Consumption-based approach for assessing the contribution of hospitals towards the load of pharmaceutical residues in municipal wastewater

Knowledge and practices on home medication storage and disposal in Syria: a population-based, cross-sectional study

BACKGROUND

Medications are commonly found in every household. In Syria, where healthcare infrastructure faces significant challenges, improper storage can lead to reduced medication efficacy and increased health risks. Additionally, inappropriate disposal practices pose serious environmental concerns, especially in a region already grappling with environmental degradation. This study aimed to evaluate the knowledge, and practices of Syrian individuals regarding the appropriate storage and disposal of home medications.

METHOD

A cross-sectional study was conducted from September 22 to October 20, 2023, using an online survey distributed via social media apps (WhatsApp, Facebook, and Telegram) in Syria. The questionnaire, adapted from a similar study in Saudi Arabia, was translated to Arabic using the forward-backward translation technique. A convenience sampling technique was used. Inclusion criteria were participants over eighteen with expired or unused medications at home. Descriptive statistics, Chi-square tests, and binary logistic regression analysis were performed using SPSS version 27, with statistical significance defined as p < 0.05.

RESULTS

A total of 2,217 responses were analyzed, with the majority of participants being female (79%) and aged between 21-30 years (56%). The study found that 90.7% of respondents dispose of expired medications in the garbage, while 95% keep medications in their original containers. Additionally, 30% consult pharmacists for storage instructions, and 64% read storage information on medication leaflets. Logistic regression analysis revealed that males were less likely to check expiration dates before use (OR: 0.58, 95% CI: 0.40-0.84) and periodically (OR: 0.68, 95% CI: 0.54-0.85). Participants aged 31-40 years were less likely to check expiration dates periodically (OR: 0.46, 95% CI: 0.31-0.68), while those with children under six years old were more likely to do so (OR: 1.29, 95% CI: 1.01-1.67). Males were also less likely to read storage instructions (OR: 0.61, 95% CI: 0.50-0.76) but more likely to ask pharmacists about them (OR: 1.26, 95% CI: 1.01-1.57). There was no significant difference in these practices between medical professionals and the general population.

CONCLUSION

This study reveals gaps in the practices related to the storage and disposal of medications among the Syrian public. The findings suggest a need for targeted public education and awareness programs to improve these practices and reduce the associated health and environmental risks.

Occurrence and environmental risk assessment of pharmaceuticals in the Mondego river (Portugal)

In this case study pharmaceuticals were analysed in the Mondego river (Portugal) and their environmental risk assessed by means of risk quotients based on an extensive retrieval of ecotoxicological data for freshwater and saltwater species. The Mondego river crosses Coimbra, the most populated city in the Portuguese Centro Region hosting a complex of regional hospitals. Environmentally relevant and prioritised pharmaceuticals were investigated in this study and their potential hazards were evaluated by conducting a separate risk assessment for the freshwater and estuary parts of the examined river section. A target analysis approach with method detection limits down to 0.01 ng L-1 was used to determine pharmaceuticals. Twenty-one prioritised target analytes out of seven therapeutical classes (antibiotics, iodinated X-ray contrast media (ICM), analgesics, lipid reducers, antiepileptics, anticonvulsants, beta-blockers) were investigated by applying ultra-high pressure liquid chromatography coupled to a triple quadrupole mass spectrometer equipped with an electrospray ionisation source. The relative pattern of pharmaceuticals along the middle to the lower Mondego showed a quite uniform picture while an approximately 40fold increase of absolute concentrations was observed downstream of the wastewater treatment plant (WWTP) discharge of Coimbra. The most frequently measured substance groups were the ICM, represented by the non-ionic ICM iopromide (βmin: 3.03 ng L-1 - βmax: 2,810 ng L-1). Environmentally more critical substances such as carbamazepine, diclofenac, and bezafibrate, with concentrations up to and 52.6 ng L-1, 59.8 ng L-1, and 10.2 ng L-1 respectively, may potentially affect aquatic wildlife. Carbamazepine revealed elevated risk quotients (RQs >1) along the middle and lower Mondego with a maximum RQ of 53 downstream of Coimbra. Especially for saltwater species, carbamazepine and clarithromycin pose high potential risks. Especially in periods of low water discharge of the Mondego river, other pharmaceuticals as diclofenac and bezafibrate may pose additional risks downstream of the WWTP.

Per- and polyfluoroalkyl substances in Chinese commercially available red swamp crayfish (Procambarus clarkii): Implications for human exposure and health risk assessment

The extensive utilization of per- and polyfluoroalkyl substances (PFASs) has led to their pervasive presence in the environment, resulting in contamination of aquatic products. Prolonged exposure to PFASs has been linked to direct hepatic and renal damage, along with the induction of oxidative stress, contributing to a spectrum of chronic ailments. Despite the recent surge in popularity of red swamp crayfish as a culinary delicacy in China, studies addressing PFASs' exposure and associated health risks from their consumption remain scarce. To address this gap, our study investigated the PFASs' content in 85 paired edible tissue samples sourced from the five primary red swamp crayfish breeding provinces in China. The health risks associated with dietary exposure were also assessed. Our findings revealed widespread detection of PFASs in crayfish samples, with short-chain perfluoroalkyl carboxylic acids (PFCAs) exhibiting the highest concentrations. Notably, the total PFAS concentration in the hepatopancreas (median: 160 ng/g) significantly exceeded that in muscle tissue (5.95 ng/g), as did the concentration of every single substance. The hazard quotient of perfluorohexanesulfonic acid (PFHxS) via consuming crayfish during peak season exceeded 1. In this case, a potential total non-cancer health risk of PFASs, which is mainly from the hepatopancreas and associated with PFHxS, is also observed (hazard index>1). Thus, it is recommended to avoid consuming the hepatopancreas of red swamp crayfish. Greater attention should be paid to governance technology innovation and regulatory measure strengthening for short-chain PFASs.

Interconnected environmental challenges: heavy metal-drug interactions and their impacts on ecosystems

Industrial expansion and inadequate environmental safety measures are major contributors to environmental contamination, with heavy metals (HMs) and pharmaceutical waste playing crucial roles. Their negative effects are most noticeable in aquatic species and vegetation, where they accumulate in tissues and cause harmful results. Interactions between HMs and pharmaceutical molecules result in the production of metal-drug complexes (MDCs), which have the potential to disturb diverse ecosystems and their interdependence. However, present studies frequently focus on individual pollutants and their effects on specific environmental parameters, leaving out the cumulative effects of pollutants and their processes across several environmental domains. To address this gap, this review emphasizes the environmental sources of HMs, elucidates their emission pathways during anthropogenic activities, investigates the interactions between HMs and pharmaceutical substances, and defines the mechanisms underlying the formation of MDCs across various ecosystems. Furthermore, this review underscores the simultaneous occurrence of HMs and pharmaceutical waste across diverse ecosystems, including the atmosphere, soil, and water resources, and their incorporation into biotic organisms across trophic levels. It is important to note that these complex compounds represent a higher risk than individual contaminants.

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.

