pumps:- One of the simplest ways bacteria avoid the effects of antibiotics is by using efflux
pumps. These pumps are like tiny machines embedded in the bacteria’s cell walls. Their job is to
actively pump out antibiotics that enter the cell, before the drug has a chance to work.
 How it works:- Imagine antibiotics as intruders trying to enter a fortress (the bacterial cell). The
efflux pumps act as the security guards that throw the intruders out before they can cause harm.
 Examples: Efflux pumps are common in many bacteria, including E. coli and Pseudomonas
aeruginosa, which use them to resist drugs like tetracyclines and fluoroquinolones.
 Enzyme Production:- Some bacteria produce enzymes, which are special proteins that can break
down antibiotics. These enzymes destroy the antibiotic’s structure, making it useless.
 How it works: Imagine the antibiotic as a key trying to open a lock (which represents a target on the
bacteria). The enzyme acts like a locksmith who changes the lock so that the key no longer fits. As a
result, the antibiotic cannot do its job.[9]
 Examples: The most well-known enzyme is beta-lactamase, which bacteria like Staphylococcus
aureus and Klebsiella pneumoniae produce to destroy beta-lactam antibiotics (such as penicillin and
cephalosporins). Some bacteria can even produce enzymes that break down a wide range of
antibiotics, called *extended-spectrum beta-lactamases (ESBLs)*.
 Modification of Target Sites:- Bacteria can change the parts of themselves that antibiotics are
supposed to target. Antibiotics typically work by binding to a specific part of the bacterial cell to
interfere with essential processes. But if the bacteria modify these target sites, the antibiotics can no
longer bind effectively.
 How it works: Think of an antibiotic as a key designed to fit into a specific lock on the bacteria. If
the bacteria changes the shape of the lock (the target site), the key (antibiotic) no longer fits and
cannot unlock or harm the bacteria.[9]
 Examples: This mechanism is common in methicillin-resistant Staphylococcus aureus (MRSA),
which alters its penicillin-binding proteins so that antibiotics like methicillin can no longer bind to
them.
 Bypass Mechanisms:- Sometimes, bacteria can “bypass” the antibiotic’s effects by finding an
alternative way to carry out the cellular process the antibiotic was trying to stop.
 How it works: Imagine that an antibiotic is blocking a road that bacteria need to use. In response, the
bacteria build a new road (an alternate pathway) to reach their destination.

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 Examples: Bacteria that are resistant to the antibiotic trimethoprim can create a new version of the
enzyme that the drug targets, allowing them to continue making vital substances even when the drug
is present.
 Reduced Permeability:- Some bacteria resist antibiotics by making their outer cell membrane
harder to penetrate. This makes it difficult for antibiotics to enter the bacterial cell in the first place.
 How it works: Think of the bacterial cell as a fortress surrounded by a wall. Some bacteria can
thicken the wall, making it harder for antibiotics to get through. If the antibiotic can’t get inside the
bacteria, it can’t kill it or stop its growth.
 Examples: This mechanism is seen in bacteria like Pseudomonas aeruginosa, which have low
permeability to many antibiotics, especially beta-lactams.[11]

Horizontal Gene Transfer:- Bacteria can acquire resistance genes from other bacteria. This process is
called horizontal gene transfer and allows resistance to spread rapidly within bacterial populations. If
one bacterium develops resistance to an antibiotic, it can pass this ability on to other bacteria like sharing
information. This transfer can happen in four ways:

 Conjugation: Two bacteria connect and transfer genetic material.

 Transformation: A bacterium takes up free-floating resistance genes from its environment.

 Transduction: Viruses that infect bacteria (called bacteriophages) can carry resistance genes from
one bacterium to another.
 Vesiduction:- refers to the transfer of genetic material between bacteria via extracellular vesicles,
facilitating the spread of antibiotic resistance.
 Examples: Many bacteria acquire resistance to multiple antibiotics through horizontal gene transfer,
which has contributed to the spread of dangerous pathogens like carbapenem-resistant
Enterobacteriaceae (CRE).

ARTIFICIAL INTELLIGENCE IN HEALTHCARE

AI APPLICATIONS IN MEDICINE :-

AI Applications in Medicine: A Synthesis of Research Insights:- Artificial intelligence (AI) applications in

medicine are rapidly advancing, driven by vast amounts of health data, increasing computational power, and
innovative algorithms. Here are key areas where AI is being applied, synthesizing findings from recent
research: [12]

1. Diagnostics and Imaging

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AI is revolutionizing diagnostic accuracy and speed, especially in medical imaging. Techniques such as deep
learning are used in radiology, pathology, and dermatology to identify abnormalities, including tumors,
fractures, and infections, often at early stages. Studies show that AI models can sometimes match or exceed
human experts in identifying complex patterns in images, reducing misdiagnosis rates and optimizing
treatment timelines.

2. Personalized Medicine

AI enables tailored treatment plans by analyzing patient data, including genetic information, lifestyle factors,
and historical responses to treatments. Machine learning algorithms are helping in predicting patient
responses to drugs, thus supporting precision medicine, especially in fields like oncology. Research
highlights AI’s potential to predict the most effective treatment protocols for individual patients, improving
outcomes and minimizing side effects.

3. Drug Discovery and Development

AI speeds up drug discovery by identifying promising compounds, predicting drug behavior, and optimizing
chemical structures. Traditional drug discovery can take years, but AI-driven simulations and predictive
models are accelerating this process, often leading to cost-effective and targeted drugs. Numerous studies
report that AI is instrumental in identifying potential treatments for complex diseases, such as cancer and
neurodegenerative disorders, by analyzing vast biochemical datasets.

4. Predictive Analytics in Patient Monitoring

AI is transforming patient monitoring through predictive analytics, where wearable devices and sensors
collect real-time health data. Machine learning algorithms can predict health events, such as heart attacks or
strokes, before they occur. Research shows that this proactive monitoring has significant potential to reduce
hospital admissions and mortality rates, particularly in patients with chronic conditions.

5. Natural Language Processing (NLP) for Medical Records

NLP techniques are applied to electronic health records (EHRs) to extract critical information for clinical
decision-making and research. AI tools can summarize patient histories, identify risk factors, and flag
potential issues by analyzing unstructured data within EHRs. Recent studies demonstrate that NLP enhances
clinical workflows, minimizes administrative workload, and improves data accuracy, enabling more efficient
and accurate patient care.

