Indirect human exposure to pharmaceuticals via drinking water

Treatment of micropollutants in municipal wastewater: ozone or powdered activated carbon?

Many organic micropollutants present in wastewater, such as pharmaceuticals and pesticides, are poorly removed in conventional wastewater treatment plants (WWTPs). To reduce the release of these substances into the aquatic environment, advanced wastewater treatments are necessary. In this context, two large-scale pilot advanced treatments were tested in parallel over more than one year at the municipal WWTP of Lausanne, Switzerland. The treatments were: i) oxidation by ozone followed by sand filtration (SF) and ii) powdered activated carbon (PAC) adsorption followed by either ultrafiltration (UF) or sand filtration. More than 70 potentially problematic substances (pharmaceuticals, pesticides, endocrine disruptors, drug metabolites and other common chemicals) were regularly measured at different stages of treatment. Additionally, several ecotoxicological tests such as the Yeast Estrogen Screen, a combined algae bioassay and a fish early life stage test were performed to evaluate effluent toxicity. Both treatments significantly improved the effluent quality. Micropollutants were removed on average over 80% compared with raw wastewater, with an average ozone dose of 5.7 mg O3 l(-1) or a PAC dose between 10 and 20 mg l(-1). Depending on the chemical properties of the substances (presence of electron-rich moieties, charge and hydrophobicity), either ozone or PAC performed better. Both advanced treatments led to a clear reduction in toxicity of the effluents, with PAC-UF performing slightly better overall. As both treatments had, on average, relatively similar efficiency, further criteria relevant to their implementation were considered, including local constraints (e.g., safety, sludge disposal, disinfection), operational feasibility and cost. For sensitive receiving waters (drinking water resources or recreational waters), the PAC-UF treatment, despite its current higher cost, was considered to be the most suitable option, enabling good removal of most micropollutants and macropollutants without forming problematic by-products, the strongest decrease in toxicity and a total disinfection of the effluent.

Temporal variability of antibiotics fluxes in wastewater and contribution from hospitals

Significant quantities of antibiotics are used in all parts of the globe to treat diseases with bacterial origins. After ingestion, antibiotics are excreted by the patient and transmitted in due course to the aquatic environment. This study examined temporal fluctuations (monthly time scale) in antibiotic sources (ambulatory sales and data from a hospital dispensary) for Lausanne, Switzerland. Source variability (i.e., antibiotic consumption, monthly data for 2006-2010) were examined in detail for nine antibiotics--azithromycin, ciprofloxacin, clarithromycin, clindamycin, metronidazole, norfloxacin, ofloxacin, sulfamethoxazole and trimethoprim, from which two main conclusions were reached. First, some substances--azithromycin, clarithromycin, ciprofloxacin--displayed high seasonality in their consumption, with the winter peak being up to three times higher than the summer minimum. This seasonality in consumption resulted in seasonality in Predicted Environmental Concentrations (PECs). In addition, the seasonality in PECs was also influenced by that in the base wastewater flow. Second, the contribution of hospitals to the total load of antibiotics reaching the Lausanne Wastewater Treatment Plant (WTP) fluctuated markedly on a monthly time scale, but with no seasonal pattern detected. That is, there was no connection between fluctuations in ambulatory and hospital consumption for the substances investigated.

Efficiency of membrane technology, activated charcoal, and a micelle-clay complex for removal of the acidic pharmaceutical mefenamic acid

The efficiency of sequential advanced membrane technology wastewater treatment plant towards removal of a widely used non-steroid anti-inflammatory drug (NSAID) mefenamic acid was investigated. The sequential system included activated sludge, ultrafiltration by hollow fibre membranes with 100 kDa cutoff, and spiral wound membranes with 20 kDa cutoff, activated carbon and a reverse osmosis (RO) unit. The performance of the integrated plant showed complete removal of mefenamic acid from spiked wastewater samples. The activated carbon column was the most effective component in removing mefenamic acid with a removal efficiency of 97.2%. Stability study of mefenamic acid in pure water and Al-Quds activated sludge revealed that the anti-inflammatory drug was resistant to degradation in both environments. Batch adsorption of mefenamic acid by activated charcoal and a composite micelle (otadecyltrimethylammonium (ODTMA)-clay (montmorillonite) was determined at 25.0°C. Langmuir isotherm was found to fit the data with Qmax of 90.9 mg g(-1) and 100.0 mg g(-1) for activated carbon and micelle-clay complex, respectively. Filtration experiment by micelle-clay columns mixed with sand in the mg L(-1) range revealed complete removal of the drug with much larger capacity than activated carbon column. The combined results demonstrated that an integration of a micelle-clay column in the plant system has a good potential to improve the removal efficiency of the plant towards NSAID drugs such as mefenamic acid.

Spatially explicit prioritization of human antibiotics and antineoplastics in Europe

This paper presents a screening tool for the location-specific prioritization of human pharmaceutical emissions in Europe, based on risk quotients for the aquatic environment and human health. The tool provides direction towards either monitoring activities or additional research. Its application is illustrated for a set of 11 human antibiotics and 7 antineoplastics. Risk quotients for the aquatic environment were highest for levofloxacin, doxycycline and ciprofloxacin, located in Northern Italy (Milan region; particularly levofloxacin) and other densely populated areas in Europe (e.g. London, Krakow and the Ruhr area). Risk quotients for human health not only depend on pharmaceutical and location, but also on behavioral characteristics, such as consumption patterns. Infants in eastern Spain that consume locally produced food and conventionally treated drinking water were predicted to run the highest risks. A limited comparison with measured concentrations in surface water showed that predicted and measured concentrations are approximately within one order of magnitude.

Biochemical effects of veterinary antibiotics on proliferation and cell cycle arrest of human HEK293 cells

The purpose of this study was to examine the effects of veterinary antibiotics, including amoxicillin (AMX), chlortetracycline (CTC) and tylosin (TYL), on the biochemical mechanism of human embryonic kidney cells (HEK293). CTC and TYL inhibited HEK293 cell proliferation, in both time- and dose-dependent manners, and changed the cell morphology; whereas, AMX showed no cytotoxic effects. The cell cycle analysis of CTC and TYL revealed G1-arrest in HEK293 cells. Western blot analysis also showed that CTC and TYL affected the activation of DNA damage responsive proteins, as well as cell cycle regulatory proteins, such as p53, p21(Waf1/Cip1) and Rb protein, which are crucial in the G1-S transition. The activation of p21(Waf1/Cip1) was significantly up-regulated over time, but there was no change in the level of CDK2 expression. The results of this study suggest that veterinary antibiotics, even at low level concentrations on continuous exposure, can potentially risk the development of human cells.