European-wide spatial analysis of sewage treatment plants and the possible benefits to nature of advanced treatment to reduce pharmaceutical emissions

Pharmaceuticals are known to widely occur in the environment and to affect the health of ecosystems. Sewage treatment plants (STPs) are main emission pathways for pharmaceuticals, which are often not sufficiently removed during wastewater treatment. In Europe, STP treatment requirements are specified under the Urban WasteWater Treatment Directive (UWWTD). The introduction of advanced treatment techniques, such as ozonation and activated carbon, under the UWWTD is expected to be an important option to reduce pharmaceutical emissions. In this study, we present a European-wide analysis of STPs reported under the UWWTD, their current treatment level and potential to remove a set of 58 prioritised pharmaceuticals. Three different scenarios were analysed to show 1) UWWTD present effectiveness, 2) the effectiveness at full UWWTD compliance, and 3) the effectiveness when advanced treatment is implemented at STPs with a treatment capacity of >100.000 person equivalents. Based on a literature study, the potential of individual STPs to reduce pharmaceutical emissions ranged from an average of 9% for STPs with primary treatment to 84% for STPs applying advanced treatment. Results of our calculations show that European-wide emission of pharmaceuticals can be reduced with 68% when large STPs are updated with advanced treatment, but spatial differences exist. We argue that adequate attention should also be paid with regards to preventing environmental impacts of STPs with a capacity <100.000 p.e. Circa 44% of total STP effluent is emitted near Natura2000 sites (EU nature protection areas). Of all surface waters receiving STP effluent for which the ecological status has been assessed under the Water Framework Directive, 77% have a status of less than good. Relatively often only primary treatment is applied to wastewater emitted into coastal waters. This analysis can be used to further model pharmaceutical concentrations in European surface waters, to identify STPs for which more advanced treatment might be required and to protect EU aquatic biodiversity.

Comprehensive micropollutant characterization of wastewater during Covid-19 crisis in 2020: Suspect screening and environmental risk prioritization strategy

Micropollutants monitoring in wastewater can serve as a picture of what is consuming society and how it can impact the aquatic environment. In this work, a suspect screening approach was used to detect the known and unknown contaminants in wastewater samples collected from two wastewater treatment plants (WWTPs) located in the Basque Country (Crispijana in Alava, and Galindo in Vizcaya) during two weekly sampling campaigns, which included the months from April to July 2020, part of the confinement period caused by COVID-19. To that aim, high-resolution mass spectrometry was used to collect full-scan data-dependent tandem mass spectra from the water samples using a suspect database containing >40,000 chemical substances. The presence of > 80 contaminants was confirmed (level 1) and quantified in both WWTP samples, while at least 47 compounds were tentatively identified (2a). Among the contaminants of concern, an increase in the occurrence of some compounds used for COVID-19 disease treatment, such as lopinavir and hydroxychloroquine, was observed during the lockdown. A prioritization strategy for environmental risk assessment was carried out considering only the compounds quantified in the effluents of Crispijana and Galindo WWTPs. The compounds were scored based on the removal efficiency, estimated persistency, bioconcentration factor, mobility, toxicity potential and frequency of detection in the samples. With this approach, 33 compounds (e.g. amantadine, clozapine or lopinavir) were found to be considered key contaminants in the analyzed samples based on their concentration, occurrence and potential toxicity. Additionally, antimicrobial (RQ-AR) and antiviral (EDRP) risk of certain compounds was evaluated, where ciprofloxacin and fluconazole represented medium risk for antibiotic resistance (1 > RQ-AR > 0.1) in the aquatic ecosystems. Regarding mixture toxicity, the computed sum of toxic unit values of the different effluents (> 1) suggest that interactions between the compounds need to be considered for future environmental risk assessments.

Dopamine removal from water by advanced oxidative processes with Fe/N-doped carbon nanotubes

Dopamine (DA) is an important neurotransmitter in the human body, and a subnormal level is associated with some neurological problems, such as Alzheimer's and Parkinson's diseases. Its use as medicine has progressively increased, as well as its appearance in water bodies, such as domestic or hospital effluents. Dopamine has been found to produce neurological and cardiac damage to the animals that have consumed water with its content, so the removal of dopamine from water is of utmost importance to ensure water safety. Advanced oxidative processes (AOPs) are one of the most effective technologies to eliminate hazardous and toxic compounds in wastewater. In this work, Fe-based multi-walled carbon nanotubes (MWCNTs) were synthesized by aerosol-assisted catalytic chemical vapor deposition to be applied in the AOP of DA. MWCNTs (carbon nanotubes) exhibited high catalytic activity in removing DA with 99% of elimination.By increasing 4 times the initial concentration of DA, the removal percentage of the molecule was lower than the original one, which was attributed to the DA saturation of active sites. Even so, the percentage of degradation was high (76.2%).

Emissions of pharmaceuticals and plant protection products to the lagoon of Venice: development of a new emission inventory

Estimating the emissions of chemical pollutants to water is a fundamental step for the development and application of effective and sustainable management strategies of water resources, but methods applied so far to build chemicals inventories at the European or national scale show several limitations when applied at the local scale. The issue is particularly relevant when considering contaminants of emerging concern (CECs), whose environmental releases and occurrence are still poorly studied and understood. In this work, an approach to estimate water emissions of nine active pharmaceutical ingredients (APIs) and ten most applied plant protection products (PPPs) is presented, considering proxy indicators (e.g., sales data and census information). The application area is the lagoon of Venice (Italy), a complex transitional environment highly influenced by anthropic pressures (e.g., agricultural and industrial activities, animal breeding, and wastewater discharge). The presented approach can be tailored to the information available for any local scale case study. Data on annual regional sales of PPPs and APIs were integrated with georeferenced demographic and economic statistics (such as census and land-use information) to estimate chemicals emissions to surface water and groundwater. A sensitivity and uncertainty analysis identified the main factors affecting emissions estimates, and those contributing more significantly to results uncertainty. Results showed the highest estimated emissions of APIs for antibiotics (i.e., amoxicillin, clarithromycin, azithromycin, and ciprofloxacin) used for humans and animals, while most of hormones' emission (i.e., 17- α-ethinylestradiol and 17-β-estradiol) derived from animal breeding. Regarding PPPs, glyphosate and imidacloprid emissions were one to two orders of magnitude higher compared to the other chemicals. Uncertainty and sensitivity analysis showed that the variability of each parameter used to estimate emissions depends greatly both on the target chemical and the specific emission source considered. Excretion rates and removal during wastewater treatment were major key parameters for all the target pharmaceutical compounds, while for PPPs the key parameter was their loss into the natural waters after application.

Pharmaceutical pollution of hospital effluents and municipal wastewaters of Eastern Canada

Quantification of drugs residues in wastewaters of different sources could help better understand contamination pathways, eventually leading to effluent regulation. However, limited data are available for hospital-derived wastewaters. Here, an analytical method based on automated on-line solid-phase extraction liquid chromatography tandem mass spectrometry (on-line SPE - UPLC-MS/MS) was developed for the quantification of multi-class pharmaceuticals in wastewaters. Filtrate phase and suspended solids (SPM) were both considered to evaluate the distribution of targeted analytes. Experimental design optimization involved testing different chromatographic columns, on-line SPE columns, and loading conditions for the filtrate phase, and different organic solvents and cleanup strategies for suspended solids. The selected methods were validated with suitable limits of detection, recovery, accuracy, and precision. A total of 30 hospital effluents and 6 wastewater treatment plants were sampled to evaluate concentrations in real field-collected samples. Certain pharmaceuticals were quantified at high levels such as caffeine at 670,000 ng/L in hospital wastewaters and hydroxyibuprofen at 49,000 ng/L in WWTP influents. SPM samples also had high contaminant concentrations such as ibuprofen at 31,000 ng/g in hospital effluents, fluoxetine at 529 ng/g in WWTP influents or clarithromycin at 295 ng/g in WWTP effluents. Distribution coefficients (K_d) and particle-associated fractions (Φ) indicate that pharmaceuticals tend to have better affinity to suspended solids in hospital wastewater than in municipal wastewaters. The results also bring arguments for at source treatment of these specific effluents before their introduction into urban wastewater systems.

