Spatially explicit prioritization of human antibiotics and antineoplastics in Europe

Pharmaceuticals and Personal Care Products in the Aquatic Environment: How Can Regions at Risk be Identified in the Future?

Pharmaceuticals and personal care products (PPCPs) are an indispensable component of a healthy society. However, they are well-established environmental contaminants, and many can elicit biological disruption in exposed organisms. It is now a decade since the landmark review covering the top 20 questions on PPCPs in the environment (Boxall et al., 2012). In the present study we discuss key research priorities for the next 10 years with a focus on how regions where PPCPs pose the greatest risk to environmental and human health, either now or in the future, can be identified. Specifically, we discuss why this problem is of importance and review our current understanding of PPCPs in the aquatic environment. Foci include PPCP occurrence and what drives their environmental emission as well as our ability to both quantify and model their distribution. We highlight critical areas for future research including the involvement of citizen science for environmental monitoring and using modeling techniques to bridge the gap between research capacity and needs. Because prioritization of regions in need of environmental monitoring is needed to assess future/current risks, we also propose four criteria with which this may be achieved. By applying these criteria to available monitoring data, we narrow the focus on where monitoring efforts for PPCPs are most urgent. Specifically, we highlight 19 cities across Africa, Central America, the Caribbean, and Asia as priorities for future environmental monitoring and risk characterization and define four priority research questions for the next 10 years. Environ Toxicol Chem 2024;43:575-588. © 2023 The Authors. Environmental Toxicology and Chemistry published by Wiley Periodicals LLC on behalf of SETAC.

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.

Reducing risks of antibiotics to crop production requires land system intensification within thresholds

Land system intensification has substantially enhanced crop production; however, it has also created soil antibiotic pollution, undermining crop production. Here, we projected soil antibiotic pollution risks to crop production at multiple geographical scales in China and linked them to land system intensification (including arable land expansion and input increase). Our projections suggest that crop production will substantially decrease when the soil antibiotic pollution risk quotient exceeds 8.30-9.98. Land systems explain most of the variability in antibiotic pollution risks (21-66%) across spatial scales. The convex nonlinearities in tradeoffs between antibiotic pollution risk and crop production indicate that vegetable and wheat production have higher thresholds of land system intensification at which the risk-yield tradeoffs will peak than do maize and rice production. Our study suggests that land system intensification below the minimum thresholds at multiple scales is required for acceptable antibiotic pollution risks related to crop yield reduction.

Experimental and numerical elucidation of the fate and transport of antibiotics in aquatic environment: A review

This review highlights various experimental and mathematical modeling strategies to investigate the fate and transport of antibiotics that elucidate antimicrobial selective pressure in aquatic environments. Globally, the residual antibiotic concentrations in effluents from bulk drug manufacturing industries were 30- and 1500-fold greater than values reported in municipal and hospital effluents, respectively. The antibiotic concentration from different effluents enters the waterbodies that usually get diluted as they go downstream and undergo various abiotic and biotic reactive processes. In aquatic systems, photolysis is the predominant process for antibiotic reduction in the water matrix, while hydrolysis and sorption are frequently reported in the sediment compartment. The rate of antibiotic reduction varies widely with influencing factors such as the chemical properties of the antibiotics and hydrodynamic conditions of river streams. Among all, tetracycline was found to more unstable (log Kow =  - 0.62 to - 1.12) that can readily undergo photolysis and hydrolysis; whereas macrolides were more stable (log Kow = 3.06 to 4.02) that are prone to biodegradation. The processes like photolysis, hydrolysis, and biodegradation followed first-order reaction kinetics while the sorption followed a second-order kinetics for most antibiotic classes with reaction rates occurring in the decreasing order of Fluoroquinolones and Sulphonamides. The reports from various experiments on abiotic and biotic processes serve as input parameters for an integrated mathematical modeling to predict the fate of the antibiotics in the aquatic environment. Various mathematical models viz. Fugacity level IV, RSEMM, OTIS, GREAT-ER, SWAT, QWASI, and STREAM-EU are discussed for their potential capabilities. However, these models do not account for microscale interactions of the antibiotics and microbial community under real-field conditions. Also, the seasonal variations for contaminant concentrations that exert selective pressure for antimicrobial resistance has not been accounted. Addressing these aspects collectively is the key to exploring the emergence of antimicrobial resistance. Therefore, a comprehensive model involving antimicrobial resistance parameters like fitness cost, bacterial population dynamics, conjugation transfer efficiency, etc. is required to predict the fate of antibiotics.