Prioritizing environmental risk of prescription pharmaceuticals

Low levels of pharmaceutical compounds have been detected in aquatic environments worldwide, but their human and ecological health risks associated with low dose environmental exposure is largely unknown due to the large number of these compounds and a lack of information. Therefore prioritization and ranking methods are needed for screening target compounds for research and risk assessment. Previous efforts to rank pharmaceutical compounds have often focused on occurrence data and have paid less attention to removal mechanisms such as human metabolism. This study proposes a simple prioritization approach based on number of prescriptions and toxicity information, accounting for metabolism and wastewater treatment removal, and can be applied to unmeasured compounds. The approach was performed on the 200 most-prescribed drugs in the US in 2009. Our results showed that under-studied compounds such as levothyroxine and montelukast sodium received the highest scores, suggesting the importance of removal mechanisms in influencing the ranking, and the need for future environmental research to include other less-studied but potentially harmful pharmaceutical compounds.

Aqueous chlorination of diclofenac: kinetic study and transformation products identification

Diclofenac reactivity and fate during water chlorination was investigated in this work. In the first step, chlorination kinetic of diclofenac (DCF) was studied in the pH range of 4-10 at 20 ± 2 °C and in the presence of an excess of total chlorine. A second-order reaction (first-order relative to DCF concentration and first-order relative to free chlorine concentration) was shown with rate constant about 3.89 ± 1.17 M(-1) s(-1) at pH 7. The elementary reactions (i.e. reactions of hypochlorous acid (HOCl) with neutral and ionized forms of DCF, and acid-catalysed reaction of HOCl with neutral and ionized forms of DCF) were proposed to explain the pH-dependence of the rate constants and intrinsic constant of each of them were calculated. In the second step, several degradation products formed during chlorination of DCF were identified. These compounds could come from an initial chlorine electrophilic attack on aromatic ring or amine function of DCF. Some of these chlorinated derivatives seem to accumulate in solution in the presence of an excess of chlorine.

Storage and disposal of unused medications: knowledge, behavior, and attitudes among Serbian people

BACKGROUND

Improper disposal of medications potentially poses a significant environmental risk and storage of expired and unused medications in households provides an increased risk of accidental childhood poisonings.

OBJECTIVE

The objective of this study was to investigate the storage and disposal habits of medications amongst the population in the South Bačka District of Serbia, and to gain insight into the attitudes and knowledge of the population about the proper disposal of medications. Setting Households in South Bačka District.

METHOD

The study was conducted during the 6-month period from February 2010 to July 2010 and involved a random sample of households. The questionnaire-based study was performed by a trained interviewer.

MAIN OUTCOME MEASURE

number of expired and unused medications in families, behavior and knowledge about the disposal of medications.

RESULTS

Of 230 families, 208 (108 urban and 100 rural) agreed to participate and complete the questionnaire(90 % response rate). The drugs were mostly kept in a specific place-home pharmacy (89.8 % [urban] and 89.0 % [rural]). Exposure of children to medications in the home environment was similar in urban and rural families (19.6 % [urban] and 23.1 % [rural]). The frequency of expired medications was not observed to be different between the urban and rural households (10.3 % [urban] and 11.8 % [rural]). The most common method for disposal of household medications is disposal in the garbage (85.6 % [urban] and 74.5 % [rural]) or in the toilet (8.7 % [urban] and 6.4 % [rural]). However, inconsistent with disposal practices, half of the urban and rural participants thought that throwing medications in the garbage, toilet, or sink has a detrimental effect on the environment.

CONCLUSION

Public services in Serbia, including government and health sectors, need to be more proactive about educating people on how to store and dispose medications, as well as finding a way for implementation of the law on medications wastage destruction.

Methodology to account for uncertainties and tradeoffs in pharmaceutical environmental hazard assessment

Many pharmaceutical products find their way into receiving waters, giving rise to concerns regarding their environmental impact. A procedure was proposed that enables ranking of the hazard to aquatic species and human health due to such products. In the procedure, hazard assessment is based on five of the pharmaceutical product's individual physico-chemical properties. These properties are aggregated using the weighted Euclidian distance as the utility function. The weights and physico-chemical properties are considered as random variables. Physico-chemical property uncertainty criteria are obtained from a literature review. Weight uncertainty is based on a hazard ranking from a panel of experts, the histogram of which is converted into a continuous probability density function using statistical Kernel smoothing technique. The hazard-ranking procedure was applied to a list of common pharmaceuticals used in Switzerland. The procedure is target-specific. Two rankings were presented: One giving priority to environmental protection and the other to human health. For most substances, the hazard rank depends on the target. For the Swiss case study, the ranking procedure led to the conclusion that the hormones ethinylestradiol and testosterone, along with the antibiotic erythromycin A, should be in all cases included in risk-assessment methodologies, environmental concentration estimates and regular measurement campaigns. The methodology proposed is flexible and can be extrapolated to other substances and groups of experts.

Optimizing removal of ibuprofen from water by magnetic nanocomposite using Box-Behnken design

PURPOSE

The present research aims to optimize the removal of ibuprofen (IBP), a non-steroidal anti-inflammatory, analgesic, and antipyretic drug from the aqueous solution using a synthesized magnetic carbon-iron nanocomposite, and to investigate the individual and combined effects of the independent process variables.

METHOD

Combining the adsorptive capability of carbon and magnetic property of iron, a carbon-iron nanocomposite was synthesized. A four-factor Box-Behnken experimental design-based optimization modeling was performed for maximizing the removal of IBP from water by the nanocomposite using the batch experimental data. A quadratic model was built to predict the responses. Significance of the process variables and their interactions was tested by the analysis of variance and t test statistics.

RESULTS

The experimental maximum removals of IBP from the aqueous solution by carbon and magnetic nanocomposite were 14.74% and 60.39%, respectively. The model predicted maximum removal of 65.81% under the optimum conditions of the independent variables (IBP concentration 80 mg/l; temperature 48°C; pH 2.50; dose 0.6 g/l) was very close to the experimental value (65.12 ± 0.92%). pH of the solution exhibited most significant effect on IBP adsorption.