Critical review of technologies for the on-site treatment of hospital wastewater: From conventional to combined advanced processes

This review aims to assess different technologies for the on-site treatment of hospital wastewater (HWW) to remove pharmaceutical compounds (PhCs) as sustances of emerging concern at a bench, pilot, and full scales from 2014 to 2020. Moreover, a rough characterisation of hospital effluents is presented. The main detected PhCs are antibiotics and psychiatric drugs, with concentrations up to 1.1 mg/L. On the one hand, regarding the presented technologies, membrane bioreactors (MBRs) are a good alternative for treating HWW with PhCs removal values higher than 80% in removing analgesics, anti-inflammatories, cardiovascular drugs, and some antibiotics. Moreover, this system has been scaled up to the pilot plant scale. However, some target compounds are still present in the treated effluent, such as psychiatric and contrast media drugs and recalcitrant antibiotics (erythromycin and sulfamethoxazole). On the other hand, ozonation effectively removes antibiotics found in the HWW (>93%), and some studies are carried out at the pilot plant scale. Even though, some families, such as the X-ray contrast media, are recalcitrant to ozone. Other advanced oxidation processes (AOPs), such as Fenton-like or UV treatments, seem very effective for removing pharmaceuticals, Antibiotic Resistance Bacteria (ARBs) and Antibiotic Resistance Genes (ARGs). However, they are not implanted at pilot plant or full scale as they usually consider extra reactants such as ozone, iron, or UV-light, making the scale-up of the processes a challenging task to treat high-loading wastewater. Thus, several examples of biological wastewater treatment methods combined with AOPs have been proposed as the better strategy to treat HWW with high removal of PhCs (generally over 98%) and ARGs/ARBs (below the detection limit) and lower spending on reactants. However, it still requires further development and optimisation of the integrated processes.

Fate of selected pharmaceuticals in hospital and municipal wastewater effluent: occurrence, removal, and environmental risk assessment

The concentrations and distribution of β-blockers, lipid regulators, and psychiatric and cancer drugs in the influent and effluent of the municipal wastewater treatment plant (WWTP) and the effluent of 16 hospitals that discharge into the wastewater treatment plant mentioned in this study at two sampling dates in summer and winter were examined. The pharmaceutical contribution of hospitals to municipal wastewater was determined. The removal of target pharmaceuticals was evaluated in a WWTP consisting of conventional biological treatment using activated sludge. Additionally, the potential environmental risk for the aquatic receiving environments (salt lake) was assessed. Beta-blockers and psychiatric drugs were detected in high concentrations in the wastewater samples. Atenolol (919 ng/L) from β-blockers and carbamazepine (7008 ng/L) from psychiatric pharmaceuticals were detected at the highest concentrations in hospital wastewater. The total pharmaceutical concentration determined at the WWTP influent and effluent was between 335 and 737 ng/L in summer and between 174 and 226 ng/L in winter. The concentrations detected in hospital effluents are higher than the concentrations detected in WWTP. The total pharmaceutical contributions from hospitals to the WWTP in summer and winter were determined to be 2% and 4%, respectively. Total pharmaceutical removal in the WWTP ranged from 23 to 54%. According to the risk ratios, atenolol could pose a high risk (risk quotient > 10) for fish in summer and winter. There are different reasons for the increase in pharmaceutical consumption in recent years. One of these reasons is the COVID-19 pandemic, which has been going on for 2 years. In particular, hospitals were operated at full capacity during the pandemic, and the occurrence and concentration of pharmaceuticals used for the therapy of COVID-19 patients has increased in hospital effluent. Pandemic conditions have increased the tendency of people to use psychiatric drugs. It is thought that beta-blocker consumption has increased due to cardiovascular diseases caused by COVID-19. Therefore, the environmental risk of pharmaceuticals for aquatic organisms in hospital effluent should be monitored and evaluated.

The anode is more beneficial to the advanced treatment of wastewater containing antibiotics by three-dimensional electro-biofilm reactor: Degradation, mechanism and optimization

The three-dimensional electrode biological aerated filter (3DE-BAF) has the potential to overcome inherent limitations of conventional electrochemical and biofilm methods. Electrochemical means could enhance the performance and sustainability of biofilm technologies and stimulate the spread of new applications in (waste) water treatment. This paper describes the construction and performance of 3DE-BAF in the treatment of simulated wastewater represented by tetracycline (TC). This is followed by a discussion of electrode performance, the electron transport mechanism and the electrode's effect on the biological community of 3D-EBAF. Given the gap between experimental studies and practical applications, the enlarged anode 3DE-BAF named 3DEAE-BAF reactor was applied with good results to duck farm wastewater. This study could provide guidance as to developing new methods to construct a highly stable 3DE-BAF. The paper concludes that improved 3DE-BAF technology is promising for advanced treatment of livestock wastewater containing antibiotics.

Prevalence of Pharmaceuticals in Surface Water Samples in Ghana

Pharmaceuticals, among the emerging contaminants, are pseudopersistent and recently of serious concern due to universal use, toxicity, and resistance development at low concentrations. This study was aimed at assessing the prevalence and risk of eight pharmaceuticals in surface water used for vegetable irrigation in Ghana’s Kumasi and Sunyani metropolises, which are influenced by hospitals, sewage treatment facilities, and market effluents. Samples were concentrated via solid-phase extraction (SPE) while liquid chromatography was used to identify and quantify the analytes. Ibuprofen, acetaminophen, and diclofenac were the detected analgesics in this study, with concentrations stretching from below detection limit (not detected) to 319.0 ng/L, while amoxicillin, trimethoprim, and cefuroxime were the detected antibiotics with a concentration range of no detection to 840.0 ng/L. Based on the available long-term data, an environmental risk assessment was conducted. Because of the presence of ibuprofen, the lowest trophic level and fish were shown to be at risk. The estimated risk quotient values for antibiotics resistance were above 1 for all the antibiotics investigated in surface water impacted by the wastewater of hospitals and pharmaceutical companies’ except surface water impacted by sewage treatment plants (STPs) and market wastewater. The existence of these pharmaceuticals in surface water does not only point to a general concern for the environment but also a potential health risk on humans and other lives as a result of their impact on drinking water and vegetable production in Ghana.

End-of-use and end-of-life medicines-insights from pharmaceutical care process into waste medicines management

End-of-use and end-of-life medicines waste management has been a challenge for public and private managers in different countries. Reverse logistics is a waste management strategy whose application to public pharmaceutical care processes faces legal restrictions and incertitude. Nevertheless, reverse logistics of end-of-use and end-of-life medicines may be both a saving and an environmental strategy in developing countries that manage health under limited resources. How to overcome restrictions to reverse logistics mainly in the context of primary health level? This study aims to investigate the most relevant critical factors for implementing medicine waste management in pharmaceutical care process. The unit analysis is the primary health level process in a developing country capital. Considering the characteristics of the issue at hand, it was designed a qualitative study. Data was collected through semi-structured interviews. The interviewees were key individuals who work directly with the process-from administering medicine to patients to managing waste at the end of the medicine's lifespan or after its use. Results indicated that despite reverse logistics arising from end users is legally forbidden, another type of reverse flow emerged from process analysis. The reverse flow, named reassignment flow, consists of still useful end-of-use medicines exchanged among the 10 government-ran pharmacies and over 140 health centers, where healthcare professionals administer and offer guidance on how to use them correctly. Another result was the identification of the most critical factors in implementing reverse logistics strategies in the public management context. The factors mentioned included aspects pertaining to management, information technology, infrastructure, and government, but they differ from the private context management, in which decision-makers has more freedom. Due to the barriers named by interviewees, the political barriers and complexity of primary health system, results of this investigation point to (i) reinforcing the reassignment flows inside pharmaceutical care logistics cycle, for saving purposes, and (ii) further development of a specific management unit to perform reverse logistics of end-of-use medicines arising from consumers, for environmental purposes. In times of shortage or resources caused by the COVID-19 pandemic, to know the critical factors is a step necessary in overcoming the current restrictions in direction of a well-succeeded medicines reverse logistics, either of reassignment or from final consumers. These results clarify the literature on end-of-use and end-of-life medicines reverse logistics. It also provides managers of 5000 municipalities in the country a perspective on the most relevant critical factors involved in their decision-making process, concerning the reuse of end-of-use medicines or the adequate disposal of end-of-life medicines in the environment.