Methodology for risk-based monitoring of contaminants in food - A case study in cereals and fish

In this study, a methodology was developed that can be used as input for risk-based monitoring plans for chemical contaminants in food products. The novel methodology was applied to a case study in which cereals and fish were evaluated simultaneously for the possible presence of mycotoxins and heavy metals. The methodology was based on hazard quotients that were estimated by dividing the daily intake - using concentrations of the contaminants in the different food products and consumption of the respective products combined per product group - by the health based guidance value (HBGV) or reference points used for assessing potential health concerns (RPHC). The most relevant hazard-product combinations were further ranked based on the volume of import of the ingredients, per import country and a defined contaminant prevalence level per country. For fish, the hazard quotients were around ten times lower compared to the highest hazard quotients in cereals. Consumption of molluscs, mackerel-type fish and herring-type fish contaminated with mercury contributed most to the HBGV or RPHC. The top 25 hazard-product combinations for various age groups included: aflatoxin B1 in combination with wheat, rice (products), maize (products), and pasta, zearalenone in combination with wheat (products), T2/HT2-toxin in combination with rice (products), and DON in combination with wheat (products). The methodology presented showed to be useful in identifying the most relevant hazard-food-age group combinations and the most relevant import countries linked to these that should be included in the monitoring. As such, the method can help risk managers in establishing risk-based monitoring programs.

Urbanization-land-use interactions predict antibiotic contamination in soil across urban-rural gradients

Antibiotics ubiquitously occur in soils and pose a potential threat to ecosystem health. Concurrently, urbanization and land-use intensification have transformed soil ecosystems, but how they affect antibiotic contamination remain largely unknown. Therefore, we profiled a broad-scale pattern of antibiotics in soil from agricultural lands and green spaces across urbanization gradients, and explored the hypothetical models to verify the effects of urbanization and land-use intensity on antibiotic contamination. The results showed that antibiotic concentrations and seasonality were higher in agricultural soil than in green spaces, which respectively showed linear or hump-shaped declines along with the increasing distance to urban centers. However, the response of antibiotic pollution to land-use intensity depended strongly on the urbanization level. More importantly, interactions between urbanization and land-use explained, on average, 59.6 % of the variation in antibiotic concentrations in soil across urbanization gradients. The proposed interactions can predict the non-linear changes in soil vulnerability to antibiotic contamination. Our study revealed that the urbanization can modulate the effects of land-use intensity on antibiotic concentration and seasonality in the soil environment, and that there is high stress on peri-urban soil ecosystems due to ongoing land-use changes arising from rapid urbanization processes.

Fractionation of levofloxacin and ofloxacin during their transport in NOM-goethite: Batch and column studies

Adsorption and transport of levofloxacin (LEV) and ofloxacin (OFL) enantiomers in a matrix containing goethite and natural organic matter (NOM) were investigated using batch and column experiments. In batch studies, competition and enantioselectivity were observed in the adsorption of LEV and OFL. Enantioselectivity upon adsorption was investigated by comparing changes in the enantiomer fraction (EF) (the ratio of LEV to the sum of LEV and OFL remaining in the solution) after and before adsorption. At pH < 7, there was hardly any selectivity in adsorption of OFL and LEV to goethite. At pH > 7, OFL showed a stronger adsorption than LEV to goethite, and this preference remained when NOM samples of Leonardite humic acid (LHA) and Elliott Soil fulvic acid (ESFA) were added. However, when Suwannee River NOM (SRNOM) was added, the preference was reversed, and LEV was adsorbed more strongly. In single systems, the presence of different types of NOM increased adsorption of LEV and OFL, especially LEV. In column studies, preloaded NOM decreased the transport of LEV and OFL through goethite-coated sand. The EF values in the effluent increased with retention time and reached the largest values (0.59-0.72) at around 1.5 pore volume (PV), and then decreased again, reaching a stable value at 5.0-30.0 PV. Both batch and column experiments showed that, fractionation of LEV and OFL occurred during adsorption and transport in the presence of NOM-goethite complexes, which would eventually affect their environmental fate.

Human health risk assessment of pharmaceuticals in the European Vecht River

Active pharmaceutical ingredients (APIs) can reach surface waters used for drinking water extraction and recreational activities, such as swimming and fishing. The aim of the present study was to systematically assess the lifetime human health risks posed by 15 individual APIs and their mixtures occurring in the German-Dutch transboundary Vecht River. An exposure model was developed and used to assess the combined risks of oral and dermal exposure under a variety of exposure conditions. A total of 4500 API uptake values and 165 lifetime risk values were estimated for 15 and 11 APIs, respectively. Overall, the lifetime human health risks posed by the APIs and their mixtures based on modeling results were deemed acceptable under typical exposure conditions. Under very extreme environmental conditions and human behavior, API mixture risks were of potential concern while the risks of individual APIs were negligible, with a few exceptions. The antibiotic doxycycline and analgesic phenazone showed the highest and lowest risks, respectively. The study did not evaluate the potential risks caused by metabolite compounds. Recommendations for water managers are provided to help improve the accuracy and utility of human health risk assessments of pharmaceuticals. Integr Environ Assess Manag 2022;18:1639-1654. © 2022 The Authors. Integrated Environmental Assessment and Management published by Wiley Periodicals LLC on behalf of Society of Environmental Toxicology & Chemistry (SETAC).