CONCLUSION

The developed magnetic nanocomposite was found superior than its precursor carbon exhibiting higher removal of IBP from the water and can be easily separated from the aqueous phase under temporary external magnetic field. The developed magnetic nanocomposite may be used for an efficient removal of IBP from the water.

Synthesis by precipitation polymerization of molecularly imprinted polymer for the selective extraction of diclofenac from water samples

A molecularly imprinted polymer (MIP) was synthesized by precipitation polymerization using diclofenac (DFC) as a template, 2-vinylpyridine (2-VP) as functional monomer, ethylene glycol dimethacrylate (EGDMA) as cross-linker, and toluene as porogen. The MIP showed outstanding affinity toward DFC in aqueous solution with a binding site capacity (Q(max)) of 324.8 mg/g (1.09 mmol/g) and was used as solid-phase extraction (SPE) material for the quantitative enrichment of DFC in environmental water samples and off-line coupled to a reversed-phase HPLC/DAD. Various parameters including washing solvent, elution solvent and breakthrough volume affecting the extraction efficiency of the polymers have been evaluated to achieve the selective preconcentration of DFC from water samples and to reduce non-specific interactions. Recoveries of DFC extracted from tap water, river water and wastewater samples were higher than 95%, and no significant DFC recovery difference was obtained among the different water matrix. The stability of MIP was tested by consecutive percolation of water sample, and it was shown that the performance of the MIP did not vary even after 30 adsorption and desorption cycles. Furthermore, the MISPE was used for the analysis of DFC in river water and wastewater samples and revealed DFC concentrations of 0.69±0.002 μg/L (n=3) and 0.31±0.004μg/L (n=3), respectively. The results were in good agreement with corresponding LC-MS/MS data.

Temporal dynamics of periphyton exposed to tetracycline in stream mesocosms

Significant amounts of antibiotics enter the environment via point and nonpoint sources. We examined the temporal dynamics of tetracycline exposure to stream periphyton and associated organisms across a logarithmically dosed-series of experimental mesocosms, designed to mimic natural conditions. Target in-stream tetracycline exposures were based on environmentally relevant concentrations in aquatic ecosystems throughout the United States (<1-100 μg L(-1)). Significant changes in the stream biotic community were observed within 7 days with in-stream tetracycline concentrations as low as 0.5 μg L(-1), including significant changes in antibiotic resistance, bacteria abundance and productivity, algae biomass, cyanobacteria, organic biomass, and nematodes. These effects were magnified with increased exposure time and dosing concentration. Recovery of the periphyton community after 28 days of exposure was dependent upon the tetracycline dose. At the highest doses, 10 and 100 μg L(-1), bacteria productivity recovered; however, bacteria, algae, and nematode abundance did not recover at the same rate and remained low even after a 28-day recovery period (of nondosing). This study demonstrates that tetracycline exposure under near-natural conditions and at concentrations currently observed in aquatic environments may have important consequences for the structure and function of stream periphyton and, potentially, public health via increasing resistance of naturally occurring bacteria.

Toxicity evaluation of verapamil and tramadol based on toxicity assay and expression patterns of Dhb, Vtg, Arnt, CYP4, and CYP314 in Daphnia magna

In this study, the toxicities of two pharmaceuticals, verapamil and tramadol were evaluated in Daphnia magna using the conventional toxicity tests (acute and chronic test) and the expression patterns of five stress responsive genes. In the chronic toxicity test, several parameters, such as the survival percentage, the body length of D. magna, the time of first reproduction, and the number of offspring per female, were adversely affected during the exposure to 4.2 mg L(-1) verapamil and 34 mg L(-1) tramadol. During the 24-h short-term exposure, verapamil particularly caused a downregulated expression of the CYP4 and CYP314 genes, whereas tramadol upregulated the expression of the CYP314 gene. Neither pharmaceutical affected the expression of Dhb, Arnt, and Vtg. However, during the 21-day long-term exposure, both verapamil and tramadol significantly reduced the expression level of the Vtg gene, a biomarker of the reproduction ability in an oviparous animal, whereas neither affected the other genes.

Screening of pharmaceuticals and hormones at the regional scale, in surface and groundwaters intended to human consumption

As part of a regional screening to evaluate the risk, for the health of populations, to certain classes of emerging substances, several families of pharmaceuticals and hormones were looked for in waters intended to drinking. Thus, 52 substances were investigated in 71 surface waters and 70 groundwaters. Results indicate that no water was free of pollutants, regardless of its origin (surface or groundwater) and the season of collect. The pharmaceuticals most frequently detected and with the highest concentration levels were salicylic acid, carbamazepine and acetaminophen. Among hormones, testosterone, androstenedione and progesterone were detected in almost all the samples. Globally the groundwaters were less contaminated than surface waters in regards pharmaceuticals frequencies and levels. On the other side, androgens and progestagens were present with comparable frequencies and levels in both compartments. The risk linked to the presence of these substances on human health is discussed.

Occurrence and concentrations of pharmaceutical compounds in groundwater used for public drinking-water supply in California

Pharmaceutical compounds were detected at low concentrations in 2.3% of 1231 samples of groundwater (median depth to top of screened interval in wells=61 m) used for public drinking-water supply in California. Samples were collected statewide for the California State Water Resources Control Board's Groundwater Ambient Monitoring and Assessment (GAMA) Program. Of 14 pharmaceutical compounds analyzed, 7 were detected at concentrations greater than or equal to method detection limits: acetaminophen (used as an analgesic, detection frequency 0.32%, maximum concentration 1.89 μg/L), caffeine (stimulant, 0.24%, 0.29 μg/L), carbamazepine (mood stabilizer, 1.5%, 0.42 μg/L), codeine (opioid analgesic, 0.16%, 0.214 μg/L), p-xanthine (caffeine metabolite, 0.08%, 0.12 μg/L), sulfamethoxazole (antibiotic, 0.41%, 0.17 μg/L), and trimethoprim (antibiotic, 0.08%, 0.018 μg/L). Detection frequencies of pesticides (33%), volatile organic compounds not including trihalomethanes (23%), and trihalomethanes (28%) in the same 1231 samples were significantly higher. Median detected concentration of pharmaceutical compounds was similar to those of volatile organic compounds, and higher than that of pesticides. Pharmaceutical compounds were detected in 3.3% of the 855 samples containing modern groundwater (tritium activity>0.2 TU). Pharmaceutical detections were significantly positively correlated with detections of urban-use herbicides and insecticides, detections of volatile organic compounds, and percentage of urban land use around wells. Groundwater from the Los Angeles metropolitan area had higher detection frequencies of pharmaceuticals and other anthropogenic compounds than groundwater from other areas of the state with similar proportions of urban land use. The higher detection frequencies may reflect that groundwater flow systems in Los Angeles area basins are dominated by engineered recharge and intensive groundwater pumping.