Differentiation Between Metronidazole Residues Disposal by Using Adsorption and Photodegradation Processes Onto MgO Nanoparticles

Background

Metronidazole (MNZ) is an antibiotic form that is considered as a dangerous environmental pollutant due to its widespread use as growth promoters in livestock and aquaculture operations along with its therapeutic application for humans.

Purpose

The objective of this work was to conduct a comparative study between the efficiency of the adsorption and photocatalytic degradation of MNZ in an aqueous solution by using magnesium oxide nanoparticles (MgO NP) under different effects, as well as evaluate the performance, reusability and cost study.

Materials and Methods

Several instruments such as XRD, EDX, SEM, and TEM were used to characterize the chemical composition and morphological properties of the synthesized MgO NP, while the GC-MS analysis was used to monitor the degradation pathway of MNZ particles within 180 min. The simple photo-batch reactor was used to investigate the degradation of MNZ under the effect of UV radiation, initial concentration of MNZ, pH, catalyst loading, inorganic salts addition, time, and temperature.

Results

The degradation efficiency is mainly divided into two steps: 35.7% for maximum adsorption and 57.5% for photodegradation. Adsorption isotherm models confirmed that the process nature is chemisorption and appropriate Langmuir model, as well as to be a nonspontaneous and endothermic reaction according to the thermodynamic study. Adsorption constant during dark condition is smaller than typical adsorption equilibrium constant derived from the Langmuir-Hinshelwood kinetic model through photodegradation of MNZ that follows pseudo-first-order kinetics. Toxicity rates were reduced considerably after the photodegradation process to 88.21%, 79.84%, and 67.32% and 57.45%, 51.98%, and 43.87% by heamolytic and brine shrimp assays, respectively, for initial MNZ concentrations (20, 60, and 100 mg/L).

Conclusion

We significantly recommend using MgO NP as a promising catalyst in the photodegradation applications for other organic pollutants in visible light.

The study of biological activity of transformation products of diclofenac and its interaction with chlorogenic acid

In the present work we compared the biological activity of DCF, 4'-OHDCF and 5-OHDCF as molecules of most biodegradation pathways of DCF and selected transformation products (2-hydroxyphenylacetic acid; 2,5-dihydroxyphenylacetic acid and 2,6-dichloroaniline) which are produced during AOPs, such as ozonation and UV/H₂O₂. We also examined the interaction of DCF with chlorogenic acid (CGA). CGA is commonly used in human diet and entering the environment along with waste mainly from the processing and brewing of coffee and it can be toxic for microorganisms included in activated sludge. In the present experiment the evaluation of following parameters was performed: E. coli K-12 cells viability, growth inhibition of E. coli K-12 culture, LC₅₀ and mortality of Chironomus aprilinus, genotoxicity, sodA promoter induction and ROS generation. In addition the reactivity of E. coli SM recA:luxCDABE biosensor strain in wastewater matrices was measured. The results showed the influence of DCF, 4'-OHDCF and 5-OHDCF on E. coli K-12 cells viability and bacteria growth, comparable to AOPs by-products. The highest toxicity was observed for selected, tested AOPs by-products, in comparison to the DCF, 4'-OHDCF and 5-OHDCF. Genotoxicity assay indicated that 2,6-dichloroaniline (AOPs by-product) had the highest toxic effect. The oxidative stress assays revealed that the highest level of ROS generation and sodA promoter induction were obtained for DCF, 4'-OHDCF and 5-OHDCF, compared to other tested compounds. We have also found that there is an interaction between chlorogenic acid and DCF, which resulted in increased toxicity of the mixture of the both compounds to E. coli K-12, comparable to parent chemicals. The strongest response of E. coli SM biosensor strain with recA:luxCDABE genetic construct in filtered treated wastewaters, comparable to control sample was noticed. It indicates, that E. coli SM recA:luxCDABE biosensor strains is a good tool for bacteria monitoring in wastewater environment. Due to toxicity and biological activity of tested DCF transformation products, there is a need to use additional wastewater treatment systems for wastewater contaminated with pharmaceutical residues.

Occurrence and treatment of contaminants of emerging concern in the African aquatic environment: Literature review and a look ahead

Awareness about the rising detection and reported (eco)toxicological effects of contaminants of emerging concern (CECs, e.g. pharmaceuticals and personal care products - PPCPs - and modern pesticides) in the aquatic environment is growing. CECs are increasingly reported in the African aquatic environment, although the amount of data available is still limited. In this work, a comprehensive review is presented on the occurrence of CECs in wastewater, sludge, surface water, sediment, groundwater and drinking water of Africa. Further attention is given to the performance of wastewater stabilization ponds (WSPs) and trickling filters (TF) with respect to CECs removal. For the first time, we also look at the state of knowledge on the performance of point-of-use technologies (POUs) regarding the removal of CECs in drinking water. Generally, CECs in Africa occur at the same order of magnitude as in the Western world. However, for particular groups of compounds and at specific locations such as informal settlements, clearly higher concentrations are reported in Africa. Whereas antiretroviral and antimalarial drugs are rarely detected in the Western world, occurrence patterns in Africa reveal concentrations up to >100 μg L^-1. Removal efficiencies of WSPs and TFs focus mainly on PPCPs and vary significantly, ranging from no removal (e.g. carbamazepine) to better than 99.9% (e.g. paracetamol). Despite the rising adoption of POUs, limited but promising information is available on their performance regarding CECs treatment in drinking water, particularly for the low-cost devices (e.g. ceramic filters and solar disinfection - SODIS) being adopted in Africa and other developing countries.

Development and validation of a UHPLC-MS/MS method for the identification of irinotecan photodegradation products in water samples

Irinotecan (CPT-11) is a water-soluble anticancer drug widely used to treat several types of cancer. Even if the metabolites of CPT-11 are well-known and investigated, only limited information is available in the literature about the formation of photo-degradation products that can naturally originate from sunlight irradiation when the drug is released in aqueous systems. CTP-11 solutions at 10.0 mg L^-1 were irradiated by simulated sunlight. The intensity of the drug decreased by 90% after 7.5 days of irradiation and no significant reduction of absorbance values was observed after 13 days. A sensitive UHPLC-MS/MS method was developed employing a hybrid triple quadrupole/linear ion trap mass spectrometer, that is able to work in data-dependent acquisition mode and to obtain information about the compounds formed during the photoirradiation. Moreover, a selected reaction monitoring method was built using the MS/MS fragmentation pattern of the compounds previously investigated. The method was validated considering LOD, LOQ, linearity, precision, selectivity, recovery and matrix effect. LOD and LOQ values were 0.02 and 0.05 ng mL^-1, respectively, whereas MDL and MQL values in real water samples (river water, groundwater, well water, and wastewater) were lower than 0.05 and 0.2 ng mL^-1, respectively. Eight photodegradation products were identified, among which five for the first time. Based on the MS and MS/MS fragmentation, the chemical structures of the degradation products were proposed. Hydrolysis experiments were carried out on the same solutions preserved in the dark, but no formation of other species was highlighted. The method was applied to several real samples: CPT-11 was detected and quantified only in a hospital effluent sample at the concentration of 0.41 ± 0.2 ng mL^-1 together with the occurrence of PDP3. The outcomes of this study may be useful for updating the pollutant screening in water samples.

