Comparison of Prioritisation Schemes for Human Pharmaceuticals in the Aquatic Environment

What Approaches Should be Used to Prioritize Pharmaceuticals and Personal Care Products for Research on Environmental and Human Health Exposure and Effects?

Pharmaceuticals and personal care products (PPCPs) are released from multiple anthropogenic sources and thus have a ubiquitous presence in the environment. The environmental exposure and potential effects of PPCPs on biota and humans has aroused concern within the scientific community and the public. Risk assessments are commonly conducted to evaluate the likelihood of chemicals including PPCPs that pose health threats to organisms inhabiting various environmental compartments and humans. Because thousands of PPCPs are currently used, it is impractical to assess the environmental risk of all of them due to data limitations; in addition, new PPCPs are continually being produced. Prioritization approaches, based either on exposure, hazard, or risk, provide a possible means by which those PPCPs that are likely to pose the greatest risk to the environment are identified, thereby enabling more effective allocation of resources in environmental monitoring programs in specific geographical locations and ecotoxicological investigations. In the present review, the importance and current knowledge concerning PPCP occurrence and risk are discussed and priorities for future research are proposed, in terms of PPCP exposure (e.g., optimization of exposure modeling in freshwater ecosystems and more monitoring of PPCPs in the marine environment) or hazard (e.g., differential risk of PPCPs to lower vs. higher trophic level species and risks to human health). Recommended research questions for the next 10 years are also provided, which can be answered by future studies on prioritization of PPCPs. Environ Toxicol Chem 2024;43:488-501. © 2022 SETAC.

Pharmacokinetic model of human exposure to ciprofloxacin through consumption of fish

Fluoroquinolones are broad-spectrum antibiotics that accumulate in the environment. To assess human exposure through the food chain, we developed a pharmacokinetic model of fluoroquinolone accumulation in fish and a human pharmacokinetic model to predict gastrointestinal concentrations of ciprofloxacin, a common fluoroquinolone, following consumption of fish. At 70 ng/L ciprofloxacin, the average in North American surface waters, the fish steady-state concentration was calculated to be 7.5 × 10-6 µg/g. Upon human consumption of the FDA-recommended portion of 113 g of fish containing this ciprofloxacin level, the predicted human intestinal concentration was 2 × 10-6 µg/mL. At 4 × 106 ng/L (4 µg/mL) ciprofloxacin, the highest recorded environmental measurement, these numbers were 0.42 µg/g in fish and 0.1 µg/mL in the human intestine. Thus, based on the ciprofloxacin MIC for E. coli of 0.13 µg/mL, background environmental ciprofloxacin levels are unlikely to be problematic, but environmental pollution can result in high intestinal levels that may cause gut dysbiosis and antibiotic resistance.

Occurrence of selected antibiotics in urban rivers in northwest Pakistan and assessment of ecotoxicological and antimicrobial resistance risks

Antibiotics in aquatic systems of developing countries are a growing concern, particularly with the potential ecological risks and emergence of antimicrobial resistance. In Pakistan, antibiotics are widely consumed and released untreated into rivers, however, there is little information on their occurrence and potential risks. In this study, the concentrations and risk assessment of three commonly consumed antibiotics, ciprofloxacin (CIP), amoxicillin (AMX), and cefixime (CFM) belonging to different classes of fluoroquinolone, penicillin, and cephalosporin respectively were investigated in the Kabul River and its two tributaries, Bara River and Shah Alam River in the northwest region of the country. Composite samples were collected in different sampling campaigns and analyzed using the LC-ESI-MS/MS technique. All three antibiotics were found in higher concentrations ranging from 410 to 1810 ng/L, 180-850 ng/L, and 120-600 ng/L for CIP, AMX, and CFM respectively. The Friedman and Wilcoxon signed-ranked tests revealed insignificant differences in average concentrations of each antibiotic in the three rivers and the Pearson Correlation showed a significant positive correlation of CIP with both AMX and CFM indicating their similar pollution sources. Ecotoxicological risk assessment showed a higher risk to algae and bacteria (P. putida) in the rivers with CIP posing a greater risk. The potential risk of antimicrobial resistance development (ARD) was higher in all the three rivers, particularly in Kabul River where maximum risk quotients (RQARD) of 28.3, 9.4 and 3.4 were noted for CIP, CFM and AMX respectively. The human health (HH) risk was insignificant, though the RQHH was higher for the lower age groups (0-3 months). In addition, the combined flux of the antibiotics in the Kabul River was estimated as 59 tons/year with CIP having a significant flux relative to the other antibiotics.