Ozonation of secondary treated wastewater reduces ecotoxicity to Gammarus fossarum (Crustacea; Amphipoda): are loads of (micro)pollutants responsible?

Ozone application is an effective tool to reduce loads of (micro)pollutants in wastewater, however, its ecotoxicological implications are largely unknown. Therefore, the feeding rates of a leaf-shredding invertebrate (Gammarus fossarum) exposed to secondary (=non-ozone) or ozone treated wastewater were investigated to assess potential ecotoxicological effects. Two repetitive experiments resulted in significantly higher feeding rates for gammarids exposed to ozone compared to non-ozone treated wastewater sampled from a treatment plant equipped with a full-scale ozonation. A further experiment confirmed these results also for wastewater from the same treatment plant, when ozonation was conducted at the lab-scale. However, the deviations in dissolved organic carbon profiles of ozone and non-ozone wastewater did not seem to be the driving factor for the effects observed. Two additional experiments displayed on the one hand a higher feeding rate of G. fossarum if exposed to ten-fold enriched eluates from solid phase extraction cartridges loaded with ozone compared to non-ozone treated wastewater. On the other hand, the mean feeding rate of gammarids exposed to non-ozone treated wastewater, which contained hardly any (micro)pollutants (i.e. pharmaceuticals), was at the same level as wastewater from the same source additionally treated with ozone. These results suggest that not an alteration in the organic matrix but a reduction in the load of micropollutants most likely triggered the effects in the bioassay applied. Hence, the feeding rate of G. fossarum appears to be a well-suited bioassay to indicate alterations in ecotoxicological properties of wastewater due to the application of advanced oxidation processes like ozonation.

Selective removal of diclofenac from contaminated water using molecularly imprinted polymer microspheres

A molecularly imprinted polymer (MIP) was synthesized by precipitation polymerization using diclofenac (DFC) as a template. Binding characteristics of the MIP were evaluated using equilibrium binding experiments. Compared to the non-imprinted polymer (NIP), the MIP showed an outstanding affinity towards DFC in an aqueous solution with a binding site capacity (Q(max)) of 324.8 mg/g and a dissociation constant (K(d)) of 3.99 mg/L. The feasibility of removing DFC from natural water by the MIP was demonstrated by using river water spiked with DFC. Effects of pH and humic acid on the selectivity and adsorption capacity of MIP were evaluated in detail. MIP had better selectivity and higher adsorption efficiency for DFC as compared to that of powdered activated carbon (PAC). In addition, MIP reusability was demonstrated for at least 12 repeated cycles without significant loss in performance, which is a definite advantage over single-use activated carbon.

Pharmaceuticals in drinking water: local analysis of the problem and finding a solution through awareness

OBJECTIVES

To evaluate public awareness of pharmaceuticals in drinking water and to develop educational efforts to promote awareness in our community.

METHODS

A review of the literature was conducted to gain a full perspective of the current issue. Questionnaires, interviews, and website feedback were used to assess awareness of the problem and the most commonly used medication disposal methods. In addition, educational flyers were created to disseminate information to the public.

RESULTS

The questionnaires were completed by a total of 96 respondents. Of respondents employed in health care, 72% had previous knowledge of pharmaceutical medications being found in our local (Charleston, SC) water supply, and of respondents not employed in health care, 54% had previous knowledge. For those with previous knowledge, 7% disposed of medications in the toilet or sink, 38% used the trash, and 36% used multiple methods. Of respondents indicating no previous knowledge, 3% disposed of medications in the toilet or sink, 35% used the trash, and 42% used multiple methods.

CONCLUSION

Public awareness of pharmaceuticals in drinking water and educational efforts focusing on proper disposal of medications are essential in helping to reduce drinking water contamination.

Population response to ozone application in wastewater: an on-site microcosm study with Gammarus fossarum (Crustacea: Amphipoda)

We assessed possible ecotoxicological implications of ozone application to secondary treated wastewater from a municipal wastewater treatment plant on Gammarus fossarum, an aquatic leaf shredding amphipod. Our 10-week study exposed G. fossarum populations to ozone-treated, non-ozone treated wastewater, or tap water in replicated outdoor flow-through stream microcosms. Feeding activity, an indicator for organic matter decomposition, of amphipod populations exposed to ozone treated wastewater was significantly higher compared to those exposed to non-ozone treated wastewater (repeated measure ANOVA, p = 0.0002, df = 44). Also the population size was at the end of the experiment with approximately 150% significantly (t-test, p = 0.0059, n = 4) increased in ozone treated wastewater compared to non-ozone treated wastewater. Additionally, chlorophyll-a concentration, an indicator for algal biomass, was significantly higher in ozone treated wastewater (repeated measure ANOVA, p = 0.0404, df = 65). Thus, from an ecotoxicological viewpoint, we conclude that ozonation may improve wastewater quality, which should translate into positive ecological outcomes in the receiving waters. However, because ozonation also can cause toxic transformation products, the process may best be considered on a case-by-case basis.