Antibiotic pollution in lakes in China: Emission estimation and fate modeling using a temperature-dependent multimedia model

The high use of antibiotics worldwide has poses a serious threat to both human and environmental health. Lakes are served as reservoirs for antibiotics, however, there is a lack of information available on antibiotics emissions and the subsequent pollution. Here, the emission and fate of 34 frequently detected antibiotics were studied in 226 Chinese lakes, via the built emission estimation method and a temperature-dependent multimedia lake model. It has been estimated that totally 5711 tons antibiotic were discharged into the lakes of China in 2019. Antibiotics emissions are due to human activities, with 3800-fold higher emissions in the Eastern China than that in Western China. The antibiotic fate in lakes has been successfully modelled by simulating the lake stratification, freeze-melt cycles and the stable condition throughout the year. Both stratification and freeze-melt cycles can lead to increased antibiotic concentrations in lake water. Deep-water lakes were shown to serve as a highly effective natural storage medium for antibiotics. The reliability of the model was confirmed by published measured concentrations and Monte Carlo method. This is the first study to comprehensively investigate the antibiotic fate in lakes of China, providing valuable guidance for the remediation of contaminated lakes.

Identifying targets of potential concern by a screening level ecological risk assessment of human use pharmaceuticals in China

The pollution of pharmaceuticals has attracted a lot of concerns during recent years. The goal of this study was to identify targets of ecological concern considering human use pharmaceuticals marketed in China. We constructed a database for 593 active pharmaceutical ingredients (APIs) by collecting their information on use and emission (e.g. production, human excretion, and removal by wastewater treatment) to calculated predicted environmental concentrations (PECs) by using an adapted European Medicines Agency method. PECs were comparable to the reported measurements for most APIs, demonstrating that the adapted method is reliable for the prioritization practice. Then PECs were compared to toxicity thresholds of three aquatic taxa (algae, daphnia, and fish). As a result, a total of 31 APIs, which were potentially risky and should be taken into consideration in future studies, were identified. Three APIs would pose a high risk with risk quotient (RQ) greater than 10. Six APIs were identified with moderate risks (1 < RQ < 10), and four of them were not reported before: rifaximin, griseofulvin, amikacin, and niclosamide. Of the 22 APIs with low risks (0.1 < RQ < 1), 17 have never been monitored previously in China and even worldwide. This study has yielded some probable antibiotics that should be considered as monitoring targets in China in the future.

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).

A review of multimedia transport and fate models for chemicals: Principles, features and applicability

The frequent use of chemicals has caused ecosystems and humans to be threatened due to their discharge into the environment. Multimedia environmental fate models could provide a comprehensive picture of transport behaviour and fate for organic chemicals in multiple environmental media. They have been designed and widely used for chemical risk assessment, chemical ranking and management support, and determination of chemical bioaccumulation. This study reviewed the principles, features and applicability of recent commonly used multimedia fate models from peer-reviewed literature. Fugacity-based and concentration-based models are now widely adopted for use in chemical fate evaluation, while they are more appropriate for volatile and semi-volatile chemicals. Or the fugacity-based models can use aquivalence equilibrium criterion to cations, anions and involatile chemicals. The MAMI and SESAMe models based on activity approach are applicable to neutral and ionizable molecules. However, interactions of ionic species with other water solutes are not taken into account in these models. Additionally, they could not directionally simulate how chemicals transported form one grid to another. Future attention should be focused on the reliability of transfer behaviour and fate of ionizable chemicals, as integrating the advantages of these two kinds of models into a reconstructed one may be a better choice. In a word, environmental multimedia models have been beneficial tools for chemical control and management, risk and effect estimation, and decision supporting.

Water and health: From environmental pressures to integrated responses

The water-related exposome is a significant determinant of human health. The disease burden through water results from water-associated communicable and non-communicable diseases and is influenced by water pollution with chemicals, solid waste (mainly plastics), pathogens, insects and other disease vectors. This paper analyses a range of water practitioner-driven health issues, including infectious diseases and chemical intoxication, using the conceptual framework of Drivers, Pressures, State, Impacts, and Responses (DPSIR), complemented with a selective literature review. Pressures in the environment result in changes in the State of the water body: chemical pollution, microbiological contamination and the presence of vectors. These and other health hazards affect the State of human health. The resulting Impacts in an exposed population or affected ecosystem, in turn incite Responses. Pathways from Drivers to Impacts are quite divergent for chemical pollution, microbiological contamination and the spread of antimicrobial resistance, in vectors of disease and for the combined effects of plastics. Potential Responses from the water sector, however, show remarkable similarities. Integrated water management interventions have the potential to address Drivers, Pressures, Impacts, and State of several health issues at the same time. Systematic and integrated planning and management of water resources, with an eye for human health, could contribute to reducing or preventing negative health impacts and enhancing the health benefits.