6. Robotic Surgery Assistance

Robotics powered by AI is being used to enhance precision in surgeries. AI-guided robotic systems assist
surgeons with complex procedures by offering higher stability, precision, and real-time data insights.
Research has shown that AI-assisted robotic surgery can lead to reduced recovery times, minimized surgical
complications, and enhanced patient outcomes.
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7. AI in Mental Health Care

AI applications in mental health are growing, particularly in early diagnosis and personalized treatment. AI-
powered apps and tools can assess mood, behavior, and speech patterns to identify signs of mental health
issues like depression and anxiety. Studies indicate that these tools improve access to mental health
resources and help clinicians track patient progress over time.

8. Predicting and Managing Infectious Diseases

AI plays a crucial role in predicting the spread of infectious diseases and managing outbreaks. By analyzing
data from various sources, such as epidemiological studies, travel patterns, and climate data, AI algorithms
help anticipate outbreak hotspots. Recent research shows how AI has been instrumental in modeling disease
transmission and optimizing response strategies, as seen during the COVID-19 pandemic.

These AI applications in medicine offer immense potential for improving healthcare outcomes, lowering
costs, and enabling personalized and preventive care. However, research also emphasizes the importance of
addressing ethical, regulatory, and data privacy issues to ensure safe and equitable AI adoption in healthcare.

AI’S IMPACT ON DRUG RESISTANCE :-

Insights from Recent Research, The rise of drug-resistant pathogens has challenged conventional medicine,
leading researchers to explore AI as a tool to address and manage drug resistance in multiple ways. Below
are the primary areas in which AI has impacted the fight against drug resistance, synthesized from recent
research findings:

1. Predictive Modeling of Resistance Patterns

AI can analyze historical and current resistance data to predict how pathogens might develop resistance to
specific drugs. By applying machine learning to vast datasets on microbial genetics and treatment outcomes,
researchers are now better equipped to foresee resistance patterns. Studies indicate that predictive models
help in anticipating shifts in resistance, thus allowing preemptive measures in clinical settings.

1. Rapid Identification of Resistant Strains

Advanced AI algorithms can process genomic data to quickly identify resistant strains of bacteria or viruses.
Traditional methods for resistance testing can be slow and resource-intensive, but AI can significantly speed
up the process by identifying genetic markers associated with resistance. This rapid detection is critical in
guiding timely, effective treatments, particularly for life-threatening infections where resistance might limit
therapeutic options.

2. Optimization of Antibiotic Use

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AI-driven decision support systems in hospitals analyze patient data to recommend optimal antibiotic
regimens. By considering factors like patient history, infection type, and microbial sensitivity, these systems
help prevent overuse or misuse of antibiotics—a key factor in resistance development. Research highlights
that AI-optimized prescribing practices can significantly reduce resistance rates by ensuring antibiotics are
used appropriately.

3. Discovery of Alternative Therapies

AI is facilitating the discovery of novel antimicrobial agents and alternative therapies, such as
bacteriophages and antimicrobial peptides, which can target drug-resistant bacteria in unique ways. AI
algorithms rapidly screen thousands of compounds, identify effective candidates, and predict their
interactions with resistant pathogens. Studies have shown that AI-driven discovery processes lead to
potential alternatives that could circumvent current resistance issues.

4. Monitoring Global Resistance Trends

AI is used to track resistance data globally by collecting and analyzing information from healthcare
facilities, labs, and public health organizations. Machine learning can then detect emerging resistance trends
and hotspots, allowing healthcare authorities to respond more effectively. Recent research highlights that
global

surveillance systems powered by AI can provide early warnings and support coordinated efforts to contain
resistant outbreaks.

5. Enhancing Diagnostic Tools for Resistance

AI improves the accuracy and speed of diagnostic tools designed to detect drug-resistant infections.
Algorithms that process clinical data, such as bacterial cultures or patient histories, can rapidly diagnose
infections that are resistant to common treatments. Studies demonstrate that AI-enhanced diagnostics reduce
the time needed to identify resistant infections, which is critical for implementing effective alternative
treatments.

6. Simulating Pathogen Evolution

AI-powered simulations can model the evolution of pathogens under various environmental pressures,
including exposure to different drugs. By simulating how bacteria or viruses adapt over time, researchers can
predict future mutations that might confer resistance. Findings suggest that these simulations help in
formulating proactive treatment strategies that remain effective as pathogens evolve.

7. Improving Infection Control in Healthcare Settings

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In hospital environments, AI systems analyze patient data, healthcare practices, and environmental factors to
identify potential risks for spreading resistant infections. By highlighting vulnerabilities in infection control
protocols, AI helps prevent the spread of resistant strains within healthcare facilities. Studies indicate that
AI-supported infection control has successfully minimized outbreaks of drug-resistant pathogens in some
high-risk hospital settings.

8. Guiding Public Health Policy

AI insights are increasingly informing public health policies on antimicrobial use and resistance
management. Machine learning models provide data-driven evidence to shape guidelines on antibiotic
stewardship and infection control. Research suggests that policies derived from AI analysis are more
effective in curbing resistance and promoting sustainable antimicrobial practices at both national and
international levels.

10.Supporting Vaccine Development Against Resistant Pathogens

AI is instrumental in designing vaccines targeting drug-resistant pathogens. Machine learning can identify
suitable antigens and simulate immune responses, optimizing vaccine development. Recent studies highlight
AI’s role in accelerating vaccine design, particularly for pathogens where drug resistance poses severe health
risks, helping reduce reliance on antibiotics and other treatments.

Collectively, these applications highlight AI’s pivotal role in addressing drug resistance across clinical,

pharmaceutical, and public health domains. The integration of AI in this fight holds promise for creating
proactive and sustainable strategies to combat resistance, though ethical and regulatory considerations
remain essential to ensure safe and equitable outcomes.

AI-POWERED TOOLS FOR ANTIBIOTIC RESISTANCE:-

AI-powered tools are revolutionizing the approach to combating antibiotic resistance by providing
innovative solutions for diagnosis, treatment, and drug discovery. Here are some notable AI tools and their
workings in addressing antibiotic resistance, as derived from various research papers.

