What is Global PPS in Antibiotic Usage Practice
Global PPS refers to the WHO Global Point Prevalence Survey, a standardized surveillance methodology designed to measure antibiotic prescribing patterns and consumption across healthcare facilities worldwide, enabling countries to assess appropriateness of antibiotic use and identify targets for antimicrobial stewardship interventions.
Core Purpose and Framework
The Global PPS serves as a critical surveillance tool within the WHO's comprehensive policy package to combat antimicrobial resistance 1. This standardized methodology addresses a fundamental gap: the WHO estimates that >50% of all medicines are prescribed inappropriately, and <40% of patients with infections receive treatment according to clinical guidelines 1.
Key Surveillance Objectives
- Measure antibiotic consumption patterns across different healthcare facility types and geographic regions to establish baseline prescribing practices 1
- Identify inappropriate prescribing including wrong antibiotic selection, incorrect dosing, improper duration, or unnecessary use when no antibiotic is indicated 1
- Enable international comparisons while accounting for significant variations in prescribing practices between countries and healthcare settings 1
- Guide stewardship interventions by identifying "low-hanging fruit" targets such as IV-to-oral conversion, surgical prophylaxis optimization, and documentation improvement 1
Implementation Challenges
The Global PPS methodology faces substantial obstacles, particularly in low- and middle-income countries (LMICs). Significant methodological and logistical challenges exist in data collection, with notable absence of pediatric-specific data in many regions 1. The survey revealed marked variation in prescribing by facility type and geographic location, though exploration of these regional differences remains limited due to sparse available data 1.
Critical Surveillance Components
The WHO framework emphasizes that surveillance of both resistance patterns and antibiotic usage is essential to define the scale of bacterial resistance problems and assess impact of containment strategies 1. However, establishing standardized microbiological surveillance systems remains difficult, as does effectively influencing prescriber behavior and patient attitudes 1.
Integration with Stewardship Programs
The Global PPS data directly informs antibiotic stewardship program (ASP) development at facility and national levels 1. Recent initiatives in LMICs have used PPS findings to implement targeted interventions including:
- Restricted formulary access for high-cost, broad-spectrum agents (carbapenems, vancomycin, piperacillin/tazobactam) that account for disproportionate antibiotic expenditure 1
- Mandatory expert consultation before prescribing reserve antibiotics, though implementation and adherence monitoring varies significantly by country 1
- Centralized prescription monitoring using standardized documentation forms to ensure adherence to registered indications and national guidelines 1
Common Pitfalls in PPS Implementation
A critical limitation is that many countries fail to implement basic policies promoting rational antibiotic use despite having PPS data available 1. The survey methodology encounters challenges differentiating between appropriate empiric therapy for severe infections requiring immediate treatment and inappropriate overuse for viral infections 2.
Audit and Feedback Gaps
Processes for auditing implemented actions to establish effectiveness are not consistently incorporated into PPS frameworks 1. Methods similar to clinical trial designs should be considered, with systematic feedback to prescribers helping modify behavior based on their individual prescribing patterns compared to benchmarks 1.
Global Coordination Requirements
The WHO Global Strategy prioritizes interventions tackling antibiotic misuse in community settings, exploiting vaccine potential, and improving resistance surveillance 1. The strategy provides guidance on prioritizing interventions according to individual country healthcare situations, offering implementation models and assessment processes 1.
International collaboration remains essential, as antibiotic stewardship models must evolve beyond infection specialist-based teams to include pharmacists, nurses, and community health workers meeting global population needs 3. The Global PPS serves as the foundational data infrastructure enabling this coordinated response to antimicrobial resistance 1.