Predicting Environmental Risks of Pharmaceuticals from Wholesale Data: An Example from Norway

Environmental risk assessment (ERA) of pharmaceuticals relies on available measured environmental concentrations, but often such data are sparse. Predicted environmental concentrations (PECs), calculated from sales weights, are an attractive alternative but often cover only prescription sales. We aimed to rank, by environmental risk in Norway, approximately 200 active pharmaceutical ingredients (APIs) over 2016-2019, based on sales PECs. To assess the added value of wholesale and veterinary data, we compared exposure and risk predictions with and without these additional sources. Finally, we aimed to characterize the persistence, mobility, and bioaccumulation of these APIs. We compared our PECs to available Norwegian measurements, then, using public predicted-no-effect concentrations, we calculated risk quotients (RQs) and appended experimental and predicted persistence and bioaccumulation. Our approach overestimated environmental concentrations compared with measurements for 18 of 20 APIs with comparable predictions and measurements. Seventeen APIs had mean RQs >1, indicating potential risk, while the mean RQ was 2.05 and the median 0.001, driven by sex hormones, antibiotics, the antineoplastic abiraterone, and common painkillers. Some high-risk APIs were also potentially persistent or bioaccumulative (e.g., levonorgestrel [RQ = 220] and ciprofloxacin [RQ = 56]), raising the possibility of impacts beyond their RQs. Exposure and risk were also calculated with and without over-the-counter sales, showing that prescriptions explained 70% of PEC magnitude. Likewise, human sales, compared with veterinary, explained 85%. Sales PECs provide an efficient option for ERA, designed to overestimate compared with analytical techniques and potentially held back by limited data availability and an inability to quantify uncertainty but, nevertheless, an ideal initial approach for identification and ranking of risks. Environ Toxicol Chem 2023;42:2253-2270. © 2023 The Authors. Environmental Toxicology and Chemistry published by Wiley Periodicals LLC on behalf of SETAC.

Improving the regulatory environmental risk assessment of human pharmaceuticals: Required changes in the new legislation

One of the flagship actions of the Pharmaceutical Strategy for Europe is to address environmental challenges associated with pharmaceutical use. This includes strengthening the Environmental Risk Assessment (ERA) at marketing authorisation (MA) of pharmaceuticals, and revision of the pharmaceutical legislation where needed. The overall aim of an ERA should be to enable comprehensive and effective identification and management of environmental risks of pharmaceuticals without affecting the availability of pharmaceuticals to patients. As experts in the evaluation of ERAs of human medicinal products submitted by pharmaceutical industries (Applicants), we have summarized the current status of the ERA and suggest legislative changes to improve environmental protection without affecting availability. Six regulatory goals were defined and discussed, including possible ways forward: 1) mandatory ERAs in accordance to the EMA guideline at the time of the MA, 2) enforcement of risk mitigation measures including re-evaluation of the ERA, 3) facilitated exchange of environmental data between pharmaceutical and environmental legislations, 4) substance-based assessments, 5) transparency of data, and 6) a catching-up procedure for active pharmaceutical ingredients that lack an ERA. These legislative proposals can be considered as prerequisites for a harmonised assessment and effective management of environmental risks and hazards of human pharmaceuticals.