Introduction to wastewater microbiology: special emphasis on hospital wastewater

The important role of proper sanitation in maintaining good public health has been confirmed in the past years. Wastewater treatment plants (WWTPs) serve as efficient processes in removing pathogens, organic pollutants, nutrients, and pharmaceuticals from wastewaters. However, the advance systems of treatment that we use today are the result of a series of inventions that have been performed since 19th century. This chapter explains the evolution of the wastewater origin and the treatment processes along with the developments in microbiology and pathology that led to the present-day scenario of research and advance facilities. Pharmaceuticals can easily enter the environment due to their incomplete degradation in the treatment processes and because of their adverse effects on organisms and environment they are becoming a matter of great concern. A brief discussion on the presence of pharmaceutical compounds in different environment sectors such as wastewater, WWTPs, and the natural aquatic environment has been provided.

Degradation of ibuprofen and phenol with a Fenton-like process triggered by zero-valent iron (ZVI-Fenton)

It is shown here that ZVI-Fenton is a suitable technique to achieve effective degradation of ibuprofen and phenol under several operational conditions. Degradation of ibuprofen was possible in the pH interval 3-6 in both synthetic laboratory systems and actual wastewater (secondary treatment effluent), but operation at the higher pH values required higher H₂O₂ concentration and/or higher ZVI loading. In the case of real wastewater we offset the lower degradation efficiency, caused by the occurrence of organic and inorganic interfering agents, by carrying out multiple H₂O₂ additions. The studied wastewater sample had a buffer-capacity minimum at pH 4-5, and optimal treatment for ibuprofen degradation might take place at either pH 4 or 6. With a reagents cost in the order of 0.06-0.10 $ m^-3, the technique appears as very competitive and promising for tertiary wastewater treatment. There is a clear trade-off between savings in pH-fixing reagents and higher consumption of ZVI-Fenton reagents at the different pH values. The final choice in real application scenarios could be based on cost considerations (which favour pH 4) and/or the eventual fate of wastewater. For instance, wastewater reuse might place requirements on the salinity that is increased by the acidification/neutralization steps: in this case, operation at pH 6 is preferred. Interestingly, the ZVI-Fenton degradation of ibuprofen led to very low generation of toxic 4-isobutylacetophenone (IBAP, which is the ibuprofen by-product raising the highest concern), because of the combination of low formation yields and limited IBAP stability in the optimal reaction conditions. In addition to ibuprofen, phenol could be degraded as well by ZVI-Fenton. Interestingly, the ability of ZVI-Fenton to degrade both ibuprofen and phenol under similar conditions might open up the way to apply this technique to additional pollutants as well as to pollutant mixtures.

Risk-management tool for environmental prioritization of pharmaceuticals based on emissions from hospitals

Over the past decade, the health care sector has become increasingly aware of the impact of pharmaceutical emissions to the environment. Yet, it remains unclear which compounds are the most relevant to address and at what point emission control is most effective. This study presents a modelling framework to prioritize pharmaceuticals based on their relative risks for aquatic organisms, using purchase and prescription data from hospitals. The framework consists of an emission prediction module and a risk prioritization module. The emission prediction module accounts for three different routes of intake (oral, intravenous, rectal), for non-patient consumption, and for delayed athome excretion due to relatively long half-lives or prescription durations of selected pharmaceuticals. We showcase the modelling framework with 16 pharmaceuticals administered at two Dutch academic hospitals. Predictions were validated with experimental data from passive sampling in the sewer system. With the exception of metformin, all predictions were within a factor of 10 from measurements. The risk prioritization module ranks each pharmaceutical based on its predicted relative risk for aquatic organisms. The resulting prioritization suggests that emission mitigation strategies should mainly focus on antibiotics and non-steroidal anti-inflammatory drugs (NSAIDs).

Wastewater-based epidemiology in Beijing, China: Prevalence of antibiotic use in flu season and association of pharmaceuticals and personal care products with socioeconomic characteristics

Wastewater-based epidemiology is an emerging field that has mostly been applied to investigate consumption of illicit drugs. In this study, the wastewater-based epidemiology approach was employed to study consumption of pharmaceuticals and personal care products (PPCPs) and measure their prevalence of use in eight densely populated, urban areas of Beijing, China. Ammonium loads were used to estimate the population equivalents of each sewershed. These estimates were applied to calculate population-normalized antibiotic consumption and prevalence of use during flu season, when antibiotics are frequently misused as a medical treatment. Results indicated that 21.9 g d^-1 (10⁴ people)^-1 of ten popular antibiotics were consumed across the eight sewersheds, indicating that 1.98‰ of the 12.5 million population equivalents used these antibiotics during the sampling period. A comparison of these results to calculations made using previously reported data from 2013 suggest that recent Chinese antibiotic control policies have been effective. Uncertainty analyses were conducted to identify the 95% confidence range for antibiotic prevalence of use as 1.44-3.61‰. Human excretion factors were identified as the most sensitive variable. The wastewater-based epidemiology methods were also applied to a wider range of PPCPs, and the results indicated positive relationships between consumption and socioeconomic factors, such as housing price and population density. Overall, this work provides important public health information on antibiotic use and elucidates relationships between PPCP consumption and socioeconomic characteristics.

Influence of sulfadiazine on anaerobic fermentation of waste activated sludge for volatile fatty acids production: Focusing on microbial responses

Extensive studies on anaerobic fermentation of waste activated sludge (WAS) for volatile fatty acids (VFAs) production focused on the effects of operating parameters and pretreatment methods, and little information is available for those of organic pollutants which were absorbed on sludge. The influence of sulfadiazine (SDZ), a typical antibiotic pollutant in WAS, on VFAs production during anaerobic fermentation was investigated in this study. The accumulation of VFAs was remarkably affected in the presence of SDZ. When the content of SDZ was 50 mg per kilogram dry sludge the concentration of VFAs from sludge was 2032.8 mg COD/L, much higher than that of control (1540.2 mg COD/L). Mechanism investigation revealed that the content of extracellular polymeric substances (EPS) from sludge was increased due to the presence of SDZ, which provided more substrates, i.e., protein and carbohydrate, and created a favorable environment for anaerobes. The hydrolysis and acidification of WAS were stimulated by SDZ, and the functional microorganisms were advantageous to VFAs production. The activities of protease, α-glucosidase and acetate kinase were promoted when SDZ occurred, which were beneficial for hydrolysis and acidification. The effect of SDZ on pure strains further confirmed that the formation of VFAs during anaerobic fermentation was stimulated by SDZ.

Emerging contaminants in a river receiving untreated wastewater from an Indian urban centre

Research over the last decade on emerging trace organic contaminants in aquatic systems has largely focused on sources such as treated wastewaters in high income countries, with relatively few studies relating to wastewater sources of these contaminants in low and middle income countries. We undertook a longitudinal survey of the Ahar River for a number of emerging organic contaminants (including pharmaceuticals, hormones, personal care products and industrial chemicals) which flows through the city of Udaipur, India. Udaipur is a city of approximately 450,000 people with no wastewater treatment occurring at the time of this survey. We found the concentrations of many of the contaminants within the river water were similar to those commonly reported in untreated wastewater in high income countries. For example, concentrations of pharmaceuticals, such as carbamazepine, antibiotics and non-steroidal anti-inflammatory drugs, ranged up to 1900 ng/L. Other organic contaminants, such as steroid estrogens (up to 124 ng/L), steroid androgens (up to 1560 ng/L), benzotriazoles (up to 11 μg/L), DEET (up to 390 ng/L), BPA (up to 300 ng/L) and caffeine (up to 37.5 μg/L), were all similar to previously reported concentrations in wastewaters in high income countries. An assessment of the population densities in the watersheds feeding into the river showed increasing population density of a watershed led to a corresponding downstream increase in the concentrations of the organic contaminants, with quantifiable concentrations still present up to 10 km downstream of the areas directly adjacent to the highest population densities. Overall, this study highlights how a relatively clean river can be contaminated by untreated wastewater released from an urban centre.