1. DeepLearning4J

Overview: DeepLearning4J is an open-source deep learning library for Java. It is particularly useful in
developing predictive models for antibiotic resistance.

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Working:

It utilizes neural networks to analyze large datasets, such as genomic sequences of bacteria.By training on
these datasets, the tool can predict resistance patterns and identify specific genetic markers associated with
antibiotic resistance.

This helps in tailoring treatment strategies by identifying the most effective antibiotics for specific bacterial
strains.

2. BioSymphony

Overview: BioSymphony is a computational platform that integrates machine learning and bioinformatics to
support antibiotic discovery.

Working:

It uses machine learning algorithms to analyze biological data, such as molecular structures and biological
activity of compounds.

The platform can predict the effectiveness of new compounds against resistant bacteria by modeling
interactions between drugs and bacterial targets.

This accelerates the drug discovery process, allowing researchers to identify potential new antibiotics more
efficiently.

3. Antibiotic Resistance Database (ARDB)

Overview: The ARDB is a comprehensive resource that provides information on antibiotic resistance genes,
their functions, and associated organisms.

Working:

AI algorithms analyze data from various sources to classify and predict resistance mechanisms based on
genetic sequences.Researchers can input genomic data into the ARDB to receive insights on potential
resistance genes and their implications for treatment options.

This tool helps healthcare professionals make informed decisions regarding antibiotic prescriptions and
resistance management.

4. KNN Antibiotic Resistance Prediction Tool

Overview: This tool employs k-nearest neighbors (KNN), a machine learning algorithm, for predicting
antibiotic resistance based on clinical data.

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Working:

The KNN algorithm assesses new bacterial samples by comparing them with historical data on known
resistance profiles.It evaluates features such as clinical characteristics and previous antibiotic treatments to
predict whether a new isolate is resistant to certain antibiotics.This quick assessment aids clinicians in
making rapid decisions on antibiotic therapy.

5. AI for Drug Repurposing

Overview: AI techniques are being applied for drug repurposing, identifying existing drugs that can be
effective against resistant bacteria.

Working:

Algorithms analyze vast databases of existing drugs and their molecular profiles to find potential matches
against resistant bacterial targets.

By evaluating the efficacy and safety of these drugs, researchers can expedite the process of finding
alternative treatments for infections caused by resistant bacteria.

This approach is beneficial as it saves time and resources compared to developing new drugs from scratch.

6. Genomic Analysis Tools

Overview: AI-based genomic analysis tools, such as Next-Generation Sequencing (NGS) analysis platforms,
play a crucial role in understanding antibiotic resistance mechanisms.

Working:

These tools utilize AI algorithms to analyze sequenced genomes of bacteria, identifying mutations associated
with resistance.

By employing comparative genomics, they can reveal evolutionary pathways of resistance and help predict
future trends in antibiotic resistance. Such insights are vital for public health responses and the development
of effective intervention strategies.

AI IN MONITORING AND SURVEILLANCE

Artificial intelligence (AI) plays a critical role in monitoring and surveillance of antibiotic resistance (ABR)
patterns, providing tools for real-time data analysis and predictive modeling. Here’s a brief overview of how
AI contributes to these efforts:

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1. Data Integration: AI systems can aggregate and analyze vast amounts of data from various sources,
including clinical records, laboratory results, and genomic sequencing data. This comprehensive
approach allows for the identification of emerging resistance trends more effectively than traditional
methods.
2. Predictive Analytics: Machine learning algorithms can analyze historical ABR data to predict future
resistance patterns. By recognizing patterns and correlations in the data, AI can forecast potential
outbreaks and inform public health responses. This predictive capability is crucial for implementing
timely interventions.
3. Real-Time Surveillance: AI-powered surveillance tools enable continuous monitoring of resistance
patterns across healthcare settings. By utilizing automated data collection methods, these tools can
provide healthcare providers with immediate insights into local resistance trends, facilitating more
informed decision-making.
4. Geospatial Analysis: AI applications can analyze geographical data to track the spread of resistant
strains in specific regions. This spatial analysis helps public health officials allocate resources
efficiently and target interventions where they are most needed.
5. Collaboration and Data Sharing: AI facilitates collaboration among healthcare institutions by
standardizing data formats and promoting data sharing. This collaborative approach enhances the
accuracy and reliability of resistance monitoring and provides a broader context for understanding
ABR.By leveraging these capabilities, AI enhances the surveillance and monitoring of antibiotic
resistance, providing valuable insights that can guide public health initiatives and improve patient
outcomes.

ETHICAL AND REGULATORY CONSIDERATIONS

The integration of artificial intelligence (AI) in combating antibiotic resistance (ABR) raises several ethical
and regulatory challenges. These challenges need to be addressed to ensure responsible use of AI
technologies in healthcare.

1. Ethical Challenges in AI Use

AI applications in healthcare can lead to ethical dilemmas, particularly concerning patient consent and the
potential for bias in algorithms.

Informed Consent: Patients may not fully understand how their data is being used, especially when AI
systems analyze personal health information. Ensuring that patients provide informed consent is crucial, as it
fosters trust and transparency in AI applications.

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Bias and Discrimination: AI algorithms can inadvertently perpetuate existing biases in healthcare. For
example, if training data primarily reflects certain demographics, the AI may perform poorly for
underrepresented groups. This could lead to disparities in treatment and access to care.

2. Data Privacy and Security

The use of AI in monitoring and analyzing antibiotic resistance involves handling sensitive patient data,
which raises significant concerns regarding data privacy and security.

Data Protection: Healthcare organizations must ensure that patient data is protected against unauthorized
access and breaches. Implementing strong data encryption, anonymization, and secure storage practices is
essential to safeguarding personal information.

Compliance with Regulations: Compliance with data protection regulations, such as the General Data
Protection Regulation (GDPR) in Europe and the Health Insurance Portability and Accountability Act
(HIPAA) in the United

States, is vital. These regulations mandate strict guidelines for collecting, storing, and sharing health data,
emphasizing the need for transparency and accountability.