Sonochemical advanced oxidation process for the degradation of furosemide in water: Effects of sonication's conditions and scavengers

The intensive consumption of pharmaceuticals and drugs in the last decades has led to their increased concentrations in wastewaters from industrial sources. The present paper deals, for the first time, with the sonochemical degradation and mineralization of furosemide (FSM) in water. FSM is a potent loop diuretic used to treat fluid build-up due to heart failure, liver scarring, or kidney disease. The influence of several operating parameters such as acoustic intensity, ultrasonic frequency, initial FSM concentration, solution's pH, nature of the dissolved gas (Ar, air and N2) and radical scavengers (2-propanol and tert-butanol) on the oxidation of FSM was assessed. The obtained results showed that the degradation rate of the drug increased significantly with the increase of the acoustic intensity in the range of 0.83 to 4.3 W cm-2 and decreased with the augmentation of the frequency in the range of 585-1140 kHz. It was also found that the initial rate of the sonolytic degradation of FSM increased with the increase of its initial concentration (2, 5, 10, 15 and 20 mg/L). The most significant degradation was achieved in acidic conditions at pH 2, while in terms of saturating gas, the rate of FSM degradation decreased in the order of Ar > air > N2. The FSM degradation experiments with radical scavengers showed that the diuretic molecule degraded mainly at the interfacial region of the bubble by hydroxyl radical attack. Additionally, in terms of acoustic conditions, the sono-degradation of 30.24 µmol L-1 of FSM solution demonstrate an optimal performance at 585 kHz and 4.3 W/cm2, the results indicated that even if the ultrasonic action eliminated the total concentration of FSM within 60 min, a low degree of mineralization was obtained due to the by-products formed during the sono-oxidation process. The ultrasonic process transforms FSM into biodegradable and environmentally friendly organic by-products that could be treated in a subsequent biological treatment. Besides, the efficiency of the sonolytic degradation of FSM in real environmental matrices such as natural mineral water and seawater was demonstrated. Consequently, the sonochemical advanced oxidation process represent a very interesting technique for the treatment of water contaminated with FSM.

The potential for adverse effects in fish exposed to antidepressants in the aquatic environment

Antidepressants are one of the most commonly prescribed pharmaceutical classes for the treatment of psychiatric conditions. They act via modulation of brain monoaminergic signaling systems (predominantly serotonergic, adrenergic, dopaminergic) that show a high degree of structural conservation across diverse animal phyla. A reasonable assumption, therefore, is that exposed fish and other aquatic wildlife may be affected by antidepressants released into the natural environment. Indeed, there are substantial data reported for exposure effects in fish, albeit most are reported for exposure concentrations exceeding those occurring in natural environments. From a critical analysis of the available evidence for effects in fish, risk quotients (RQs) were derived from laboratory-based studies for a selection of antidepressants most commonly detected in the aquatic environment. We conclude that the likelihood for effects in fish on standard measured end points used in risk assessment (i.e., excluding effects on behavior) is low for levels of exposure occurring in the natural environment. Nevertheless, some effects on behavior have been reported for environmentally relevant exposures, and antidepressants can bioaccumulate in fish tissues. Limitations in the datasets used to calculate RQs revealed important gaps in which future research should be directed to more accurately assess the risks posed by antidepressants to fish. Developing greater certainty surrounding risk of antidepressants to fish requires more attention directed toward effects on behaviors relating to individual fitness, the employment of environmentally realistic exposure levels, on chronic exposure scenarios, and on mixtures analyses, especially given the wide range of similarly acting compounds released into the environment.

Environmental risk assessments of multiclass pharmaceutical active compounds: selection of high priority concern pharmaceuticals using entropy-utility functions