Uptake of carbamazepine by cucumber plants--a case study related to irrigation with reclaimed wastewater

Reclaimed wastewater is an important source of irrigation in semiarid and arid zones. Here we report data on carbamazepine (CBZ) uptake by cucumber plants in hydroponic culture and greenhouse experiments using different soil types irrigated with fresh water or reclaimed wastewater. Data obtained from the hydroponic culture experiments suggest that CBZ is mainly translocated by water mass flow, and thus it is concentrated and accumulated to the largest extent in the mature/older leaves. Carbamazepine concentration in cucumber fruits and leaves was negatively correlated with soil organic matter content. The concentrations of CBZ in the roots and stems were relatively low, and most CBZ in the plant (76-84% of total uptake) was detected in the leaves. A greenhouse experiment using fresh water and reclaimed wastewater spiked, or not, with CBZ at 1 μg L(-1) (typical concentration in effluents) revealed that CBZ can be taken up and bioaccumulated from its background concentration in reclaimed wastewater. Bioaccumulation factor (calculated as the ratio of CBZ concentration in the plant to that in the soil solution) for the fruits (0.8-1) was significantly lower than the value calculated for the leaves (17-20). This study emphasizes the potential uptake of active pharmaceutical compounds by crops in organic-matter-poor soils irrigated with reclaimed wastewater and highlights the potential risks associated with this agricultural practice.

Occurrence and loss over three years of 72 pharmaceuticals and personal care products from biosolids-soil mixtures in outdoor mesocosms

Municipal biosolids are in widespread use as additives to agricultural soils in the United States. Although it is well known that digested sewage sludge is laden with organic wastewater contaminants, the fate and behavior of micropollutants in biosolids-amended agricultural soils remain unclear. An outdoor mesocosm study was conducted in Baltimore, Maryland, to explore the fate of 72 pharmaceuticals and personal care products (PPCPs) over the course of three years in that were placed in plastic containers made from polyvinylchloride and kept exposed to ambient outdoor conditions. Of the 72 PPCPs tested for using EPA Method 1694, 15 were initially detected in the soil/biosolids mixtures at concentrations ranging from low parts-per-billion to parts-per-million levels. The antimicrobials triclocarban and triclosan showed the highest initial concentrations at 2715 and 1265 μg kg(-1), respectively. Compounds showing no discernable loss over three years of monitoring included diphenhydramine, fluoxetine, thiabendazole and triclocarban. The following half-life estimates were obtained for compounds showing first-order loss rates: azithromycin (408-990 d) carbamazepine (462-533 d), ciprofloxacin (1155-3466 d), doxycycline (533-578 d), 4-epitetracycline (630 d), gemfibrozil (224-231 d), norfloxacin (990-1386 d), tetracycline (578 d), and triclosan (182-193 d). Consistent with other outdoor degradation studies, chemical half-lives determined empirically exceeded those reported from laboratory studies or predicted from fate models. Study results suggest that PPCPs shown in the laboratory to be readily biotransformable can persist in soils for extended periods of time when applied in biosolids. This study provides the first experimental data on the persistence in biosolids-amended soils for ciprofloxacin, diphenhydramine, doxycycline, 4-epitetracycline, gemfibrozil, miconazole, norfloxacin, ofloxacin, and thiabendazole.

Human health risk assessment of pharmaceuticals in water: issues and challenges ahead

This study identified existing issues related to quantitative pharmaceutical risk assessment (QPhRA, hereafter) for pharmaceuticals in water and proposed possible solutions by analyzing methodologies and findings of different published QPhRA studies. Retrospective site-specific QPhRA studies from different parts of the world (U.S.A., United Kingdom, Europe, India, etc.) were reviewed in a structured manner to understand different assumptions, outcomes obtained and issues, identified/addressed/raised by the different QPhRA studies. Till date, most of the published studies have concluded that there is no appreciable risk to human health during environmental exposures of pharmaceuticals; however, attention is still required to following identified issues: (1) Use of measured versus predicted pharmaceutical concentration, (2) Identification of pharmaceuticals-of-concern and compounds needing special considerations, (3) Use of source water versus finished drinking water-related exposure scenarios, (4) Selection of representative exposure routes, (5) Valuation of uncertainty factors, and (6) Risk assessment for mixture of chemicals. To close the existing data and methodology gaps, this study proposed possible ways to address and/or incorporation these considerations within the QPhRA framework; however, more research work is still required to address issues, such as incorporation of short-term to long-term extrapolation and mixture effects in the QPhRA framework. Specifically, this study proposed a development of a new "mixture effects-related uncertainty factor" for mixture of chemicals (i.e., mixUF(composite)), similar to an uncertainty factor of a single chemical, within the QPhRA framework. In addition to all five traditionally used uncertainty factors, this uncertainty factor is also proposed to include concentration effects due to presence of different range of concentration levels of pharmaceuticals in a mixture. However, further work is required to determine values of all six uncertainty factors and incorporate them to use during estimation of point-of-departure values within the QPhRA framework.

Pharmaceuticals, personal care products and endocrine-disrupting chemicals in U.S. surface and finished drinking waters: a proposed ranking system

This study developed a comprehensive ranking system, for the first time as per authors' knowledge, for prioritizing the monitoring of pharmaceuticals and personal care products and endocrine-disrupting chemicals (together termed as EOCs, hereafter; a total of 100 EOCs considered) in U.S. stream water/source water and finished drinking water (termed as "EOCRank," hereafter). The EOCRank system was developed using a total of 4 criteria: (1) occurrence, (2) treatment in drinking water treatment plants, (3) ecological effects, and (4) health effects and characterized using 7 attributes: prevalence, frequency of detection, removal, bioaccumulation, ecotoxicity (for fish, daphnid, and algae aquatic indicator species), pregnancy effects, and health effects. The health effects attribute was characterized using 7 sub-attributes: carcinogenicity, mutagenicity, impairment of fertility, central nervous system acting, endocrine effects, immunotoxicity, and developmental effects. Rank scores of EOCs were calculated as summations of multiplications of importance weights and utility functions of multiple criteria and were arranged to highlight EOCs needing immediate attention. Two different ranking lists of EOCs were developed for U.S. finished drinking water and stream water/source water and observed to differ with each other, indicating the effect of water type on ranking of EOCs. A ranking list of priority EOCs, developed using a particular criterion, was observed to differ with that, developed using multiple criteria. Health effects and treatment criteria were observed to be important criteria influencing overall data gap rank scores and need further data collection. The generalized nature of the system could be customized for specific geographical locations (occurrence information and importance weights of different components). The developed database of the EOCRank system is available on: http://www.egr.msu.edu/~xagorara/research.html).