3. Regulatory Frameworks

Establishing a robust regulatory framework for AI applications in healthcare is essential to ensure their safe
and effective use.

Guidelines for AI Development: Regulatory bodies should develop clear guidelines for the development
and deployment of AI technologies in healthcare.

These guidelines should address issues such as algorithm validation, safety, efficacy, and ethical
considerations.

Monitoring and Evaluation: Continuous monitoring of AI systems post-deployment is necessary to assess

their performance and impact on patient outcomes. This includes regular audits to identify and rectify biases
or inaccuracies in AI algorithms.

Stakeholder Engagement: Engaging a diverse range of stakeholders, including healthcare professionals,

patients, and ethicists, in the regulatory process is crucial. This collaborative approach ensures that multiple
perspectives are considered when establishing regulations governing AI in healthcare

CHALLENGES IN AI IMPLEMENTATION

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The integration of artificial intelligence (AI) into strategies for combating antibiotic resistance (ABR)
presents several challenges that need to be addressed to ensure effective deployment. These challenges can
be broadly categorized into technical and financial barriers, integration into healthcare systems, and
infrastructure needs.

Technical and Financial Barriers

 High Development Costs: The creation of AI systems requires significant financial investment in
research and development. This includes costs for hiring skilled professionals, purchasing advanced
technologies, and maintaining complex systems. Many healthcare organizations, particularly in low-
resource settings, may find these costs prohibitive.

Lack of Technical Expertise: Implementing AI solutions demands a workforce with specialized skills in
data science, machine learning, and bioinformatics. However, there is a shortage of trained professionals in
these fields, which hampers the development and deployment of AI technologies in healthcare.

 Algorithmic Challenges: Developing accurate and reliable AI algorithms is complex. Algorithms must
be trained on high-quality data sets that represent diverse populations and conditions. Poor-quality data
can lead to biased or ineffective AI models, undermining their potential to address ABR.

Integration into Healthcare Systems

 Interoperability Issues: Integrating AI tools into existing healthcare systems can be challenging due to
a lack of standardization across different platforms. Many healthcare providers use disparate electronic
health record (HER) systems that may not communicate effectively with AI applications, creating
barriers to data sharing and collaboration.
 Resistance to Change: Healthcare professionals may be hesitant to adopt AI technologies due to
concerns about reliability, job displacement, and the complexity of new systems. Overcoming this
resistance requires effective change management strategies and education on the benefits of AI in
improving patient care and outcomes.
 Clinical Validation: AI tools must undergo rigorous clinical validation to ensure their safety and
effectiveness in real-world settings. This process can be time-consuming and resource-intensive,
delaying the implementation of potentially beneficial AI applications.

Infrastructure Needs

 Technological Infrastructure: Implementing AI systems requires robust technological infrastructure,

including high-speed internet access, secure data storage solutions, and advanced computing
capabilities. Many healthcare facilities, especially in rural or underserved areas, may lack the necessary
infrastructure to support AI applications.

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 Data Management Systems: Effective AI implementation depends on the availability of
comprehensive data management systems that can collect, store, and analyze large volumes of health
data. Developing these systems can be expensive and require ongoing maintenance and upgrades.
 Funding for Infrastructure Development: Significant investment is needed to build the required
infrastructure for AI integration in healthcare. This includes not only the technological components but
also training programs for staff and ongoing support systems. Securing funding from government
sources, private investors, or public-private partnerships is critical to overcoming these barriers.

CONCLUSION

The project on “Harnessing AI to Combat the Threat of Antibiotic Resistance” highlights the significant
potential of artificial intelligence (AI) in addressing one of the most pressing public health challenges of our
time. Through this exploration, several key insights emerge:

1. AI’s Transformative Role: AI technologies offer innovative solutions for the detection, monitoring,
and management of antibiotic resistance (ABR). By utilizing advanced machine learning algorithms,
AI can analyze vast datasets to identify patterns and predict resistance, enabling more effective
treatment strategies.
2. Integration with Healthcare Systems: Successful implementation of AI tools requires careful
integration into existing healthcare infrastructures. This includes ensuring interoperability with
electronic health records (EHRs) and overcoming resistance from healthcare professionals. Change
management and education are vital for fostering acceptance and maximizing the benefits of AI.
3. Ethical and Regulatory Considerations: The deployment of AI in healthcare raises important ethical
questions regarding data privacy, informed consent, and algorithmic bias.

Establishing robust regulatory frameworks is essential to address these concerns and ensure that AI
applications are used responsibly and equitably.
4. Infrastructure Development: For AI to be effective in combating ABR, significant investment in
technological infrastructure is needed. This includes enhancing data management systems, ensuring
high-speed internet access, and providing ongoing training for healthcare professionals.
5. Collaboration and Data Sharing: Enhanced collaboration among healthcare stakeholders is crucial.
By sharing data and best practices, healthcare organizations can collectively tackle the challenges of
antibiotic resistance. AI tools can facilitate this collaboration by standardizing data formats and
enabling real-time information sharing.

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Summary

In summary, AI holds immense promise in the fight against antibiotic resistance, offering tools that can
enhance detection, improve treatment outcomes, and inform public health strategies. However, realizing this
potential requires addressing the technical, ethical, and infrastructural challenges associated with AI
implementation. Continued research, investment, and collaboration among stakeholders are essential to
harness AI effectively, ensuring a proactive response to the evolving threat of antibiotic resistance.

PRACTICAL-1

AIM: To study introduction of pharmacy practice in India.

It is now more than 75 years since the establishment of India’s first degree in Pharmacy. The Pharmacy Act
was drafted in 1948 under the aegis of the Pharmacy Council of India, the statutory body established to
control the standards for the pharmacy profession. In 1953, the diploma in Pharmacy (D Pharma) became
the minimum qualification required to practice pharmacy in India.

During the 1980s and 90s, the consequences of drug misuse, such as poor health outcomes from drug
treatment, antibiotic resistance, Adverse Drug Reactions (ADRs), and economic loss of patients and
healthcare strain the system, were acknowledged not just by pharmacy professionals, consumers, and patient
organizations but also by the government.

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The 1990s were a period of awakening when the profession clearly recognized the urgent need for
pharmacists to contribute to improving medication use in the community.