This research aimed to identify high-risk pharmaceutically active compounds (PhACs) by analyzing occurrence (O), persistence (P), bioaccumulation (B), and toxicity (T) of 62 drugs which are widely used in Iran. A comprehensive approach was taken in risk assessment of the selected PhACs and in their prioritization using multiple-criteria decision analysis (MCDA) such as utility functions and principal component analysis (PCA). In practice, assigning weight to each criterion (i.e., O, P, B, and T) for risk assessment of PhACs is a challenge. In this research, the impact of giving both equal and unequal weight to each criterion by using a quantitative entropy method was studied. For risk assessment, two exposure approaches (consumption rate and occurrence of PhACs) and three MCDA approaches (PCA and utility functions with and without equal weights for each criterion) were compared. The utility function using equal weights for all O, P, B, and T criteria showed that thioridazine, pimozide, chlorpromazine, sertraline, clomipramine, and aripiprazole were at the highest level of risk, with concern score of 0.75, 0.75, 0.67, 0.58, 0.58, and 0.58, respectively. Unequal weight approach included additional compounds such as fluoxetine, citalopram, and methadone as a priority. All three MCDA approaches showed that sedatives and antidepressants were prevalent PhACs in the risk-based priority lists. However, the exposure-based approaches showed antibiotics and analgesics as the pharmaceutical of the highest priority. Overall, selection of the high priority concern pharmaceuticals depends on the prioritization approach employed. However, the utility function using unequal weights is a more conservative and effective approach for prioritization.

Determination of pharmaceuticals and heavy metals in groundwater for human and animal consumption and crop irrigation in Galicia

Pharmaceuticals and heavy metals are contaminants present in groundwaters, which are the main source of drinking water in most parts of the world. In the northwest region of Spain, Galicia, groundwater harvesting is a common practice for drinking water supply, crop irrigation, cattle watering, as well as recreational use such as filling pools. In order to assess the quality of Galician groundwaters, the presence of 21 pharmaceuticals and 10 heavy metals was analysed by UPLC-MS/MS and ICP/MS methods, respectively, in a total of 118 groundwater samples from private wells. Seventeen of the 21 compounds studied were detected in 28% of the samples, with the highest presence of pharmaceuticals belonging to the antimicrobial group (52%), specifically the sulphonamides group in a range of concentration between 21 and 14.9 ng/L. In addition, 30% of the samples contained at least one heavy metal (Mn, As and Fe) above the legally permitted levels. Evaluation of the risk associated with the consumption of the analysed groundwater indicated no human risk for any of the detected pharmaceuticals but high cancer risk for children due to Cd, Cr and As concentrations was observe.

Targeted eco-pharmacovigilance as an optimized management strategy for adverse effects of pharmaceuticals in the environment

From a perspective of drug administration, eco-pharmacovigilance (EPV) has been proposed as a new approach to prevent the environmental risks posed by pharmaceutical emerging contaminants. However, it is impracticable to practice unitary and rigor EPV process for all the pharmaceutical substances with complex and diversified chemical, biological or toxicological properties. We proposed the "targeted EPV" that is the science and activities associated with the targeted detection, evaluation, understanding, and prevention of adverse effects of high-priority hazardous pharmaceuticals in the environment, especially focusing on the control of main anthropogenic sources of pharmaceutical emission among key stakeholders in high-risk areas could be used as an optimized management strategy for pharmaceutical pollution. "Targeted EPV" implementation should focus on the targeted monitoring of the occurrence of high-priority pharmaceuticals in environmental samples, the targeted reporting of over-standard discharge, the targeted management for main emission sources, the targeted legislation and researches on high-priority pharmaceutical pollutants, as well as the targeted educational strategies for specific key populations.

Antibiotics in the surface water of Shanghai, China: screening, distribution, and indicator selecting

The widespread existence of antibiotics has caused inevitable influence on ecology and humans. In this study, we screened the most commonly used antibiotics, and 64 antibiotics were detected in Shanghai, an international metropolis. Most of the target substances were detected in all 46 water samples including main rivers and districts in Shanghai, with concentrations ranging from 0.02 to 502.43 ng L^-1. In particular, sulfadiazine (502.43 ng L^-1) had the highest maximum concentration. Besides, risk quotients based on fish suggested that sulfonamides had a medium risk (0.12) in Shanghai. Correlation studies had shown that most compounds with frequencies exceeding 60% were significantly positively correlated with the total concentration. Based on further analysis, sulfadiazine, sulfamerazine, and sulfapyridine were screened as indicators to reflect the pollution status of antibiotics in Shanghai for a long time. The screening conditions for these indicators include detection rate (> 60%), maximum concentration (> 100 ng L^-1), RQ (> 0.01), and correlation (> 0). In addition, population density may be the main factor for antibiotic pollution through regional comparison. In a word, this work can systematically reflect the overall situation of Shanghai antibiotics and provide support for global data comparison in the future. Meanwhile, we provided the potential indicators that can be applied in the long term and economical monitoring of antibiotics.

