Frequency and use of pharmaceuticals in selected Slovakian town via wastewater analysis

Antifungal drugs in the aquatic environment: A review on sources, occurrence, toxicity, health effects, removal strategies and future challenges

Fungal infections pose a significant global health burden, resulting in millions of severe cases and deaths annually. The escalating demand for effective antifungal treatments has led to a rise in the wholesale distribution of antifungal drugs, which consequently has led to their release into the environment, posing a threat to ecosystems and human health. This article aims to provide a comprehensive review of the presence and distribution of antifungal drugs in the environment, evaluate their potential ecological and health risks, and assess current methods for their removal. Reviewed studies from 2010 to 2023 period have revealed the widespread occurrence of 19 various antifungals in natural waters and other matrices at alarmingly high concentrations. Due to the inefficiency of conventional water treatment in removing these compounds, advanced oxidation processes, membrane filtration, and adsorption techniques have been developed as promising decontamination methods.In conclusion, this review emphasizes the urgent need for a comprehensive understanding of the presence, fate, and removal of antifungal drugs in the environment. By addressing the current knowledge gaps and exploring future prospects, this study contributes to the development of strategies for mitigating the environmental impact of antifungal drugs and protecting ecosystems and human health.

Retrospective spatiotemporal study of antidepressants in Slovenian wastewaters

This study utilizes wastewater-based epidemiology (WBE) to evaluate spatiotemporal changes in the consumption of antidepressants before and during the COVID-19 pandemic in Slovenia. Composite 24-h influent wastewater samples (n = 210) were collected from six wastewater treatment plants between summer 2019 and spring 2021. The samples were extracted using 96-well solid-phase extraction and analysed by liquid chromatography-tandem mass spectrometry. The measured concentrations of target antidepressant biomarkers were then converted to population-normalised mass loads (PNMLs), taking into account flow rate and catchment population. Ten biomarkers, including amitriptyline, bupropion, bupropion-OH, citalopram, norcitalopram, normirtazapine, venlafaxine, O-desmethylvenlafaxine, trazodone, and moclobemide, were above the lower limit of quantification and were included in the spatiotemporal temporal assessment. The highest PNMLs were detected for O-desmethylvenlafaxine (mean ± SD: 82.1 ± 21.2 mg/day/1000 inhabitants) and venlafaxine (38.0 ± 10.6 mg/day/1000 inhabitants), followed by citalopram (27.0 ± 10.7 mg/day/1000 inhabitants). In addition, the mean metabolite/parent compound ratios were comparable with other WBE studies indicating consumption rather than direct disposal. Overall, the results indicated significant spatiotemporal variations depending on the location, and the PNMLs of most biomarkers increased during the first wave of the COVID-19 pandemic (spring of 2020). However, no clear spatial patterns were revealed related to the pandemic.

A Fully Automated Online SPE-LC-MS/MS Method for the Determination of 10 Pharmaceuticals in Wastewater Samples

The increasing use of pharmaceuticals, their presence in the aquatic environment, and the associated toxic effects, have raised concerns in recent years. In this work, a new multi-residue analytical method was developed and validated for the determination of 10 pharmaceuticals in wastewaters using online solid-phase extraction (online SPE) and liquid chromatography-tandem mass spectrometry (LC-MS/MS). The compounds included in the method were antineoplastics (cabazitaxel, docetaxel, doxorubicin, etoposide, irinotecan, methotrexate, paclitaxel, and topotecan), renin inhibitors (aliskiren), and antidepressants (maprotiline). The method was developed through several experiments on four online SPE cartridges, three reversed phase chromatography columns, and four combinations of mobile phase components. Under optimal conditions, very low limits of detection (LODs) of 1.30 to 10.6 ng L⁻¹ were obtained. The method was repeatable, with relative standard deviations (RSD, %) for intraday and interday precisions ranged from 1.6 to 7.8 and from 3.3 to 13.2, respectively. Recovery values ranged from 78.4 to 111.4%, indicating the reproducibility of the method. Matrix effects were mainly presented as signal suppression, with topotecan and doxorubicin being the two most affected compounds (31.0% signal suppression). The proposed method was successfully applied to hospital effluents, detecting methotrexate (4.7–9.3 ng L⁻¹) and maprotiline (11.2–23.1 ng L⁻¹). Due to the shorter overall run time of 15 min, including sample preparation, and reduced sample volume (0.9 mL), this on-line SPE-LC-MS/MS method was extremely convenient and efficient in comparison to the classical off-line SPE method. The proposed method was also highly sensitive and can be used for ultratrace quantification of the studied pharmaceuticals in wastewaters, providing useful data for effective environmental monitoring.