Influence of water and food consumption on inadvertent antibiotics intake among general population

Antibiotic entry into the water environment has been of growing concern. However, few investigations have been performed to examine the potential for indirect human exposure to environmental antibiotic residues. We evaluated the contribution of drinking water and major food consumption to inadvertent intake of antibiotic residues among general human population in Korea. We estimated daily human intake of six antibiotics, i.e., sulfamethazine (SMZ), sulfamethoxazole (SMX), sulfathiazole (STZ), trimethoprim (TMP), enrofloxacin (EFX), and roxithromycin (RTM), by measuring the concentrations of the antibiotics and their major metabolites in urine from general population in Korea (n=541). In addition, we measured antibiotics from source water of drinking water as well as in tap water samples, and surveyed water consumption rates among the study population. To assess the contribution of dietary factor, we also surveyed consumption pattern for several major foods which are suspected of antibiotics residue. SMZ, Sulfamethazine-N4-acetyl (SMZ-N4), TMP, EFX, ciprofloxacin (CFX), and RTM were detected up to 448, 6210, 11,900, 6970, 32,400, and 151pg/ml in the urine samples, respectively. Estimates of daily intake of major antibiotics did not appear to be related with consumption of drinking water although antibiotics were frequently detected in source waters (10-67ng/l). Consumption of several foods correlated significantly with urinary excretion of several antibiotics. Daily intake estimates of EFX and CFX were associated with consumption of beef, pork, and dairy products; those of SMZ and TMP associated with pork and dairy products; and that of TMP related with raw fish. Daily antibiotics intake estimates however did not exceed the acceptable daily intake levels.

Occurrence and fate of micropollutants in the Vidy Bay of Lake Geneva, Switzerland. Part I: priority list for environmental risk assessment of pharmaceuticals

Pharmaceuticals are substances designed to have a biological effect in humans. Their presence in the environment, especially in surface waters, is of increasing concern because of their potential risk to non-target species. A large number of pharmaceuticals are on the market; for example, approximately 2,000 active ingredients are approved in Europe, and many of them have already been detected in surface water. It is therefore crucial to select the substances that may do the most harm to the environment prior to performing measurements and extensive risk assessment. In the present study, a method to determine a list of pharmaceuticals to survey in surface water is proposed. Inclusion of substances on the list was based on a screening procedure, the analytical feasibility, and previous knowledge of pharmaceuticals detected in water. The screening procedure proposed here is an improvement on the standard procedure of the European Medicine Evaluation Agency (EMEA). It is designed to decrease the number of pharmaceuticals to be evaluated in a stepwise manner, thus decreasing the number of data necessary for the evaluation. We applied our approach to determine a list of 37 pharmaceuticals and four hormones to survey in a specific region of Switzerland, the Lake Geneva area, and discussed the advantages and weak points of the method.

Toxicological relevance of pharmaceuticals in drinking water

Interest in the public health significance of trace levels of pharmaceuticals in potable water is increasing, particularly with regard to the effects of long-term, low-dose exposures. To assess health risks and establish target concentrations for water treatment, human health risk-based screening levels for 15 pharmaceutically active ingredients and four metabolites were compared to concentrations detected at 19 drinking water treatment plants across the United States. Compounds were selected based on rate of use, likelihood of occurrence, and potential for toxicity. Screening levels were established based on animal toxicity data and adverse effects at therapeutic doses, focusing largely on reproductive and developmental toxicity and carcinogenicity. Calculated drinking water equivalent levels (DWELs) ranged from 0.49 microg/L (risperidone) to 20,000 microg/L (naproxen). None of the 10 detected compounds exceeded their DWEL. Ratios of DWELs to maximum detected concentrations ranged from 110 (phenytoin) to 6,000,000 (sulfamethoxazole). Based on this evaluation, adverse health effects from targeted pharmaceuticals occurring in U.S. drinking water are not expected.

Potential Ecological and Human Health Risks Associated With the Presence of Pharmaceutically Active Compounds in the Aquatic Environment

Recently, considerable interest has developed regarding the presence of pharmaceuticals in the environment, but as yet the potential ecological effects associated with the presence of these compounds have been largely ignored. In this review, laboratory-based acute and chronic toxicity data, as well as studies concerned with the effects of pharmaceuticals on a variety of different organisms, are examined, along with the reported environmental concentrations of pharmaceuticals in aquatic systems. The possible sources and pathways of these compounds to the environment and the effects of a variety of medicines on a range of organisms are also highlighted, and recommendations are made for further research.

Influence of a five-day vegetarian diet on urinary levels of antibiotics and phthalate metabolites: a pilot study with "Temple Stay" participants

Diet is purported to be means of exposure to many environmental contaminants. The purpose of this study is to understand the influence of dietary change on the levels of exposure to several environmental chemicals - in particular, antibiotics and phthalates. For this purpose, we examined the extent to which short-term changes in diet influenced the inadvertent exposure levels to these chemicals in an adult population. We recruited participants (n=25) of a five-day 'Temple Stay' program in Korea and collected urine samples before and after the program. We also conducted a questionnaire survey on participants' dietary patterns prior to their participation. During the program, participants followed the daily routines of Buddhist monks and maintained a vegetarian diet. Urinary levels of three antibiotics and their major metabolites, metabolites of four major phthalates, and malondialdehyde (MDA) as an oxidative stress biomarker were analyzed. The frequency and levels of detection for antibiotics and phthalates noticeably decreased during the program. Urinary MDA levels were significantly lower than before program participation (0.16 versus 0.27mg/g creatinine). Although the exposure to target compounds might be influenced by other behavioral patterns, these results suggest that even short-term changes in dietary behavior may significantly decrease inadvertent exposure to antibiotics and phthalates and hence may reduce oxidative stress levels.