Autopsy, thanatopraxy, cemeteries and crematoria as hotspots of toxic organic contaminants in the funeral industry continuum

The occurrence and health risks of toxic organic contaminants (TOCs) in the funeral industry are relatively under-studied compared to other industries. An increasing body of literature reports TOCs including emerging contaminants in the funeral industry, but comprehensive reviews of the evidence are still lacking. Hence, evidence was analysed to address the proposition that, the funeral industry constitutes several hotspot reservoirs of a wide spectrum of TOCs posing ecological and human health risks. TOCs detected include embalming products, persistent organic pollutants, synthetic pesticides, pharmaceuticals, personal care products and illicit drugs. Human cadavers, solid wastes, wastewaters and air-borne particulates from autopsy, thanatopraxy care facilities (mortuaries, funeral homes), cemeteries and crematoria are hotspots of TOCs. Ingestion of contaminated water, and aquatic and marine foods constitutes non-occupational human exposure, while occupational exposure occurs via inhalation and dermal intake. Risk factors promoting exposure to TOCs include unhygienic burial practices, poor solid waste and wastewater disposal, and weak and poorly enforced regulations. The generic health risks of TOCs are quite diverse, and include; (1) genotoxicity, endocrine disruption, teratogenicity and neurodevelopmental disorders, (2) development of antimicrobial resistance, (3) info-disruption via biomimicry, and (4) disruption of ecosystem functions and trophic interactions. Barring formaldehyde and inferential evidence, the epidemiological studies linking TOCs in the funeral industry to specific health outcomes are scarce. The reasons for the lack of evidence, and limitations of current health risk assessment protocols are discussed. A comprehensive framework for hazard identification, risk assessment and mitigation (HIRAM) in the funeral industry is proposed. The HIRAM includes regulatory, surveillance and control systems such as prevention and removal of TOCs. Future directions on the ecotoxicology of mixtures, behaviour, and health risks of TOCs are highlighted. The opportunities presented by emerging tools, including isotopic labelling, genomics, big data analytics (e.g., machine learning), and in silico techniques in toxicokinetic modelling are highlighted.

Modelling the fate of micropollutants in integrated urban wastewater systems: Extending the applicability to pharmaceuticals

Pharmaceutical active compounds (PhACs) are a category of micropollutants frequently detected across integrated urban wastewater systems. Existing modelling tools supporting the evaluation of micropollutant fate in such complex systems, such as the IUWS_MP model library (which acronym IUWS stands for Integrated Urban Wastewater System), do not consider fate processes and fractions that are typical for PhACs. This limitation was overcome by extending the existing IUWS_MP model library with new fractions (conjugated metabolites, sequestrated fraction) and processes (consumption-excretion, deconjugation). The performance of the extended library was evaluated for five PhACs (carbamazepine, ibuprofen, diclofenac, paracetamol, furosemide) in two different integrated urban wastewater systems where measurements were available. Despite data uncertainty and the simplicity of the modelling approach, chosen to minimize data requirements, model prediction uncertainty overlapped with the measurements ranges across both systems, stressing the robustness of the proposed modelling approach. Possible applications of the extended IUWS_MP model library are presented, illustrating how this tool can support urban water managers in reducing environmental impacts from PhACs discharges.

Antibacterials in Aquatic Environment and Their Toxicity to Fish

Antibacterial agents are commonly present in aquatic environment at low concentrations. Terrestrial animal farms, human medicine and aquaculture are main sources of water contamination with antibacterials. Antibiotics were proved to be directly toxic to fish causing oxidative stress, general stress response, histopathological lesions, hematological, metabolic, and reproductive disorders, as well as immunosuppressive and genotoxic effects. Environmentally realistic low concentrations of antibiotics also disturb aquatic bacterial communities causing alterations in fish symbiotic microbiota and induce emergence of antibiotic-resistant pathogenic bacteria by exerting selective pressure on spread of antibiotic-resistance genes.