The first Master's in Pharmacy Practice programs were offered by JSS College of Pharmacy at Mysore, and
soon in 1997, with the support of Australian institutions. In 2011, 23 institutions are offered PG programmes
in pharmacy practice that helped produce .pharmacist with skill in patient and pharmaceutical care.

The result of this expansion is that the pharmacy profession in India is in transition. It is moving from a
technical, industry-oriented profession to one that also has a significant role to play in patient care.

Need for Clinical Pharmacy in India:

Clinical Pharmacy practice is concerned with the provision of effective, safe, and economical drug therapy.

Pharmacy practice is a broad term that includes clinical pharmacy and other patient-related activities
performed by pharmacists in the hospital and community settings. These include: Dispensing and drug
distribution, Drug information, Health promotion, Patient counseling, Pharmacovigilance, Medication
reviews, Academic detailing, Sterile and non-sterile manufacturing.

Clinical Pharmacy practice in the hospital and community settings can improve the drug-use process by
promoting the quality and safe use of medication.

Pharmaceutical Industry: Around 190,000 formulations are available in the market today. Many of these
formulations are irrational drug combinations and non essential medication such as vitamins preparations.
Many doctors use the promotional material from pharmaceutical companies as their main source of drug
information.

Government: The govt. drug policies are mainly cumed at pharmaceutical industry rather than at patient.

ADR monitoring and reporting is an important role for clinical pharmacist and will improve medication
safety especially among paediatrics and geriatric patients.

Scope of Clinical Pharmacy Practice in India:

There is tremendous scope for clinical pharmacy practice at various level of pharmacy profession. Based on
physician surveys at the Hospital, Mysore the services that are most appreciate by medical staff includes:

 Drug information services.

 Clinical Pharmacy input on ward round.
 Information about drugs new drug.
 ward rounds and advice on Individual

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 Patient counselling and advice on individual patient management.

In community pharmacy, knowledge of clinical pharmacy can be used to counsel patients about their
medications identify drug interaction and other drug related problem and provide advice regarding the
management of minor ailments.

Clinical Pharmacy Educations:-

The Following subjects are tough in the Master of Pharmacy practice Programme;

 Pathophysiology basis of various diseases.

 Patient data analysis.
 Applied therapeutics to understand the role of various classes of drug in particular disease and
conditions, with an emphasis on the safety, efficacy and ration selection of drug.
 Clinical pharmacokinetic to understand the kinetic of drug and how this affects their selection and
dosage.
 Communication skill to support clinical pharmacy practice ,particularly in the area of patient counseling.

Hospital infrastructure and resources: Clinical pharmacist spends most of their time in the ward’ they
must have a department where administrative educational and other professional activities can be based and
where documentation about clinical pharmacy services is stored.

PRACTICAL-2

Aim: Clinical pharmacy-An International perspective

Development of clinical pharmacy practice:

The international perspective of pharmacy involves looking at how pharmacy practices, regulations, and
education vary across different countries. In many countries, pharmacists play a crucial role in healthcare by
dispensing medications, providing patient counseling, and sometimes even prescribing medications. For
example, in some countries, pharmacists have the authority to administer vaccinations, conduct health

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screenings, and manage chronic conditions like diabetes. On the other hand, in some countries, pharmacists
are primarily focused on dispensing medications and providing basic health advice.

Pharmacy Practice in Australia:

Pharmacists in Australia are increasingly involved in medication management, medication review, chronic
disease management, and medication counseling.

The Australian pharmacy profession has also seen the introduction of advanced practice roles for
pharmacists, such as accredited pharmacist, consultant pharmacist, and clinical pharmacy specialists. These
roles require additional training and certification, allowing pharmacist to take on more responsibilities in
patient care and medication management.

Pharmacy Practice in the US: Pharmacists in the US are now actively involved in medication therapy
management, medication reconciliation, immunizations, chronic disease management, and collaborative
drug therapy management with other healthcare providers.

Relationship with the Medical Profession: The relationship between the pharmacy profession and the
medical profession in pharmacy practice is essential for delivering high-quality patient care. Pharmacists and
doctors work together closely as part of healthcare teams to ensure that patients receive the best possible
medication therapy and healthcare outcomes. Doctors rely on pharmacists for their expertise in medication
management, including identifying and resolving medication-related issues. Pharmacists, on the other hand,
consult with doctors to clarify prescriptions, adjust medication regimens, and provide recommendations for
optimizing therapy.

Pharmacist also works as a ward pharmacist. Ward pharmacy is defined as a system where the pharmacist
visit ward regularly to monitor for completeness and accuracy of prescription is available for consultation by
medical staff and ensure that the drug distribution system is operating correctly.

Future prospective:The future of pharmacy practice is evolving rapidly with advancement in technology
changes in healthcare delivery, and an increased focus on patient -centred care.

In the coming years, pharmacy practice is expected to continue to expand its scope and influence in
healthcare.

Some of the future perspectives in pharmacy practice include:

1. Pharmacist as primary care provider: Expanded role in primary care, including diagnosis and
treatment of common condition.

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2. Advanced practice roles: Specialized pharmacist will take on more responsibility in area like
oncology, paediatrics and critical care.
3. Leadership and Entrepreneurship: Pharmacist will take on leadership roles and develop innovative
business model to transform healthcare.

PRACTICAL-3

Aim: To study Adverse Drug Reaction

Drugs are prescribed with a specific intention and a physician would expect a drug to act effectively and
selectively without any undesirable phenomenon in the organism. Thus when a physician prescribes a drug
for cardiac dysfunction he would very much like to select a drug which acts only on heart, and on no other
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physiological system. A drug with such an ideal selectivity, however, exists only in our imagination as there
is no drug which does not exert some action on the system other than one on which its clinical use is based.
To a certain extent such side effects are tolerated but they become problematic when the side effects are also
as potent as therapeutic effect and particularly when they cause distress to the patient and treating physician.
All such side effects of drugs are generally classified as Adverse Drug Reactions.

WHO defines an adverse drug reaction as "any noxious and unintended effects of drug which occur at doses
normally used in man for the prophylaxis, diagnosis or therapy of disease or for the modification of
physiological functions.”