A two-year study of emerging micro-pollutants and drugs of abuse in two Western Cape wastewater treatment works (South Africa)

This study evaluated the occurrence and fate of fourteen contaminants of emerging concern (CECs) at two South African wastewater treatment works (WWTW). Daily loads of the drug targets were calculated in the aqueous phase of influent- and effluent wastewater to evaluate their fate at the treatment works, along with population-normalised daily loads in raw influent wastewater to identify community-wide substance use patterns in the two study areas. Environmental risk characterisation of the CECs at WWTW effluent discharge was done using conventional risk quotient (RQ) estimations. A significant reduction of most CECs was observed at both WWTW locations, except for some that have been previously recorded to persist through various WWTW processes globally, including the illicit drug methaqualone that was reported here for the first time to evaluate its fate during wastewater treatment, substance use trends, and potential toxicological risk. Moderate-to high-RQs were estimated for several target CECs during the sampling period for both treatment facilities. The results presented here suggest the need for a multi-disciplinary approach to WWTW monitoring of CECs and highlight the need for further refinement of risk assessment approaches to mitigate recalcitrant- or pseudo-persistent CECs in wastewater discharge. Such refinement should include: (1) identifying the potential ecological risk on a wider range of sentinel indicators, (2) interaction of CECs with various biochemical pathways (including sub-lethal toxicity responses), (3) identifying the persistence and toxicological risks of breakdown products and (4) partitioning of CECs in the aqueous environment and/or bioaccumulation in freshwater biota.

Current and future perspectives for wastewater-based epidemiology as a monitoring tool for pharmaceutical use

The medical and societal consequences of the misuse of pharmaceuticals clearly justify the need for comprehensive drug utilization research (DUR). Wastewater-based epidemiology (WBE) employs the analysis of human metabolic excretion products in wastewater to monitor consumption patterns of xenobiotics at the population level. Recently, WBE has demonstrated its potential to evaluate lifestyle factors such as illicit drug, alcohol and tobacco consumption at the population level, in near real-time and with high spatial and temporal resolution. Up until now there have been fewer WBE studies investigating health biomarkers such as pharmaceuticals. WBE publications monitoring the consumption of pharmaceuticals were systematically reviewed from three databases (PubMed, Web of Science and Google Scholar). 64 publications that reported population-normalised mass loads or defined daily doses of pharmaceuticals were selected. We document that WBE could be employed as a complementary information source for DUR. Interest in using WBE approaches for monitoring pharmaceutical use is growing but more foundation research (e.g. compound-specific uncertainties) is required to link WBE data to routine pharmacoepidemiologic information sources and workflows. WBE offers the possibility of i) estimating consumption of pharmaceuticals through the analysis of human metabolic excretion products in wastewater; ii) monitoring spatial and temporal consumption patterns of pharmaceuticals continuously and in near real-time; and iii) triangulating data with other DUR information sources to assess the impacts of strategies or interventions to reduce inappropriate use of pharmaceuticals.

Environmental concentration of methamphetamine induces pathological changes in brown trout (Salmo trutta fario)

Methamphetamine, mainly consumed as an illicit drug, is a potent addictive psychostimulant that has been detected in surface water at concentrations ranging from nanograms to micrograms per litre, especially in Middle and East Europe. The aim of this study was to expose brown trout (Salmo trutta fario) to environmental (1 μg L^-1) and higher (50 μg L^-1) concentrations of methamphetamine for 35 days with a four-day depuration phase to assess the possible negative effects on fish health. Degenerative liver and heart alterations, similar to those described in mammals, were observed at both concentrations, although at different intensities. Apoptotic changes in hepatocytes, revealed by activated caspase-3, were found in exposed fish. The parent compound and a metabolite (amphetamine) were detected in fish tissues in both concentration groups, in the order of kidney > liver > brain > muscle > plasma. Bioconcentration factors ranged from 0.13 to 80. A therapeutic plasma concentration was reached for both compounds in the high-concentration treatment. This study indicates that chronic environmental concentrations of methamphetamine can lead to health issues in aquatic organisms.