A High-Resolution Spatial Model to Predict Exposure to Pharmaceuticals in European Surface Waters: ePiE

Environmental risk assessment of pharmaceuticals requires the determination of their environmental exposure concentrations. Existing exposure modeling approaches are often computationally demanding, require extensive data collection and processing efforts, have a limited spatial resolution, and have undergone limited evaluation against monitoring data. Here, we present ePiE (exposure to Pharmaceuticals in the Environment), a spatially explicit model calculating concentrations of active pharmaceutical ingredients (APIs) in surface waters across Europe at ∼1 km resolution. ePiE strikes a balance between generating data on exposure at high spatial resolution while having limited computational and data requirements. Comparison of model predictions with measured concentrations of a diverse set of 35 APIs in the river Ouse (UK) and Rhine basins (North West Europe), showed around 95% were within an order of magnitude. Improved predictions were obtained for the river Ouse basin (95% within a factor of 6; 55% within a factor of 2), where reliable consumption data were available and the monitoring study design was coherent with the model outputs. Application of ePiE in a prioritisation exercise for the Ouse basin identified metformin, gabapentin, and acetaminophen as priority when based on predicted exposure concentrations. After incorporation of toxic potency, this changed to desvenlafaxine, loratadine, and hydrocodone.

Environmental impact of switching from the synthetic glucocorticoid prednisolone to the natural alkaloid berberine

Low amounts of human pharmaceuticals in the aquatic environment can affect bacteria, animals and ultimately humans. Here, the environmental consequences of a shift in prescription behavior from prednisolone to berberine was modeled using an environmental decision support system based on four consecutive steps: emission, fate, exposure and effect. This model estimates the relative aquatic and human health impacts of alternative pharmaceutical prescriptions throughout Europe. Since a Defined Daily Dose (DDD) of berberine has yet to be formulated, the environmental impacts of berberine and prednisolone were compared under the assumption of equal DDDs. Subsequently, the relative impact ratio indicates the extent to which the actual DDD of berberine might be higher to still be environmentally preferable over prednisolone. In fact, berberine can be administered at a six times higher dose throughout Europe before its impact on the aquatic environment exceeds that of one prescription of prednisolone. On average, the results for impacts on human health are similar, with the median impact ratio ranging between 5.87 and 22.8 depending on the level of drinking water purification. However, for some regions in Spain, Austria, Baltic States and Finland, berberine can only be considered an environmentally better alternative if it is administered at a lower dose than prednisolone. We conclude that for most regions in Europe it is, up until a certain dose of berberine, beneficial for the aquatic environment and therefore human health to prefer prescription of berberine over prednisolone.

Pharmaceuticals released from senior residences: occurrence and risk evaluation

One of the main pursuits, yet most difficult, in monitoring studies is to identify the sources of environmental pollution. In this study, we have identified health-care facilities from south European countries as an important source of pharmaceuticals in the environment. We have estimated that compounds consumed in by the elderly and released from effluents of senior residences can reach river waters at a concentration higher than 0.01 μg/L, which is the European Medicines Agency (EMA) threshold for risk evaluation of pharmaceuticals in surface waters. This study has been based on five health institutions in Portugal, Spain, and France, with 52 to 130 beds. We have compiled the pharmaceuticals dispensed on a daily base and calculated the consumption rates. From 54.9 to 1801 g of pharmaceuticals are consumed daily, with laxatives, analgesics, antiepileptics, antibiotics, and antidiabetic agents being the main drug families administered. According to excretion rates, dilution in the sewerage system, and elimination in wastewater treatment plants, macrogol, metformin, paracetamol, acetylcysteine, amoxicillin, and gabapentin, among others, are expected to reach river waters. Finally, we discuss the risk management actions related to the discharge of pharmaceuticals from senior residences to surface waters.

Quantifying variability in removal efficiencies of chemicals in activated sludge wastewater treatment plants - a meta-analytical approach

Large variations in removal efficiencies (REs) of chemicals have been reported for monitoring studies of activated sludge wastewater treatment plants (WWTPs). In this work, we conducted a meta-analysis on REs (1539 data points) for a set of 209 chemicals consisting of fragrances, surfactants, and pharmaceuticals in order to assess the drivers of the variability relating to inherent properties of the chemicals and operational parameters of activated sludge WWTPs. For a reduced dataset (n = 542), we developed a mixed-effect model (meta-regression) to explore the observed variability in REs for the chemicals using three chemical specific factors and four WWTP-related parameters. The overall removal efficiency of the set of chemicals was 82.1% (95% CI 75.2-87.1%, N = 1539). Our model accounted for 17% of the total variability in REs, while the process-based model SimpleTreat did not perform better than the average of the measured REs. We identified that, after accounting for other factors potentially influencing RE, readily biodegradable compounds were better removed than non-readily biodegradable ones. Further, we showed that REs increased with increasing sludge retention times (SRTs), especially for non-readily biodegradable compounds. Finally, our model highlighted a decrease in RE with increasing K_OC. The counterintuitive relationship to K_OC stresses the need for a better understanding of electrochemical interactions influencing the RE of ionisable chemicals. In addition, we highlighted the need to improve the modelling of chemicals that undergo deconjugation when predicting RE. Our meta-analysis represents a first step in better explaining the observed variability in measured REs of chemicals. It can be of particular help to prioritize the improvements required in existing process-based models to predict removal efficiencies of chemicals in WWTPs.

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.