SIGNIFICANCE OF ADVERSE DRUG REACTIONS

Some physicians have a tendency to over-prescribe a patient with potent drugs. Self-medication by patients
lead to misuse of drugs causing adverse drug reactions. Sometimes physicians fail to set the therapeutic end
point for drugs like corticosteroids, diuretics, etc. Continued use of such drugs invariably gives rise to their
adverse drug reactions. Several factors such as environment, diet, physical and psychic condition of the
patient etc. could be held responsible for the onset of such actions. Difference in bio-availability from
various manufacturers of oxytetracycline, theophylline, chloramphenicol, etc.. have resulted in toxicity in
some cases. Old persons and young children are more susceptible to adverse drug reactions because of their
difference in metabolism and execration pathway.

How to Avoid Adverse Effects

Some scientists believe that a new delivery system that bypass both the liver and the gastro-intestinal tract
and approach target organs directly by more natural means may medicate patients more effectively and
avoid many side reactions. Adverse drug reactions can be minimised by:

1. Decreasing rate of parenterals administration.

2. Decreasing frequency of administration by use of prolonged action formulation.

3. Buffering to the optimum pH before injecting or applying the medication.

4. Adjusting tonicity to suit body fluids.

5. Achieving appropriate rates of dissolution and absorption of oral formulations.

6. Administering minimum effective dose for the shortest possible time.

7. Monitoring closely the blood levels of toxic drugs particularly those which are hepatotoxic or
nephrotoxic.

CLASSIFICATION OF ADR

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Traditionally ADRs are classified into two categories-Type A and Type B reactions. Type A (Augmented)
reactions are usually the exacerbation of pharmacological effects of a drug and thus are dose-dependent. An
example is insulin-induced hypoglycaemia. These reactions are usually predictable due to the known
pharmacology of a drug and thus preventable. Although the incidence of occurrence of type A reactions is
high in any society, they are responsible for considerable morbidity. The mortality rate is relatively low
however, since most type A reactions will disappear by reduction of the dose or by discontinuation of the
drug. In contrast, type B (Bizarre) reactions are hypersensitivity reactions and are not dose-dependent. An
example is penicillin-induced hypersensitivity reaction. These reactions are often not predictable and
preventable (unless the patient has a known history of this type of er reaction). This type of reaction is rare
but often serious with a high mortality rate.

Recently, different newer classifications on md have been proposed. One of these the classifications include
type A (Augmented), type B (Bizarre), type C (Continuous), and type D (Delayed effects).

Wills and Brown a have proposed another classification on the basis of mechanism into eight new
categories. This These include type A (Augmented), type B a (Bugs), type C (Chemical), type D (Delivery),
F (Exit), type F (Familial), type G

DRUG INDUCE DISEASES

Drug may induce disease due to following factors

1. Overdose;

2. Drug-interactions;

3. Secondary effects;

4. Idiosyncrasy;

5. Hypersensitivity.

1. Overdose

Many factors affect the plasma concentration of drug like absorption, distribution, protein and tissue
binding, metabolism and excretion. All these factors can change normal dose into a sub-therapeutic dose or
overdoses, e.g., Diphenyl hydantion. The dose is 4-5 mg/kg body weight. It is reported that this dosage gives
4-7 folds blood levels of the drug. There are several reasons for it. Diphenyl hydantoin is metabolised in
liver, where it undergoes Para hydroxylation. Some people have been found to lack the hydroxylating
enzymes. Due to this Diphenyl hydantoin gets deposited and then it leads to toxicity at normal doses. Liver
diseases can interfere with metabolism of diphenyl hydantoin. Similarly drugs like isoniazid, aminosalicylic
acid and disulfiram inhibit the metabolism of diphenyl hydantoin.

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Another factor which influences the patient response is renal function, e.g., we normally see congestive
heart failure, patients maintained on 0.25-0.5 mg of digoxin daily. Yet, patient with impaired renal function
or one with hypokalemia may exhibit digitalis toxicity at this dosage. A patient with normal renal function
loses by various routes about 35% of digoxin in body every day. The maintenance dose is meant to replace
that loss. In anuric patients only 14% of the digoxin in the body is lost per day. Therefore if normal dose of
0.25-0.5 mg is continued in the presence of this anuria (scanty urine), drug accumulation and inevitable
digitalis toxicity will result in increase in cardiac sensitivity to digoxin associated with hypokalemia.

Administration of thiazide diuretics, furosemide, results in large loads of sodium to be presented to the renal
tubules for excretion. Increased sodium-potassium exchange results, in marked increase in the potassium
excretion. Hence for digitalis therapy, the diuretic use has to be taken in account for desired responses.

Over-doses of aspirin may cause gastro-intestinal pain or even bleeding. So a pharmacist should recommend
his patients with gastro-intestinal intolerance to aspirin that the tablets be crushed and suspended in about 15
ml of water and this mixture added to a full dose of non-aluminium liquid antacid.

2. Drug Interactions

This is a new awareness on the part of pharmacist who are recognising the impact of drug interactions on
patient response and drug therapy. The pharmacist should have a basic understanding of the drug
interactions and also have an up-to-date knowledge to become a guide to the patients and hence avoid any
untoward drug induced diseases which could occur due to such interactions.

3. Secondary Effects

No drug has a single pharmacological effect. Any effects which are associated with a drug besides the
desired effects are called as secondary effects.

Examples:

1. Sedation accompanying anti-histaminic effect.

2. Loss of potassium or extra-cellular fluid concentration following thiazide diuretic therapy in treating
hypertension.

3. Marked CNS depression following reserpine.

4. Therapeutic dose of salicylates are as potent as some of the sulfonylureas in lowering blood glucose levels
in both diabetic and non-diabetic patients.

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5. Long-term diphenylhydantoin therapy leads to folic acid deficiency leading to megaloblastic anaemia
(RBC formation gets disturbed). Hence folic acid should be administered 0.5-5 mg daily while on diphenyl
hydantoin therapy.

4. Idiosyncrasy

Idiosyncrasy is the term used to describe abnormal drug response. It covers unusual bizarre or unexpected
drug responses which cannot be explained or predicted in individual recipients. Characteristics of
idiosyncrasy are as follows:

1. It occurs in genetically abnormal subjects.

2. It arises only for few drugs

.3 Prior drugs exposure is necessary.