Environmental fate and ecotoxicological effects of antiretrovirals: A current global status and future perspectives

The therapeutic efficacy of antiretroviral drugs as well as challenges and side effects against the human immunodeficiency virus is well documented and reviewed. Evidence is available in literature indication that antiretrovirals are only partially transformed and become completely excreted from the human body in their original form and/or as metabolites in urine and feces. The possibility of massive release of antiretrovirals through human excreta that enters surface water through surface runoff and wastewater treatment plant effluents is now of environmental concern because the public might be experiencing chronic exposure to antiretrovirals. The primary concern of this review is limited data concerning environmental fate and ecotoxicity of antiretrovirals and their metabolites. The review aims to provide a comprehensive insight into the evaluation of antiretrovirals in environmental samples. The objective is therefore to assess the extent of analysis of antiretrovirals in environmental samples and also look at strategies including instrumentation and predictive models that have been reported in literature on the fate and ecotoxicological effects due to presence of antiretrovirals in different environmental compartments. The review also looks at current challenges and offers possible areas of exploration that could help minimize the presence of antiretrovirals in the environment.

Relationship between modification of activated sludge wastewater treatment and changes in antibiotic resistance of bacteria

Biological treatment processes at wastewater treatment plants (WWTPs), which are the most common methods of sewage treatment, could cause selective elimination and/or changes in the proportions of phenotypes/genotypes within bacterial populations in effluent. Therefore, WWTPs based on activated sludge used in sewage treatment constitute an important reservoir of enteric bacteria which harbour potentially transferable resistance genes. Together with treated wastewater, these microorganisms can penetrate the soil, surface water, rural groundwater supplies and drinking water. Because of this, the aim of this study was to determine the impact of various modification of sewage treatment (the conventional anaerobic/anoxic/oxic (A2/O) process, mechanical-biological (MB) system, sequencing batch reactors (SBR), mechanical-biological system with elevated removal of nutrients (MB-ERN)) on the amount of antibiotic resistant bacteria (ARB) (including E. coli) and antibiotic resistance genes (ARGs) in sewage flowing out of the 13 treatment plants using activated sludge technology. There were no significant differences in ARB and ARGs regardless of time of sampling and type of treated wastewater (p > 0.05). The highest percentage of reduction (up to 99.9%) in the amount of ARB and ARGs was observed in WWTPs with MB and MB-ERN systems. The lowest reduction was detected in WWTPs with SBR. A significant increase (p < 0.05) in the percentage of bacteria resistant to the new generation antibiotics (CTX and DOX) in total counts of microorganisms was observed in effluents (EFF) from WWTPs with A2/O system and with SBR. Among all ARGs analyzed, the highest prevalence of ARGs copies in EFF samples was observed for sul1, tet(A) and qepA, the lowest for bla_TEM and bla_SHV. Although, the results of presented study demonstrate high efficiency of ARB and ARGs removal during the wastewater treatment processes, especially by WWTPs with MB and MB-ERN systems, EFF is still an important reservoir of ARGs which can be transferred to other microorganisms.

Determination of metals and pharmaceutical compounds released in hospital wastewater from Toluca, Mexico, and evaluation of their toxic impact

Due to the activities inherent to medical care units, the hospital effluent released contains diverse contaminants such as tensoactives, disinfectants, metals, pharmaceutical products and chemical reagents, which are potentially toxic to the environment since they receive no treatment or are not effectively removed by such treatment before entering the drain. They are incorporated into municipal wastewater, eventually entering water bodies where they can have harmful effects on organisms and can result in ecological damage. To determine the toxicological risk induced by this type of eflluents, eight metals and 11 pharmaceuticals were quantified, in effluent from a hospital. Developmental effects, teratogenesis and oxidative stress induction were evaluated in two bioindicator species: Xenopus laevis and Lithobates catesbeianus. FETAX (frog embryo teratogenesis assay-Xenopus) was used to obtain the median lethal concentration (LC₅₀), effective concentration inducing 50% malformation (EC₅₀), teratogenic index (TI), minimum concentration to inhibit growth (MCIG), and the types of malformation induced. Twenty oocytes in midblastula transition were exposed to six concentrations of effluent (0.1, 0.3, 0.5, 0.7, 0.9, 1%) and negative and positive (6-aminonicotinamide) controls. After 96 h of exposure, diverse biomarkers of oxidative damage were evaluated: hydroperoxide content, lipid peroxidation, protein carbonyl content, and the antioxidant enzymes superoxide dismutase and catalase. TI was 3.8 in X. laevis and 4.0 in L. catesbeianus, both exceed the value in the FETAX protocol (1.2), indicating that this effluent is teratogenic to both species. Growth inhibition was induced as well as diverse malformation including microcephaly, cardiac and facial edema, eye malformations, and notochord, tail, fin and gut damage. Significant differences relative to the control group were observed in both species with all biomarkers. This hospital effluent contains contaminants which represents a toxic risk, since these substances are teratogenic to the bioindicators used. The mechanism of damage induction may be associated with oxidative stress.

The effect of the supporting electrolyte on the electrooxidation of enrofloxacin using a flow cell with a BDD anode: Kinetics and follow-up of oxidation intermediates and antimicrobial activity

The role of the supporting electrolyte - SE (Na₂SO₄; NaCl; Na₂CO₃; NaNO₃; Na₃PO₄ - 0.1 M ionic strength) in the galvanostatic (10 mA cm^-2) electrochemical degradation of the fluoroquinolone antibiotic enrofloxacin (ENRO; 100 mg L^-1) using a filter-press flow cell with a boron-doped diamond anode was investigated (flow rate, solution volume, and temperature were kept fixed at 420 L h^-1, 1.0 L, and 25 °C, respectively). The electrochemical degradation performance with the different SEs was assessed by following up [ENRO], total organic carbon concentration (TOC), oxidation intermediates (detected by LC and LC-QqTOF), and antimicrobial activity towards Escherichia coli as the electrolyses progressed. With NaCl as SE, complete removal of ENRO was attained ∼10 times faster than with the other salts. The determination of terminal oxidation intermediates (short-chain carboxylic acids) produced during the electrolyses allowed concluding that their nature and number is indeed affected by the salt used as SE, most probably due to distinct electrogenerated oxidants. With NaCl, the antimicrobial activity of the electrolyzed solution decreased gradually (to ∼20%) from 8 to 16 h of electrolysis due to the cleavage of the fluoroquinolone structure. On the other hand, with Na₂SO₄, Na₂CO₃ and NaNO₃ as SEs the growth of Escherichia coli cells was observed only after ∼14 h, whereas it was completely inhibited with Na₃PO₄. Clearly, the electrooxidation and mineralization of ENRO is strongly affected by the SEs used, which determine the degradation mechanism and, consequently, the removal rates of the solution's organic load and antimicrobial activity.

Degradation of oxytetracycline under autotrophic nitrifying conditions in a membrane aerated biofilm reactor and community fingerprinting

Pharmaceuticals in waterbodies are a growing concern due to their extensive uses and adverse effects on aquatic life. Oxytetracycline (OTC) is one of tetracycline antibiotic group used for treatment of animals and humans. This study evaluates the simultaneous oxidation of OTC and ammonium under autotrophic nitrifying conditions by using a membrane aerated biofilm reactor (MABR) as it provides an appropriate environment for the antibiotic-degrading bacteria. The results showed that MABR achieved fluxes of 1.62 mg OTC/m².d and 1117 mg N/m².d while the fluxes of O₂ (J_OTC-O2) utilized for OTC and NH₄-N (J_NH4-N-_O2) oxidation were calculated to be 2.94 and 5105 mg O₂/m².d, respectively. Three transformation products, 4-Epi-OTC, α-Apo-OTC and β-Apo-OTC, were identified and measured at ppb levels. The biofilm community comprised of Bacteria environmental samples, b-proteobacteria, CFB group bacteria, g-proteobacteria, d-proteobacteria and a-proteobacteria.