Risks associated with the environmental release of pharmaceuticals on the U.S. Food and Drug Administration "flush list"

A select few prescription drugs can be especially harmful and, in some cases, fatal with just one dose when not used as prescribed. Therefore, the U. S. Food and Drug Administration (FDA) recommends that expired, unwanted, or otherwise unused portions of most of these drugs be disposed of quickly through a take-back program. If such an option is not readily available, FDA recommends that they be flushed down the sink or toilet. The goal of the current investigation was to evaluate the ecological and human-health risks associated with the environmental release of the 15 active pharmaceutical ingredients (APIs) currently on the FDA "flush list". The evaluation suggests that even when highly conservative assumptions are used-including that the entire API mass supplied for clinical use is flushed, all relevant sources in addition to clinical use of the API are considered, and no metabolic loss, environmental degradation, or dilution of wastewater effluents are used in estimating environmental concentrations-most of these APIs present a negligible eco-toxicological risk, both as individual compounds and as a mixture. For a few of these APIs, additional eco-toxicological data will need to be developed. Using similar conservative assumptions for human-health risks, all 15 APIs present negligible risk through ingestion of water and fish.

Critical review of methods for risk ranking of food-related hazards, based on risks for human health

This study aimed to critically review methods for ranking risks related to food safety and dietary hazards on the basis of their anticipated human health impacts. A literature review was performed to identify and characterize methods for risk ranking from the fields of food, environmental science and socio-economic sciences. The review used a predefined search protocol, and covered the bibliographic databases Scopus, CAB Abstracts, Web of Sciences, and PubMed over the period 1993-2013. All references deemed relevant, on the basis of predefined evaluation criteria, were included in the review, and the risk ranking method characterized. The methods were then clustered-based on their characteristics-into eleven method categories. These categories included: risk assessment, comparative risk assessment, risk ratio method, scoring method, cost of illness, health adjusted life years (HALY), multi-criteria decision analysis, risk matrix, flow charts/decision trees, stated preference techniques and expert synthesis. Method categories were described by their characteristics, weaknesses and strengths, data resources, and fields of applications. It was concluded there is no single best method for risk ranking. The method to be used should be selected on the basis of risk manager/assessor requirements, data availability, and the characteristics of the method. Recommendations for future use and application are provided.

A review of quantitative structure-property relationships for the fate of ionizable organic chemicals in water matrices and identification of knowledge gaps

Many organic chemicals are ionizable by nature. After use and release into the environment, various fate processes determine their concentrations, and hence exposure to aquatic organisms. In the absence of suitable data, such fate processes can be estimated using Quantitative Structure-Property Relationships (QSPRs). In this review we compiled available QSPRs from the open literature and assessed their applicability towards ionizable organic chemicals. Using quantitative and qualitative criteria we selected the 'best' QSPRs for sorption, (a)biotic degradation, and bioconcentration. The results indicate that many suitable QSPRs exist, but some critical knowledge gaps remain. Specifically, future focus should be directed towards the development of QSPR models for biodegradation in wastewater and sediment systems, direct photolysis and reaction with singlet oxygen, as well as additional reactive intermediates. Adequate QSPRs for bioconcentration in fish exist, but more accurate assessments can be achieved using pharmacologically based toxicokinetic (PBTK) models. No adequate QSPRs exist for bioconcentration in non-fish species. Due to the high variability of chemical and biological species as well as environmental conditions in QSPR datasets, accurate predictions for specific systems and inter-dataset conversions are problematic, for which standardization is needed. For all QSPR endpoints, additional data requirements involve supplementing the current chemical space covered and accurately characterizing the test systems used.

Increasing toxicity of enrofloxacin over four generations of Daphnia magna

The effects of both continuous and alternate exposure to 2mgL(-1) of enrofloxacin (EFX) on survival, growth and reproduction were evaluated over four generations of Daphnia magna. Mortality increased, reaching 100% in most groups by the end of the third generation. Growth inhibition was detected in only one group of the fourth generation. Reproduction inhibition was >50% in all groups and, in second and third generations, groups transferred to pure medium showed a greater inhibition of reproduction than those exposed to EFX. To verify whether the effects observed in these groups could be explained by the perinatal exposure to the antibacterial, a reproduction test with daphnids obtained from in vitro exposed D. magna embryos was also carried out. Perinatal exposure to EFX seemed to act as an 'all-or-nothing' toxicity effect as 31.4% of embryos died, but the surviving daphnids did not show any inhibition of reproduction activity. However, the embryonic mortality may at least partially justify the inhibition of reproduction observed in exposed groups along the multigenerational test. Concluding, the multigenerational test with D. magna did show disruption to a population that cannot be evidenced by the official tests. The increasing deterioration across generations might be inferred as the consequence of heritable alterations. Whilst the concentration tested was higher than those usually detected in the natural environment, the increasing toxicity of EFX across generations and the possible additive toxicity of fluoroquinolone mixtures, prevent harm to crustacean populations by effects in the real context from being completely ruled out.