Surface water concentrations and loading budgets of pharmaceuticals and other domestic-use chemicals in an urban watershed (Washington, DC, USA)

Pharmaceuticals and domestic-use chemicals (PDCs) are classes of emerging chemical contaminants thought to enter the aquatic environment primarily through wastewater treatment plant (WTP) discharges. The intent of this study was to quantify loadings of PDCs in an urban watershed. The watershed has two major branches but with wastewater discharge occurring in only one of the two major branches. Surface water from the Anacostia River (Washington, DC) was collected in base-flow and storm-flow regimes. Surface water was filtered to separate water and particles, and the PDCs were extracted from water with Oasis HLB solid-phase extraction cartridges and extracted from sediments using microwave-assisted extraction. The PDCs in the extracts were quantified using gas chromatography-mass spectrometry in the form of the trimethylsilyl ether derivatives. The most frequently detected PDC with the highest concentration was bisphenol-A in both branches of the Anacostia River watershed and the least frequently detected PDC was diclofenac. The overall median concentrations for all measured PDCs in surface water ranged from nondetectable to 54.9 ng/l. Alternatively, in the collected WTPs samples, naproxen was observed, with the highest concentration and the median concentrations in WTP effluent ranging from nondetectable to 276 ng/l. Estimates of PDC loadings for February 2006 from WTP effluent showed that <2% of the downstream load in the NE Branch was derived from WTP discharge. PDC sources other than WTP effluent appear to influence surface water concentrations in the urban Anacostia River watershed.

An assessment of potential exposure and risk from estrogens in drinking water

BACKGROUND

Detection of estrogens in the environment has raised concerns in recent years because of their potential to affect both wildlife and humans.

OBJECTIVES

We compared exposures to prescribed and naturally occurring estrogens in drinking water to exposures to naturally occurring background levels of estrogens in the diet of children and adults and to four independently derived acceptable daily intakes (ADIs) to determine whether drinking water intakes are larger or smaller than dietary intake or ADIs.

METHODS

We used the Pharmaceutical Assessment and Transport Evaluation (PhATE) model to predict concentrations of estrogens potentially present in drinking water. Predicted drinking water concentrations were combined with default water intake rates to estimate drinking water exposures. Predicted drinking water intakes were compared to dietary intakes and also to ADIs. We present comparisons for individual estrogens as well as combined estrogens.

RESULTS

In the analysis we estimated that a child's exposures to individual prescribed estrogens in drinking water are 730-480,000 times lower (depending upon estrogen type) than exposure to background levels of naturally occurring estrogens in milk. A child's exposure to total estrogens in drinking water (prescribed and naturally occurring) is about 150 times lower than exposure from milk. Adult margins of exposure (MOEs) based on total dietary exposure are about 2 times smaller than those for children. Margins of safety (MOSs) for an adult's exposure to total prescribed estrogens in drinking water vary from about 135 to > 17,000, depending on ADI. MOSs for exposure to total estrogens in drinking water are about 2 times lower than MOSs for prescribed estrogens. Depending on the ADI that is used, MOSs for young children range from 28 to 5,120 for total estrogens (including both prescribed and naturally occurring sources) in drinking water.

CONCLUSIONS

The consistently large MOEs and MOSs strongly suggest that prescribed and total estrogens that may potentially be present in drinking water in the United States are not causing adverse effects in U.S. residents, including sensitive subpopulations.

Estimation of the cancer risk to humans resulting from the presence of cyclophosphamide and ifosfamide in surface water

BACKGROUND, AIM, AND SCOPE

Anti-tumour agents and their metabolites are largely excreted into effluent, along with other pharmaceuticals. In the past, investigations have focused on the input and analysis of pharmaceuticals in surface and ground water. The two oxazaphosphorine compounds, cyclophosphamide and ifosfamide are important cytostatic drugs used in the chemotherapy of cancer and in the treatment of autoimmune diseases. Their mechanism of action, involving metabolic activation and unspecific alkylation of nucleophilic compounds, accounts for genotoxic and carcinogenic effects described in the literature and is reason for environmental concern. The anti-tumour agents cyclophosphamide (CP) and ifosfamide (IF) were not biodegraded in biodegradation tests. They were not eliminated in municipal sewage treatment plants. Degradation by photochemically formed HO radicals may be of some relevance only in shallow, clear, and nitrate-rich water bodies but could be further exploited for elimination of these compounds by advanced oxidation processes, i.e. in a treatment of hospital waste water. Therefore, CP and IF are assumed to persist in the aquatic environment and to enter drinking water via surface water. The risk to humans from input of CP and IF into surface water is not known.

MATERIALS AND METHODS

The local and regional, i.e. nationwide predicted environmental concentration (PEC(local), PEC(regional)) of CP and IF was calculated for German surface water. Both compounds were measured in hospital effluents, and in the influent and effluent of a municipal treatment plant. Additionally, published concentrations in the effluent of sewage treatment plants and surface water were used for risk assessment. Excretion rates were taken into account. For a worst-case scenario, maximum possible ingestion of CP or IF by drinking 2 L a day of unprocessed surface water over a life span of 70 years was calculated for adults. Elimination in drinking water processing was neglected, as no data is available. This intake was compared with intake during anti-cancer treatment.

RESULTS AND DISCUSSION

Intake of CP and IF for anti-cancer treatment is typically 10 g within a few months. Under such conditions, a relative risk of 1.5 for the carcinogenic compounds CP and IF is reported in the literature. In the worst case, the maximum possible intake by drinking water is less than 10(-3) (IF) and 10(-5) (CP) of this amount, based on highest measured local concentrations. On a nationwide average, the factor is approx. 10(-6) or less.

CONCLUSIONS

The additional intake of CP and IF due to their emission into surface water and its use without further treatment as drinking water is low compared to intake within a therapy. This approach has shortcomings. It illustrates the current lack of methodology and knowledge for the specific risk assessment of carcinogenic pharmaceuticals in the aquatic environment. IF and CP are directly reacting with the DNA. Therefore, with respect to health effects a safe threshold concentration for these compounds cannot be given. The resulting risk is higher for newborns and children than for adults. Due to the lack of data the risk for newborns and children cannot be assessed fully. The data presented here show that according to present knowledge the additional risk of cancer cannot be fully excluded, especially with respect to children. Due to the shortage of data for effects of CP and IF in low doses during a whole lifespan, possible effects were assessed using data of high doses of CP and IF within short-term ingestion, i.e. therapy. This remains an unresolved issue. Anyway, the risk assessment performed here could give a rough measure of the risks on the one hand and the methodological shortcomings on the other hand which are connected to the assessment of the input of genotoxic and carcinogenic pharmaceuticals such as CP and IF into the aquatic environment. Therefore, we recommend to take measures to reduce the input of CP and IF and other carcinogenic pharmaceuticals. We hope that our manuscript further stimulates the discussion about the human risk assessment for carcinogenic pharmaceuticals in the aquatic environment.