The prevalence of multidrug-resistant Aeromonas spp. in the municipal wastewater system and their dissemination in the environment

The objective of this study was to identify the determinants of antibiotic resistance and virulence of Aeromonas spp. isolated from treated wastewater (WW) and from samples of river water collected upstream (URW) and downstream (DRW) from the effluent discharge point. The resistance of Aeromonas spp. to antibiotics that are widely used in human and veterinary medicine, including beta-lactams, tetracyclines, glycylcyclines, fluoroquinolones, aminoglycosides and sulfamethoxazole-trimethoprim, was analyzed by disk diffusion method. The prevalence of hemolysins, aerolysins (virulence factors) and integrase genes was determined. A total of 83 Aeromonas spp. strains were selected from the isolates obtained from river water and wastewater samples. The highest percentage (81.8%) of multidrug-resistant isolates was noted in DRW samples. The analyzed isolates were most frequently resistant to beta-lactams, tetracyclines and aminoglycosides, whereas resistance to glycylcyclines was least common. Isolates resistant to beta-lactams most frequently harbored bla_TEM and bla_OXA genes. The group of genes encoding resistance to tetracyclines was most frequently represented by tet(E) and tet(O). Genes encoding virulence ahh1 (heat-labile hemolysin) or integrase intI1 occurred more frequently in the strains isolated from DRW than URW. An analysis of genetic relatedness revealed two main clusters - one with closely related WW and DRW isolates and one with less related isolates from all analyzed samples. The results of this study indicate that regardless of the applied treatment, municipal sewage may be a reservoir of antibiotic-resistant bacteria, antibiotic resistance and virulence genes and that treated water can contaminate other environmental domains.

Predicted environmental concentration and fate of the top 10 most dispensed Australian prescription pharmaceuticals

A basic environmental risk assessment was carried out for the top 10 dispensed pharmaceuticals in Melbourne, Australia, in contrast to the more commonly assessed measure of the most used drugs by physical mass. This allowed for the evaluation of compounds that had not previously been the subject of risk assessment. Estimations of the possible fate and behaviour of the target pharmaceuticals in sewage treatment plants were also made. The predicted removal rates of most drugs within standard sewage treatment were expected to be low, with the exception of the statins, which had high removal rates. Each pharmaceutical was predicted to be present in Melbourne wastewater at the nanogram per litre range or lower. All compounds were predicted to be of low toxicity risk, although it was not possible to model mixture effects. Atorvastatin and Irbesartan were also found to possess the potential to possibly bioaccumulate in the aquatic food chain but not to the extent that would require regulation or labelling.

Determination of pharmaceutical compounds in hospital wastewater and their elimination by advanced oxidation processes

This study investigates the mineralization efficiency, i.e. removal of total organic carbon (TOC) in hospital wastewater by direct ozonation, ozonation with UV radiation (O₃/UV), homogeneous catalytic ozonation (O₃/Fe²⁺) and homogeneous photocatalytic ozonation (O₃/Fe²⁺/UV). The influence of pH and reaction time was evaluated. For the best process, toxicity and degradation efficiency of the selected pharmaceutical compounds (PhCs) were determined. The results showed that the PhCs detected in the hospital wastewater were completely degraded when the mineralization efficiency reached 54.7% for O₃/UV with 120 minutes of reaction time using a rate of 1.57 g O₃ h^-1. This process also achieved a higher chemical oxygen demand removal efficiency (64.05%), an increased aromaticity reduction efficiency (81%) and a toxicity reduction.

Application of prioritization approaches to optimize environmental monitoring and testing of pharmaceuticals

Pharmaceuticals are ubiquitous in the natural environment with concentrations expected to rise as human population increases. Environmental risk assessments are available for a small portion of pharmaceuticals in use, raising concerns over the potential risks posed by other drugs that have little or no data. With >1900 active pharmaceutical ingredients in use, it would be a major task to test all of the compounds with little or no data. Desk-based prioritization studies provide a potential solution by identifying those substances that are likely to pose the greatest risk to the environment and which, therefore, need to be considered a priority for further study. The aim of this review was to (1) provide an overview of different prioritization exercises performed for pharmaceuticals in the environment and the results obtained; and (2) propose a new holistic risk-based prioritization framework for drugs in the environment. The suggested models to underpin this framework are discussed in terms of validity and applicability. The availability of data required to run the models was assessed and data gaps identified. The implementation of this framework may harmonize pharmaceutical prioritization efforts and ensure that, in the future, experimental resources are focused on molecules, endpoints, and environmental compartments that are biologically relevant.

Consumption-based approach for pharmaceutical compounds in a large hospital

Hospital wastewater contains a great variety of pharmaceutical compounds (PhCs), mainly due to excretion by patients. These PhCs, called emerging pollutants, are not fully eliminated in treatment plants, and are consequently detected in various environmental matrices, contributing to bacterial resistance and adverse environmental impacts on water resources. This study explores a consumption-based approach to predict the contribution of PhCs to a Brazilian hospital's wastewater. This approach identifies the consumption of major pharmaceutical classes in the studied hospital. Overall, this approach demonstrates a unique opportunity to screen PhCs used in hospitals and identify priority pollutants in hospital wastewater.

Eco-pharmacovigilance of non-steroidal anti-inflammatory drugs: Necessity and opportunities

Eco-pharmacovigilance (EPV) is a practical and powerful approach to minimize the potential risks posed by pharmaceutical residues in environment. However, it is impracticable to practise rigorous and unitary EPV process for all the existing and new pharmaceuticals. Here, we focused on non-steroidal anti-inflammatory drugs (NSAIDs), and discussed the necessity and potential opportunities of practising EPV of NSAIDs. We found that the consumption of NSAIDs is huge and ubiquitous across the globe. NSAIDs were worldwidely reported as one of the most dominant and frequently detected groups in environmental matrices including wastewater, surface water, suspended solids, sediments, groundwater, even drinking water. Besides, there is definitive evidence for the adverse impacts of NSAID residues on scavenging birds and aquatic species. These data suggested the necessity of implementing EPV of NSAIDs. From the perspective of drug administration, we identified some things that can be done as management practice options for EPV implementation on NSAIDs.

Removal of Antibiotics in Biological Wastewater Treatment Systems-A Critical Assessment Using the Activated Sludge Modeling Framework for Xenobiotics (ASM-X)

Many scientific studies present removal efficiencies for pharmaceuticals in laboratory-, pilot-, and full-scale wastewater treatment plants, based on observations that may be impacted by theoretical and methodological approaches used. In this Critical Review, we evaluated factors influencing observed removal efficiencies of three antibiotics (sulfamethoxazole, ciprofloxacin, tetracycline) in pilot- and full-scale biological treatment systems. Factors assessed include (i) retransformation to parent pharmaceuticals from e.g., conjugated metabolites and analogues, (ii) solid retention time (SRT), (iii) fractions sorbed onto solids, and (iv) dynamics in influent and effluent loading. A recently developed methodology was used, relying on the comparison of removal efficiency predictions (obtained with the Activated Sludge Model for Xenobiotics (ASM-X)) with representative measured data from literature. By applying this methodology, we demonstrated that (a) the elimination of sulfamethoxazole may be significantly underestimated when not considering retransformation from conjugated metabolites, depending on the type (urban or hospital) and size of upstream catchments; (b) operation at extended SRT may enhance antibiotic removal, as shown for sulfamethoxazole; (c) not accounting for fractions sorbed in influent and effluent solids may cause slight underestimation of ciprofloxacin removal efficiency. Using tetracycline as example substance, we ultimately evaluated implications of effluent dynamics and retransformation on environmental exposure and risk prediction.