Environmental risk analysis and prioritization of pharmaceuticals in a developing world context

The impact of residual pharmaceuticals on the aquatic environment has gained widespread attention over the past years. Various studies have established the occurrence of pharmaceutical compounds in different water bodies throughout the world. In view of the absence of occurrence data in a number of developing world countries, and given the limited availability of analytical resources in these countries, it is prudent to devise methodologies to prioritize pharmaceuticals for environmental monitoring purposes that are site specific. In this work, several prioritization approaches are used to rank the 88 most commonly consumed pharmaceuticals in Lebanon. A simultaneous multi-criteria decision analysis method utilizing the exposure, persistence, bioaccumulation, and toxicity (EPBT) approach is applied to a smaller subset of the original list (69 pharmaceuticals). Several base cases are investigated and sensitivity analysis is applied to one of these base case runs. The similarities and differences in the overall ranking of individual, and classes of, pharmaceuticals for the base cases and the sensitivity runs are elucidated. An environmental risk assessment (ERA), where predicted environmental concentrations (PEC) and risk quotients (RQ) are determined at different dilution factors, is performed as an alternative method of prioritization for a total of 84 pharmaceuticals. The ERA results indicate that metformin and amoxicillin have the highest PECs while 17β-estradiol, naftidrofuryl and dimenhydrinate have the highest RQs. The two approaches, EPBT prioritization and ERA, are compared and a priority list consisting of 26 pharmaceuticals of various classes is developed. Nervous system and alimentary tract and metabolism pharmaceuticals (9/26 and 5/26 respectively) constitute more than half of the numbers on the priority list with the balance consisting of anti-infective (4/26), musculo-skeletal (3/26), genito-urinary (2/26), respiratory (2/26) and cardiovascular (1/26) pharmaceuticals. This list will serve as a basis for the selection of candidate compounds to focus on for future monitoring campaigns.

The influence of uncertainty and location-specific conditions on the environmental prioritisation of human pharmaceuticals in Europe

The selection of priority APIs (Active Pharmaceutical Ingredients) can benefit from a spatially explicit approach, since an API might exceed the threshold of environmental concern in one location, while staying below that same threshold in another. However, such a spatially explicit approach is relatively data intensive and subject to parameter uncertainty due to limited data. This raises the question to what extent a spatially explicit approach for the environmental prioritisation of APIs remains worthwhile when accounting for uncertainty in parameter settings. We show here that the inclusion of spatially explicit information enables a more efficient environmental prioritisation of APIs in Europe, compared with a non-spatial EU-wide approach, also under uncertain conditions. In a case study with nine antibiotics, uncertainty distributions of the PAF (Potentially Affected Fraction) of aquatic species were calculated in 100∗100km(2) environmental grid cells throughout Europe, and used for the selection of priority APIs. Two APIs have median PAF values that exceed a threshold PAF of 1% in at least one environmental grid cell in Europe, i.e., oxytetracycline and erythromycin. At a tenfold lower threshold PAF (i.e., 0.1%), two additional APIs would be selected, i.e., cefuroxime and ciprofloxacin. However, in 94% of the environmental grid cells in Europe, no APIs exceed either of the thresholds. This illustrates the advantage of following a location-specific approach in the prioritisation of APIs. This added value remains when accounting for uncertainty in parameter settings, i.e., if the 95th percentile of the PAF instead of its median value is compared with the threshold. In 96% of the environmental grid cells, the location-specific approach still enables a reduction of the selection of priority APIs of at least 50%, compared with a EU-wide prioritisation.

Prioritizing human pharmaceuticals for ecological risks in the freshwater environment of Korea

Pharmaceutical residues are potential threats to aquatic ecosystems. Because more than 3000 active pharmaceutical ingredients (APIs) are in use, identifying high-priority pharmaceuticals is important for developing appropriate management options. Priority pharmaceuticals may vary by geographical region, because their occurrence levels can be influenced by demographic, societal, and regional characteristics. In the present study, the authors prioritized human pharmaceuticals of potential ecological risk in the Korean water environment, based on amount of use, biological activity, and regional hydrologic characteristics. For this purpose, the authors estimated the amounts of annual production of 695 human APIs in Korea. Then derived predicted environmental concentrations, using 2 approaches, to develop an initial candidate list of target pharmaceuticals. Major antineoplastic drugs and hormones were added in the initial candidate list regardless of their production amount because of their high biological activity potential. The predicted no effect concentrations were derived for those pharmaceuticals based on ecotoxicity information available in the literature or by model prediction. Priority lists of human pharmaceuticals were developed based on ecological risks and availability of relevant information. Those priority APIs identified include acetaminophen, clarithromycin, ciprofloxacin, ofloxacin, metformin, and norethisterone. Many of these pharmaceuticals have been neither adequately monitored nor assessed for risks in Korea. Further efforts are needed to improve these lists and to develop management decisions for these compounds in Korean water.