4. Its response is dose dependent.

5. Its mechanism is explained by drug receptor interaction.

It is the usual drug reaction that cannot be explained by the inherent properties of the drug themselves but
instead by some altered characteristics within the patient taking the drug. This alteration may be permanent
or temporary.

Many drugs have been shown to induce haemolytic anaemia in certain patients.

5. Hypersensitivity

One of the well-known examples under this category is penicillin hypersensitivity. The penicillin in the body
is metabolised to penicillanic acid and this reacts with lysine group of tissue protein to form penicilloyl
protein conjugates. Approximately 95% of all penicillins that react with proteins follows this path of
degradation

Anaphylaxis rarely occurs with natural penicillin G given intravenously. It is an allergic reaction which
occurs after second on subsequent exposure of drug causing allergy. Anaphylaxis may be generalised or
localised.

In localised anaphylaxis to gut there is abdominal pain and asthma to bronchi. Generalised anaphylaxis is
characterised by bronchospasm circulatory collapse with hypotension and sometimes skin rash. Severe form
of anaphylaxis is referred to as anaphylactic shock.

In allergy drug combines with protein and acts as an antigen. This antigen causes formation of antibodies.
When such person again come

in contact with antigen, antigen-antibody reaction will occur This reaction makes most cells to release
histamine which cause manifestations with symptoms of allergy.
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Example of drugs which induce various diseases

1. Carcinogenic

-Androgens

-Estrogens

-Oral contraceptives

2. Hepatotoxic

-Causing hepatic changes, excretory, metabolic function

-Amphetamine

-PAS

-Chloramphenicol

3. Nephrotoxic

-Corticosteroids

Aldosterone

-Salicylates

-Furosemide

4. Diabetogenic

-Ascorbic acid derivative

-Nicotinic acid

Furosemide

5. Dermatological toxicity

-PAS

-Lasix

-Nitrofurantoin

Phototoxic reactions are most common toxic reaction of drug towards skin. It occurs due to reaction of a
drug or its metabolite with ultraviolet rays. It is a dose related effect occurring after first exposure of drug
with skin. It does not show cross sensitivity. Tetracycline, and nifedipine are phototoxic drugs. Light acts on

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drug and skin proteins and forms an antigen which leads to photo-allergic reactions. Photo allergy is dose
independent

and needs previous exposure to the drug. It is characterised by papillae, eczematous eruption. PABA,
oestrogens, coal tar are few examples of phototoxic substances.

Steven Johnson syndrome: It is a toxic reaction induced by some drugs. It is characterised by papulae,
vesicles on skin and mucous membrane and haemorrhage of skin, e.g.,:

-penicillin

 -Phenytoin
 -Meprobamate
 Git Toxicity
 Constipation
 -Haematinics
 -Tricyclic Anti-Depressants
 Diarrhoea
 -Antibiotics
 -Digoxin
 -Neomycin
 Pancreatitis
 -Cimetidine
 -Methyldopa

TERATOGENICITY

Any drug of a chemical substance which produces deviations or abnormalities in the development of embryo
is called a teratogen.

Foetus is more sensitive to drugs than mother since foetal hepatic enzymes function is minimum and rapidly
growing foetal tissues are more susceptible to the effect. During gestation there is increase in plasma
proteins which binds drugs poorly resulting in more free drug.

Drugs are teratogenic only at specific times during embryo-genesis. Thalidomide serves as an excellent
example to explain the pattern of pathogenesis of anomalies. Following important points may be noted for
teratogenesis:

1.A teratogen may exert the effect on a developmental structure upto the time of its critical differentiation.

2. A single teratogen may produce a variety of abnormalities.

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3. A variety of teratogens may produce similar abnormalities

4. Teratogenic abnormalities may be indistinguishable from hereditary malformation.

A drug may have inoccuous effects in an adult but can be very damaging to a foetus.

Teratogenic effects are based on following principles:

1. Specificity

2. Timing of exposure

3. Genotype of mother and foetus

4. Simultaneous drug exposure

Depending on the stage of development a teratogen may show uken after 21-22 days of even no effect.
When thalidomide was gestation, following effects are observed:

Absence of external ears.

Paralysis of cranial nerves.

After about 24-27 days, the phocomelia effect was maximum shortening or complete absence of the limbs),
and a day or two later defects of legs occurred. This sensitive period terminates after 34-36 day of gestation.

Teratogens in First Trimester

-Steroids, salicylates, phenylbutazone, amphetamine, LSD.

anti-histamines.

Teratogens throughout Pregnancy

-Chloramphenicol (grey baby syndrome)

-Quinine (deafness)

-Antidiabetics (tolbutamide)

-Insulin

Teratogens prior to Delivery

-Reserpine, CNS depressants like tranquillizers, salicylates

Drugs excreted in milk

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-Large doses of reserpine (cause nasal stiffness).

-Tetracycline (Bone growth is affected)

-Anti-histamines.

-Heavy metals like, mercury, lead and arsenicals.

Different approaches for detection of adverse reaction

-Cohort study.

-Spontaneous reports of suspected adverse drug reactions.

-Review of vital statistics

COHORT STUDY

It is an approach used for detection of adverse drug reaction This is used when group of drug receivers are
followed to evalue Juicomes after drug exposure. It is used when detection of every occur with frequency
more than 1 in 500 exposed. It involves short-term and long-term clinical trials and post marketing
surveillanc of established and new drugs.

ROLE OF PHARMACIST IN MONITORING ADVERSE DRUG REACTIONS

Taking into consideration intensity and seriousness of the reaction pharmacist can advice if immediate
discontinuation of therapy in required. Pharmacist must weigh the known risk/benefit ratio of the continued
administration of drug against the availability of other drugs or no drug therapy.

Pharmacist is involved in following steps of monitoring of adverse drug reactions:

1. Literature review;

2. Patient history;

3. Drug level studies;

4. Therapeutic decision making.

Pharmacist with better knowledge of the pharmacological action the adverse reactions and the
pathophysiology.