Predicted and measured concentrations of pharmaceuticals in hospital effluents. Examination of the strengths and weaknesses of the two approaches through the analysis of a case study

This study deals with the chemical characterization of hospital effluents in terms of the predicted and measured concentrations of 38 pharmaceuticals belonging to 11 different therapeutic classes. The paper outlines the strengths and weaknesses of the two approaches through an analysis of a case study referring to a large hospital. It highlights the observed (and expected) ranges of variability for the parameters of the adopted model, presents the results of an uncertainty analysis of direct measurements (due to sampling mode and frequency and chemical analysis) and a sensitivity analysis of predicted concentrations (based on the annual consumption of pharmaceuticals, their excretion rate and annual wastewater volume generated by the hospital). Measured concentrations refer to two sampling campaigns carried out in summer and winter in order to investigate seasonal variability of the selected compounds. Predicted concentrations are compared to measured ones in the three scenarios: summer, winter and the whole year. It was found that predicted and measured concentrations are in agreement for a limited number of compounds (namely atenolol, atorvastatin and hydrochlorothiazide), and for most compounds the adoption of the model leads to a large overestimation in all three periods. Uncertainties in predictions are mainly due to the wastewater volume and excretion factor, whereas for measured concentrations, uncertainties are mainly due to sampling mode.

Possible underestimations of risks for the environment due to unregulated emissions of biocides from households to wastewater

The aim of this study was to investigate the role of household products as possible sources of biocidal active substances in municipal wastewater and their regulation under the Biocidal Products Regulation (EU) 528/2012. In 131 households, we investigated the prevalence of products used to control pests, washing and cleaning agents and select personal care products with high release to wastewater. Inventories of these products were established with the help of barcode scanning. All uses of biocidal active substances were evaluated regarding their assessment under the Biocidal Products Regulation. 2963 products were scanned in total, with 48% being washing and cleaning agents, 43% personal care products and 9% products used to control pests. Biocidal active substances were found in each household. These were observed primarily in washing and cleaning agents and personal care products (90%), while only a small percentage of the observations of biocidal active substances was in biocidal products. 64% of the observations of biocidal active substances were in applications that do not fall under the Biocidal Products Regulation and are thus not subject to its environmental risk assessment. This study shows clearly that risks for the environment are underestimated because unregulated emissions to wastewater occur. It demonstrates that there are gaps in the current chemical legislation that lead to a release of substances into wastewater that were not subject to environmental risk assessment under the Biocidal Products Regulation. This is one example of the limitations of scientific risk assessment of chemicals - its complexity is immense. From our point of view, the results underline the importance of a sustainable use of the substances as this is the only way to decrease yet unidentified risks.

Hospital-Use Pharmaceuticals in Swiss Waters Modeled at High Spatial Resolution

A model to predict the mass flows and concentrations of pharmaceuticals predominantly used in hospitals across a large number of sewage treatment plant (STP) effluents and river waters was developed at high spatial resolution. It comprised 427 geo-referenced hospitals and 742 STPs serving 98% of the general population in Switzerland. In the modeled base scenario, domestic, pharmaceutical use was geographically distributed according to the population size served by the respective STPs. Distinct hospital scenarios were set up to evaluate how the predicted results were modified when pharmaceutical use in hospitals was allocated differently; for example, in proportion to number of beds or number of treatments in hospitals. The hospital scenarios predicted the mass flows and concentrations up to 3.9 times greater than in the domestic scenario for iodinated X-ray contrast media (ICM) used in computed tomography (CT), and up to 6.7 times greater for gadolinium, a contrast medium used in magnetic resonance imaging (MRI). Field measurements showed that ICM and gadolinium were predicted best by the scenarios using number of beds or treatments in hospitals with the specific facilities (i.e., CT and/or MRI). Pharmaceuticals used both in hospitals and by the general population (e.g., cyclophosphamide, sulfamethoxazole, carbamazepine, diclofenac) were predicted best by the scenario using the number of beds in all hospitals, but the deviation from the domestic scenario values was only small. Our study demonstrated that the bed number-based hospital scenarios were effective in predicting the geographical distribution of a diverse range of pharmaceuticals in STP effluents and rivers, while the domestic scenario was similarly effective on the scale of large river-catchments.

Validated multi-drug determination using liquid chromatography with tandem mass spectrometry for the evaluation of a commercial drug disposal product

Currently, there are limited effective means of drug disposal for consumers, and this creates a gateway to illicit use and environmental contamination. Here, we evaluated the efficacy of a new drug disposal product, composed from a slurry of activated carbon, which claims to sequester up to 100% of a drug's active ingredient when the loading capacity is not exceeded, making it safe to dispose in landfill. High-performance liquid chromatography with tandem mass spectrometry was applied to quantify as many as 24 drugs (opiates, barbiturates, statins, amphetamine, and benzodiazepine drugs) in the residual solvent solution from the product. Calibration curves were established in the concentration ranges of 0.25-7.0 μg/mL and showed good linearity. The limits of detection varied from 0.001 to 0.02 μg/mL, depending on the drug. Accuracy ranged from 80 to 111% for quality control samples, with a few minor exceptions. Precision overall varied between 0.2 to 12.7%. In sample bottles tested, where active ingredient of the loaded drug was below the maximum sorption capacity stated on the label, 98 to >99.9% of the active ingredient was sequestered. Percent active ingredient adsorbed was slightly lower in bottles loaded in excess of label specifications.

Oxidation of cefazolin by potassium permanganate: Transformation products and plausible pathways

Cefazolin was demonstrated to exert high reactivity toward permanganate (Mn(VII)), a common oxidant in water pre-oxidation treatment. In this study, five transformation products were found to be classified into three categories according to the contained characteristic functional groups: three (di-)sulfoxide products, one sulfone product and one di-ketone product. Products analyses showed that two kinds of reactions including oxidation of thioether and the cleavage of unsaturated CC double bond occurred during transformation of cefazolin by Mn(VII). Subsequently, the plausible transformation pathways under different pH conditions were proposed based on the identified products and chemical reaction principles. More importantly, the simulation with real surface water matrix indicated that the proposed transformation pathways of cefazolin could be replayed in real water treatment practices.

The contribution of pharmaceutically active compounds from healthcare facilities to a receiving sewage treatment plant in Canada

Concentrations and percent loadings of pharmaceutically active compounds (PhACs) and other emerging contaminants released from healthcare facilities (2 hospitals and a long-term care facility) to a sewage treatment plant (STP) in a large urban sewershed were evaluated. An additional hospital outside the sewershed was also monitored. Fourteen of the 24 steroids/hormones and 88 of the 117 PhACs and emerging contaminants were detected at least once. Commonly used substances, including cotinine, caffeine and its metabolite 1,7-dimethylxanthine, ibuprofen and naproxen (analgesics), venlafaxine (antidepressant), and N,N-diethyl-meta-toluamide (insect repellant), were detected in all samples at all sites. Concentrations detected in the large specialty hospital outside the sewershed were similar to those within the sewershed. Cytotoxic drugs (tamoxifen and cyclophosphamide) and x-ray contrast media (iopamidol and diatrizoic acid) were infrequently detected in hospital effluents. Analysis for antibiotics indicated that azithromycin, clarithromycin, ciprofloxacin, erythromycin, ofloxacin, and sulfamethoxazole were consistently detected in hospital wastewaters, as was triclosan (antibacterial agent). Fifteen compounds individually contributed greater than 1% to the total PhAC and emerging contaminant load to the STP from the 2 hospitals in the sewershed, and 9 compounds in the STP effluent exceeded ecotoxicological criteria. The present survey demonstrates that point source discharges from healthcare facilities in this sewershed make a small contribution to the overall PhAC and emerging contaminant loading compared with the total concentrations entering the receiving STP.