Uncertainty and variability in human exposure limits - a chemical-specific approach for ciprofloxacin and methotrexate

Human exposure limits (HELs) for chemicals with a toxicological threshold are traditionally derived using default assessment factors that account for variations in exposure duration, species sensitivity and individual sensitivity. The present paper elaborates a probabilistic approach for human hazard characterization and the derivation of HELs. It extends the framework for evaluating and expressing uncertainty in hazard characterization recently proposed by WHO-IPCS, i.e. by the incorporation of chemical-specific data on human variability in toxicokinetics. The incorporation of human variability in toxicodynamics was based on the variation between adverse outcome pathways (AOPs). Furthermore, sources of interindividual variability and uncertainty are propagated separately throughout the derivation process. The outcome is a two-dimensional human dose distribution that quantifies the population fraction exceeding a pre-selected critical effect level with an estimate of the associated uncertainty. This enables policy makers to set separate standards for the fraction of the population to be protected and the confidence level of the assessment. The main sources of uncertainty in the human dose distribution can be identified in order to plan new research for reducing uncertainty. Additionally, the approach enables quantification of the relative risk for specific subpopulations. The approach is demonstrated for two pharmaceuticals, i.e. the antibiotic ciprofloxacin and the antineoplastic methotrexate. For both substances, the probabilistic HEL is mainly influenced by uncertainty originating from: (1) the point of departure (PoD), (2) extrapolation from sub-acute to chronic toxicity and (3) interspecies extrapolation. However, when assessing the tails of the two-dimensional human dose distributions, i.e. the section relevant for the derivation of human exposure limits, interindividual variability in toxicodynamics also becomes important.

Pharmaceuticals and personal care products in waters: occurrence, toxicity, and risk

Pharmaceuticals and personal care products (PPCP) are compounds with special physical and chemical properties that address the care of animal and human health. PPCP have been detected in surface water and wastewater in the ng/L to µg/L concentration range worldwide. PPCP ecotoxicity has been studied in a variety of organisms, and multiple methods have been used to assess the risk of PPCP in the environment to ecological health. Here we review the occurrence, effects, and risk assessment of PPCP in aquatic systems, as well as the sustainability of current methods for managing PPCP contamination in aquatic systems. The major points are the following: (1) a number of PPCP present potential concerns at environmentally relevant concentrations. PPCP mixtures may produce synergistic toxicity. (2) Various methods have been used for the ecological risk assessment of PPCP in aquatic systems. There are similarities in these methods, but no consensus has emerged regarding best practices for the ecological risk assessment of these compounds. (3) Human health risk assessments of PPCP contamination in aquatic systems have generally indicated little cause for concern. However, there is a lack of information regarding whether antibiotic contamination in wastewater and aquatic systems could lead to an increase in clinically relevant antibiotic-resistant bacteria and antibiotic-resistant genes. (4) Over the next century, the combination of increasing global population size and potential droughts may result in reduced water availability, increased need for water reuse, and increasing concentrations of PPCP in wastewaters. The current wastewater treatment methods do not remove all PPCP effectively. This, coupled with the possibility that antibiotics may promote the development of antibiotic-resistant bacteria and antibiotic-resistant genes, leads to concerns about the sustainability of global water supplies.

Hierarchical Bayesian Approach To Reduce Uncertainty in the Aquatic Effect Assessment of Realistic Chemical Mixtures

Species in the aquatic environment differ in their toxicological sensitivity to the various chemicals they encounter. In aquatic risk assessment, this interspecies variation is often quantified via species sensitivity distributions. Because the information available for the characterization of these distributions is typically limited, optimal use of information is essential to reduce uncertainty involved in the assessment. In the present study, we show that the credibility intervals on the estimated potentially affected fraction of species after exposure to a mixture of chemicals at environmentally relevant surface water concentrations can be extremely wide if a classical approach is followed, in which each chemical in the mixture is considered in isolation. As an alternative, we propose a hierarchical Bayesian approach, in which knowledge on the toxicity of chemicals other than those assessed is incorporated. A case study with a mixture of 13 pharmaceuticals demonstrates that this hierarchical approach results in more realistic estimations of the potentially affected fraction, as a result of reduced uncertainty in species sensitivity distributions for data-poor chemicals.

Kinetics of tetracycline, oxytetracycline, and chlortetracycline adsorption and desorption on two acid soils

The purpose of this work was to quantify retention/release of tetracycline, oxytetracycline, and chlortetracycline on two soils, paying attention to sorption kinetics and to implications of the adsorption/desorption processes on transfer of these pollutants to the various environmental compartments. We used the stirred flow chamber (SFC) procedure to achieve this goal. All three antibiotics showed high affinity for both soils, with greater adsorption intensity for soil 1, the one with the highest organic matter and Al and Fe oxides contents. Desorption was always <15%, exhibiting strong hysteresis in the adsorption/desorption processes. Adsorption was adequately modeled using a pseudo first-order equation with just one type of adsorption sites, whereas desorption was better adjusted considering both fast and slow sorption sites. The adsorption maximum (qmax) followed the sequence tetracycline > oxytetracycline > chlortetracycline in soil 1, with similar values for the three antibiotics and the sequence tetracycline > chlortetracycline > oxytetracycline in soil 2. The desorption sequences were oxytetracycline > tetracycline > chlortetracycline in soil 1 and oxytetracycline > chlortetracycline > tetracycline in soil 2. In conclusion, the SFC technique has yielded new kinetic data regarding tetracycline, oxytetracycline, and chlortetracycline adsorption/desorption on soils, indicating that it can be used to shed further light on the retention and transport processes affecting antibiotics on soils and other media, thus increasing knowledge on the behavior and evolution of these pharmaceutical residues in the environment.