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PRACTICAL – 4
AIM: TO STUDY LABORATORY LAB INTERPRETATION

Laboratory data provide a window through which we gain an understanding of a patient health And
physiological functioning. The result of most lab tests are reports with a reference range Or a numerical
range of results for that investigation when performed for a healthy subject. Lab test can also be used to
check for sign of serious drug toxicity that may be reflected by Abnormal biochemical or hematological
parameter or elevated liver function induced.

THYROID FUNCTIONING TEST

Test Function Range Increased Decreased

T4 Regulate the 0.8- Hyperthyroidism Hypothyroidism

[thyroxine] Rate of 2.8[ng/dl] • Autoimmune • Autoimmune

Metabolic
process • Thyroid • Iodine

adenoma deficiency
• Drugs
• Thyroiditis

TSH Regulates 0.5-5.0 Hypothyroidism Hyperthyroidism

[Thyroid the [mlU/L]

endocrine
Stimulating
function of
Hormone the thyroid
gland

Test Function Increased Decreased

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Total Membrane Hypercholesterolemia Hypocholesterolemia

cholesterol production • Kidney disease

• Diabetes

• Alcohol

Triglycerides An ester
containing
• Cardiovascular
glycerol and fatty
disease
acids

LDL-C-Low Lipid Hypercholesterolemia

density transportation • Kidney disease

lipoprotein
cholesterol • Diabetes

• Over weight

HDL-C-High Lipid

density transportation

lipoprotein
cholesterol

CREATINE PHOSPHATE

Test Function Increased Decreased

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Creatine An enzyme that is
phosphokinase present in various Stroke
tissues and cell
type[eg. skeletal Inflammatory muscles
and heart muscles rders

Heart attack

LFTs (LIVER FUNCTION TEST)

Test Function Range Increased Decreased

ALP (alkaline Intracellular IU/L Obstruction of Malnutrition

phosphatase) enzyme – the common bile
hydrolyses duc
synthetic t• Liver disease
phosphate • Increased
esters. Produced osteoblast
by many tissues activity (may be
– especially a result of
bone, intestine, osteoblastic
liver and bone metastases
placenta. Is or normal
excreted in bile. growth)
ALT (alanine Present IU/L Liver cell
aminotransferase) primarily in the damage
liver, to the – e.g. metastases
lesser extent in
the kidneys and
skeletal muscle
AST (aspartate Present in all IU/L Liver cell
aminotransferase) body tissues damage
especially heart, – e.g. metastases
liver and Myocardial
skeletal muscle. infarction
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Released into
the blood in
excessive
amount when
these are
damaged
GGT (Gamma- Present in many IU/L Liver metastases

glutamyl tissues. Involved

• All
transpeptidase) in transfer of
hepatobiliary
amino acids into
disorders
cells. Measure of
• Alcohol abuse
hepatobiliary
disease

HAEMATOLOGY

Test Function Unit Increased Decreased

Hb Oxygen g/dL Dehydration Chronic Blood loss

Haemoglobin carrying obstructive lung
• After
component of disease
anticancer drugs eg.
blood • Smoking chemotherapy • &
• Heart failure PARP inhibitors, due

• Renal cancer • to bone marrow

Hematological depression Iron,

malignancy folate and vitamin

B12 deficiency
• Chronic
illness
• Hemolysis

• Chronic
kidney disease
• Hematological
malignancy

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Platelets Vital for blood 10^9 / Thrombocythemia Thrombocytopenia
coagulation. L Acute blood loss Infections
(Thrombocytes)
• Chronic • Drugs – e.g.
illness • Certain cytostatic
forms of anaemia • Radiotherapy
• Infection (rare)
• Poor spleen • Immunologic
function disorders
• Hematological
malignancy • Cancer
infiltrating bone

marrow

WBC White Protect the body 10^9 / Infections Drug – e.g. cytostatic
Blood Cells / against invading L Radiotherapy
Hematological
Leukocytes microorganisms. (rare)
malignancies •
Differential: The relative
Other cancer s• Hematological
Basophils⎯ percentage of
Therapy with malignancy •
the various cells
Eosinophils⎯ corticosteroids Cancer infiltrating
found in the
Metabolic bone marrow •
Neutrophils⎯
blood is known
illnesses • Immune disorders •
Lymphocytes⎯ as the (white
Recovering Severe infections
cell) differential
Monocytes⎯ bone marrow
count.

PRACTICAL-5

CASE STUDY

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A 35 years old man has come with complaint of acute onset Diarrhoea. The Stool are relatively of small
volume, liquid but not watery frothy and proceeded By gipping pain in abdomen. Foul smelling, urgency,
and wild fever are the other complaints. He has passed Four loose motions in past 8 hours and there is no
appetite. He admits to have Spicy snacks last evening at road side stalls. Physical examination revealed
body Temperature 101℉, no signs of dehydration but diffused abdominal tenderness

Tentative diagnosis.

QUESTIONS

 Does the patient require Rehydration therapy?

 Should an antibiotic be prescribed if so which antibiotic would be Appropriate?
 Should an antimotility, antidiarrheal drug be co-prescribed to reduce the No, of stools?
 Should any other symptomatic drug be given to him?

ANSWERS

A. The patient does not requires any Rehydration Therapy due to no signs & Symptoms of dehydration.
B. Yes, Antibiotic should be prescribed CEFTRIAXONE to treat bacterial Infection caught in different
parts of body.
C. Antidiarrheal drug should be prescribed named as LOPERAMIDE.
D. Symptomatic drugs in case of weakness- DEXTROSE & SODIUM

CHLORIDE through I.V route is given.

If bloating , flatulence occurs Proton Pump Inhibitors (PPT’s)

RABEPRAZOLE, PANTAPRAZOLE should be prescribed.

REFERENCES :-

1. Laxminarayan, R., Et Al. (2013). “Antibiotic Resistance—The Need For Global Solutions.” The Lancet
Infectious Diseases.

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2. World Health Organization (Who). (2020). “Global Action Plan On Antimicrobial Resistance.”
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United States.”
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18. Rawson, T. M., et al. (2019). “Antimicrobial resistance in the digital age: AI and big data.” Clinical
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23. Xiao, Z., et al. (2021). “The use of machine learning for predicting resistance patterns.” Computational
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