RECOMMENDATIONS AND PERSPECTIVES

CP and IF are carcinogens. With respect to newborn and children, reduction of the emission of CP and IF into effluent and surface water is recommended at least as a precautionary measure. The collection of unused and outdated drugs is a suitable measure. Collection of patients' excreta as a measure of input reduction is not recommended. Data suitable for the assessment of the risk for newborn and children should be collected in order to perform a risk assessment for these groups. This can stimulate discussion and give new insights into risk assessment for pharmaceuticals in the environment. Our study showed that in the long term, effective risk management for the reduction of the input of CP and IF are recommendable.

Occurrence of iodinated X-ray contrast media in indirect potable reuse systems

A lack of knowledge of the health and environmental risks associated with chemicals of concern (COCs) and also of their removal by advanced treatment processes, such as micro-filtration (MF) and reverse osmosis (RO), have been major barriers preventing establishment of large water recycling schemes. As part of a larger project monitoring over 300 COCs, iodinated X-ray contrast media compounds (ICM) were analysed in treated secondary wastewater intended for drinking purposes. ICM are the most widely administered intravascular pharmaceuticals and are known to persist in the aquatic environment. A direct injection liquid chromatography tandem mass spectrometry (DI-LC-MS/MS) method was used to monitor secondary treated wastewater from three major wastewater treatment plants in Perth, Western Australia. In addition, tertiary water treated with MF and RO was analysed from a pilot plant that has been built as a first step in trialling the aquifer recharge. Results collected during 2007 demonstrate that MF/RO treatment is capable of removing ICM to below the analytical limits of detection, with average RO rejection calculated to be greater than 92%. A screening health risk assessment indicated negligible human risk at the concentrations observed in wastewater.

Public Health Implications of Household Pharmaceutical Waste in the United States

Household pharmaceuticals are ubiquitous and untold quantities are wasted annually. Most often, people dispose of household pharmaceuticals by flushing them down the toilet, pouring them down the drain, or throwing them away in the trash. Pharmaceuticals disposed in this manner compromise the safety of our environment. This article provides a comprehensive review on the public health issue of household pharmaceutical waste, describing its epidemiology, explaining its effects on aquatic and human life, estimating its cost burden, and discussing strategies for reducing environmental exposure to it. In doing so, this article proposes two key objectives for our nation: (1) reduce the amount of household pharmaceuticals wasted and (2) devise environmentally friendly and cost-effective ways for handling this waste once it has been generated.

Environmental risk assessment of antibiotics: an intensive care unit analysis

Hospital effluents have been usually known by the microbiological pollution they cause, but only recently they have been considered a significant source of aquatic environmental pollution due to the presence of medicines in these effluents. In this context, an environmental risk assessment (ERA) is presented for the most used intravenous antibiotics in the Intensive Care Unit (ICU) of a hospital in Curitiba (Brazil). The amount of antibiotics used in the ICU was evaluated during 18months (June 2006 until November 2007), in order to calculate the Predicted Environmental Concentration (PEC1). Antibiotic excretion data (on its original form) and the removal of the selected drugs in the sewage treatment plants based on the activated sludge system were used to calculate, respectively, PEC2 and PEC2r. The Predicted No-Effect Concentration (PNEC) of pharmaceuticals was also considered to assess the environmental risk by calculating the PEC/PNEC ratios. All PECs were 1ngL(-1). The worst-case PEC estimations (PEC1 and PEC2) were observed for sodic ceftriaxone, sodic cefazolin, meropenem, ampicillin, cefepime and sodic piperacillin. PEC/PNEC ratios showed that, given the present pattern of usage, high aquatic environmental risk is expected for these antibiotics. Further studies should be carried out to elucidate their contribution to increasing antimicrobial multi-drug-resistant species.

Sustainable risk management of emerging contaminants in municipal wastewaters

The presence of emerging contaminants in municipal wastewaters, particularly endocrine-disrupting compounds such as oestrogenic substances, has been the focus of much public concern and scientific attention in recent years. Due to the scientific uncertainty still surrounding their effects, the Precautionary Principle could be invoked for the interim management of potential risks. Therefore, precautionary prevention risk-management measures could be employed to reduce human exposure to the compounds of concern. Steroid oestrogens are generally recognized as the most significant oestrogenically active substances in domestic sewage effluent. As a result, the UK Environment Agency has championed a 'Demonstration Programme' to investigate the potential for removal of steroid oestrogens and alkylphenol ethoxylates during sewage treatment. Ecological and human health risks are interdependent, and ecological injuries may result in increased human exposures to contaminants or other stressors. In this context of limiting exposure to potential contaminants, examining the relative contribution of various compounds and pathways should be taken into account when identifying effective risk-management measures. In addition, the explicit use of ecological objectives within the scope of the implementation of the EU Water Framework Directive poses new challenges and necessitates the development of ecosystem-based decision tools. This paper addresses some of these issues and proposes a species sensitivity distribution approach to support the decision-making process related to the need and implications of sewage treatment work upgrade as risk-management measures to the presence of oestrogenic compounds in sewage effluent.

Pharmaceuticals in wastewater: behavior, preferences, and willingness to pay for a disposal program

The presence of pharmaceutical compounds in treated wastewater and in surface waters is a growing environmental concern. This paper provides information about general awareness of the issue, disposal practices, willingness to pay for a disposal program, and willingness to participate in a disposal program. The results are based on a telephone survey of 1005 residents in southern California. Less than half of the respondents are aware of the issue. While disposal of unused medications through the trash and toilet/sink is the most common practices, respondents that are aware of the issue are more likely to return pharmaceuticals to a pharmacy or drop them off at a hazardous waste center. The results of a contingent valuation question indicate a substantial willingness to pay a surcharge on prescriptions to support the establishment of a pharmaceutical disposal program. The more conservative estimate of mean willingness to pay is $1.53 per prescription, which translates into an average annual willingness to pay of approximately $14. A benefit-cost comparison suggests ample scope for establishing a pharmaceutical disposal program that would yield positive net social benefits, even if the surcharge was applied to only one prescription per year. We also find that respondents are likely to participate in a disposal program. Assuming that the program is based on drop-off locations at local pharmacies, approximately 70 percent of the respondents would be very likely to return their unwanted or expired medicines.