Occurrence and risk assessment of azole antifungal drugs in water and wastewater

The occurrence of azole antifungals in the environment presents one of the emerging concerns due to their ecotoxicological threat as well as their potential contribution to the evolution of drug resistant fungi in the environment. In this study, the occurrence of eight commonly prescribed azole antifungal drugs was seasonally determined in influent and effluent water samples from three wastewater treatment plants and a drinking water treatment plant in South Africa. In addition, the risk quotient (RQ) method was employed to investigate the potential ecological and human health risks associated with their presence in the wastewater and/or drinking water. Clotrimazole, econazole, fluconazole, itraconazole, ketoconazole and miconazole were detected at least once in the water samples, while posaconazole and voriconazole were not detected in any of the samples for all seasons at which the samples were collected. Fluconazole was detected at higher frequency (about 96%) with a concentration up to 9959.0 ng L^-1. Clotrimazole had the second highest frequency of detection (about 33%) with a concentration up to 143.3 ng L^-1. Statistically significant temporal variation in clotrimazole (p < 0.05) and spatial variation in fluconazole (p < 0.05) were observed. In general, the preliminary ecological risk assessment based on risk quotient (RQ) calculation indicated that there is currently no high risk against aquatic organisms (Algae, Daphnia and Fish) related to the azole antifungals. Meanwhile, human health risk assessment demonstrated that fluconazole represented high risk in drinking water. Furthermore, risk estimates showed a potential for the detected concentrations of fluconazole and itraconazole in water samples to pose moderate to high risk for development of antifungal drug resistance. Some of the azole antifungal drugs are ubiquitous in the wastewater and future monitoring and validation studies should be conducted for those drugs that seem to pose human health and ecological risks.

Pharmaceuticals and illicit drugs - A new threat to the application of sewage sludge in agriculture

The occurrence of 93 pharmaceuticals, illicit drugs and their metabolites has been investigated in stabilized sewage sludge from five municipal wastewater treatment plants (WWTPs) in the Slovak Republic. The total population connected to the tested WWTPs was approximately 600,000 p.e. which represents >20% of the Slovak population connected to public sewer systems. The sludge production from the five tested plants was >8100tons in 2016, which is approximately 15% of the total Slovak sewage sludge production in 2016. The highest total concentration of all pharmaceuticals was found in WWTP Bratislava Devínska Nová Ves (DNV) and Senec - 11,800 and 11,300ng/g dry matter (DM), respectively. Among individual pharmaceuticals, the highest concentrations were recorded for fexofenadine (mean 2340ng/g DM, maximum 5600ng/g DM in Bratislava DNV) and telmisartan (mean 1170ng/g DM, with a maximum of 3370ng/g DM in Senec). A principal component analysis revealed differences between pharmaceutical patterns in aerobically and anaerobically stabilized sludge. The worst-case scenario based on no further degradation of pharmaceuticals between sludge production and field application was used to predict pharmaceutical mass loads in agriculture. For the result, we estimated an annual load to soil in the Slovak Republic of up to several hundred kilograms of pharmaceuticals and drugs, with the maximum for fexofenadine (120kg/year) and verapamil (29kg/year).

Analytical and legislative challenges of sewage sludge processing and management

ABSTRACT

This article presents the most popular methods of sewage sludge management and analytical techniques which could be a powerful tool in designing new sewage sludge management methods. Chemical analysis is also described as a vital point at the subsequent stages of technological processes control and sewage sludge quality assessment. It is also an instrument essential to maintaining control of processed sewage sludge introduced to the environment as ready-to-use materials. The sludge management method is conditioned by the compliance with legal acts concerning sludge management. The most important of these contain information regarding allowable concentrations of pollutants which can be released into the environment, and the most important declarations concerning sewage sludge management. Various analytical techniques and preparation methods that can be used during the monitoring of the managed and processed sewage sludge are described. The most important are chromatographic techniques, methods based on inductively coupled plasma, and mass spectrometry based methods.

GRAPHICAL ABSTRACT

Application of liquid-liquid microextraction for the effective separation and simultaneous determination of 11 pharmaceuticals in wastewater samples using high-performance liquid chromatography with tandem mass spectrometry

A dispersive liquid-liquid microextraction method for the simultaneous determination of 11 pharmaceuticals has been developed. The method is based on a microextraction procedure applied to wastewater samples from different regions of Hungary followed by high-performance liquid chromatography with mass spectrometry. The effect of the nature of the extractant, dispersive solvent, different additives, and extraction time were examined on the extraction efficiently of the dispersive liquid-liquid microextraction method. Under optimal conditions, the linearity for determining the pharmaceuticals was in the range of 1-500 ng/mL, with the correlation coefficients ranging from 0.9922 to 0.9995. The limits of detection and limits of quantification were in the range of 0.31-6.65 and 0.93-22.18 ng/mL, respectively.