Spatial variation in the detection rates of frequently studied pharmaceuticals in Asian, European and North American rivers

Pharmaceutical consumption has expanded rapidly during the last century and their persistent presence in the environment has become a major concern. Unfortunately, our understanding of the distribution of pharmaceuticals in surface water and their effects on aquatic biota and public health is limited. Here, we explore patterns in the detection rate of the most frequently studied pharmaceuticals in 64 rivers from 22 countries using bi-clustering algorithms and subsequently analyze the results in the context of regional differences in pharmaceutical consumption habits, social and environmental factors, and removal-efficiency of wastewater treatment plants (WWTP). We find that 20% of the pharmaceuticals included in this analysis are pervasively present in all the surface waterbodies. Several pharmaceuticals also display low overall positive detection rates; however, they exhibit significant spatial variability and their detection rates are consistently lower in Western European and North America (WEOG) rivers in comparison to Asian rivers. Our analysis suggests the important role of pharmaceutical consumption and population in governing these patterns, however the role of WWTP efficiency appeared to be limited. We were constrained in our ability to assess the role of hydrology, which most likely also plays an important role in regulating pharmaceuticals in rivers. Most importantly though, we demonstrate the ability of our algorithm to provide probabilistic estimates of the detection rate of pharmaceuticals that were not studied in a river, an exercise that could be useful in prioritizing pharmaceuticals for future study.

Norm index-based QSPR model for describing the n-octanol/water partition coefficients of organics

The n-octanol/water partition coefficient (logK_ow) is widely used in the environmental, agricultural and pharmaceutical fields for the risk evaluation and application of organic chemicals. In this work, grounded on atomic distribution matrices, a norm index-based QSPR model was built for organic chemicals with 18 kinds of diverse structures. The statistical results (R² = 0.9037, RMSE = 0.4515) showed that the QSPR model for describing the logK_ow of organics was fitted well. Various validation results showed that the model had good robustness, good predictability and wide applicability. These satisfactory results indicated that the model was applicable for the logK_ow description of organic chemicals and that norm descriptors were reliable and general for the description of organic structures. The model was relatively better at describing logK_ow for aromatics, alcohols, nitriles, esters, amides, halogenated compounds, acids and amine compounds. The intensity of spatial branching and the space charge distribution intensity descriptors could have a greater impact on the logK_ow value of a compound.

Sorption of ionic and neutral species of pharmaceuticals to loessial soil amended with biochars

To clarify the impact of biochar amendment on soil sorption for coexisting pharmaceuticals, wheat straw-derived biochars pyrolyzed at 300 and 700 °C (labeled as WS300 and WS700, respectively) were prepared. Batch experiments on ketoprofen (KTP), atenolol (ATL) and carbamazepine (CBZ) sorption to biochars, loessial soil and biochar-amended soils were conducted. The results indicated that sorption affinity of different species of pharmaceuticals to WS300 and WS700 was in the order of cationic ATL > neutral CBZ > anionic KTP. Cationic ATL had the highest sorption to biochars due to electrostatic attraction. Coexisting ATL, CBZ and KTP competed for the shared adsorption sites on carbonized phase of biochars, and π-π interactions were proposed to be the main sorption mechanism. Sorption coefficients (K_d) and nonlinearity of ATL, CBZ and KTP to soil increased when biochar was added (5% by weight), especially for WS700 with higher specific surface area. K_d values of the three pharmaceuticals to WS700-amended soil in either single solute or bisolute system were one to two orders of magnitude higher than those to soil, indicating the promoting role of WS700 in sorption of coexisting pharmaceuticals in soil. The study demonstrated the enhanced and competitive sorption of ionic and neutral species of pharmaceuticals to soil amended with biochars, which is helpful in designing biochar as effective sorbents for immobilization of pharmaceuticals in soil remediation.