An integrated approach for prioritizing pharmaceuticals found in the environment for risk assessment, monitoring and advanced research

Numerous active pharmaceutical ingredients (APIs), approved prior to enactment of detailed environmental risk assessment (ERA) guidance in the EU in 2006, have been detected in surface waters as a result of advancements in analytical technologies. Without adequate knowledge of the potential hazards these APIs may pose, assessing their environmental risk is challenging. As it would be impractical to commence hazard characterization and ERA en masse, several approaches to prioritizing substances for further attention have been published. Here, through the combination of three presentations given at a recent conference, "Pharmaceuticals in the Environment, Is there a problem?" (Nîmes, France, June 2013) we review several of these approaches, identify salient components, and present available techniques and tools that could facilitate a pragmatic, scientifically sound approach to prioritizing APIs for advanced study or ERA and, where warranted, fill critical data gaps through targeted, intelligent testing. We further present a modest proposal to facilitate future prioritization efforts and advanced research studies that incorporates mammalian pharmacology data (e.g., adverse outcomes pathways and the fish plasma model) and modeled exposure data based on pharmaceutical use.

Food safety/food security aspects related to the environmental release of pharmaceuticals

The environmental presence of pharmaceuticals in top soil and in water where extensive animal farming occurs may represent an involuntary source of residues in food that might affect both food safety and food security. We modelled the presence of residues in animal matrices from the inventoried environmental concentration of selected drugs in surface waters (range: 0.1-10μgL(-1)) and agriculture soils (range: 1-100μgkg(-1) dry weight), accounting for animal production parameters (i.e., forages, water intake and milk and egg production) and drug pharmacokinetics. The results indicate that the contamination of tetracyclines in top soil may represent a major issue both for the compliance with maximum residue levels in food (100-300ngg(-1)) and for the claim of organic products. via surface water, animals may be vulnerable to the intake of anabolics and growth-promoting agents, such as 17-beta estradiol and clenbuterol, only under a worst-case scenario. Their identification, which is currently achievable at a pgg(-1) level in animal specimens, is considered proof of illegal treatment and can lead to the prosecution of farmers. The Environmental Quality Standards that have been proposed for priority substances in surface waters may also be considered protective in terms of food security/food safety; however, a broad-spectrum characterisation of drugs within the agriculture context could be envisaged to refine the uncertainties in the risk assessment and for combined intakes.

Environmental impact assessment of pharmaceutical prescriptions: Does location matter?

A methodology was developed for the assessment and comparison of the environmental impact of two alternative pharmaceutical prescriptions. This methodology provides physicians with the opportunity to include environmental considerations in their choice of prescription. A case study with the two antibiotics ciprofloxacin and levofloxacin at three locations throughout Europe showed that the preference for a pharmaceutical might show spatial variation, i.e. comparison of two pharmaceuticals might yield different results when prescribed at different locations. This holds when the comparison is based on both the impact on the aquatic environment and the impact on human health. The relative impacts of ciprofloxacin and levofloxacin on human health were largely determined by the local handling of secondary sludge, agricultural disposal practices, the extent of secondary sewage treatment, and local food consumption patterns. The relative impacts of ciprofloxacin and levofloxacin on the aquatic environment were mostly explained by the presence of specific sewage treatment techniques, as effluents from sewage treatment plants (STPs) are the most relevant emission pathway for the aquatic environment.

Fluorouracil in the environment: analysis, occurrence, degradation and transformation

5-Fluorouracil (5-FU) is a fluorinated pyrimidine analogue important in the treatment of cancer whose fate in the environment is yet to be fully addressed. Due to its high polarity 5-FU requires challenging sample preparation and therefore we thoroughly investigated different solid phase extraction mechanisms (ion pair, ion exchange, reversed phase), sorbents and derivatisation agents to enable trace-level analysis of 5-FU based on GC-MS/MS in natural and wastewaters. Ion pair and ion exchange retention mechanisms enable the extraction of 5-FU from deionised water, but were inappropriate for complex environmental matrices, where the reversed phase sorbent Isolute ENV+ gave the best extraction efficiencies (53% and 93% for wastewaters and surface waters, respectively). Further, alkylation was rejected in favour of silylation with MTBSTFA. The achieved limits of quantification (LOQ) for waste and surface waters were 1.6 ng/L and 0.54 ng/L, respectively. The method was used to analyse samples of hospital, wastewater treatment plant influent and effluent and surface waters. 5-FU was quantified in four out of the twelve samples of oncological ward wastewaters and municipal wastewater treatment plant influents in concentrations from 4.7 ng/L to 92 ng/L. This work is also the first to study the environmental transformation of 5-FU and its prodrug capecitabine (CAP). Their removal and transformation was simulated using a series of biodegradation and photodegradation experiments, where 5-FU proved more degradable in comparison to CAP. Transformation of 5-FU and CAP was studied by using ultra-performance liquid chromatography coupled to quadrupole time-of-flight mass spectrometry (UPLC-QqTOF). Overall, six transformation products for 5-FU and ten for CAP are proposed; 13 of these are to our knowledge published for the first time.