Distribution and Removal of Pharmaceuticals in Liquid and Solid Phases in the Unit Processes of Sewage Treatment Plants

The behavior of pharmaceutically active compounds and contrast agents during wastewater treatment - Combining sampling strategies and analytical techniques: A critical review

Increasing consumption of pharmaceuticals and the respective consequences for the aquatic environment have been the focus of many studies over the last thirty years. Various aspects in this field were investigated, considering diverse pharmaceutical groups and employing a wide range of research methodologies. Various questions from the perspectives of different research areas were devised and answered, resulting in a large mix of individual findings and conclusions. Collectively, the results of the studies offer a comprehensive overview. The large variety of methods and strategies, however, demands close attention when comparing and combining information from heterogeneous projects. This review critically examines the application of diverse sampling techniques as well as analytical methods in investigations concerning the behavior of pharmaceutically active compounds (PhACs) and contrast agents (CAs) in wastewater treatment plants (WWTPs). The combination of sampling and analysis is discussed with regard to its suitability for specific scientific problems. Different research focuses need different methods and answer different questions. An overview of studies dealing with the fate and degradation of PhACs and CAs in WWTPs is presented, discussing their strategic approaches and findings. This review includes surveys of anticancer drugs, antibiotics, analgesics and anti-inflammatory drugs, antidiabetics, beta blockers, hormonal contraceptives, lipid lowering agents, antidepressants as well as contrast agents for X-ray and magnetic resonance imaging.

Occurrence, removal, and prioritization of organic micropollutants in four full-scale wastewater treatment plants in Korea

This study investigated the occurrence, removal rate, and potential risks of 43 organic micropollutants (OMPs) in four municipal wastewater treatment plants (WWTPs) in Korea. Results from two-year intensive monitoring confirmed the presence of various OMPs in the influents, including pharmaceuticals such as acetaminophen (pain relief), caffeine (stimulants), cimetidine (H2-blockers), ibuprofen (non-steroidal anti-inflammatory drugs- NSAIDs), metformin (antidiabetics), and naproxen (NSAIDs) with median concentrations of >1 μg/L. Some pharmaceuticals (carbamazepine-anticonvulsants, diclofenac-NSAIDs, propranolol-β-blockers), corrosion inhibitors (1H-benzotriazole-BTR, 4-methyl-1H-benzotriazole-4-TTR), and perfluorinated compounds (PFCs) were negligibly removed during WWTP treatment. The OMP concentrations in the influents and effluents were mostly lower in August than those of other months (p-value <0.05) possibly due to wastewater dilution by high precipitation or enhanced biodegradation under high-temperature conditions. The anaerobic-anoxic-oxic process (A2O) with a membrane bioreactor exhibited higher OMP removal than other processes, such as A2O with sedimentation or the conventional activated sludge process (p-value <0.05). Pesticides (DEET and atrazine), corrosion inhibitors (4-TTR and BTR), and metformin were selected as priority OMPs in toxicity-driven prioritization, whereas PFCs were determined as priority OMPs given their persistence and bioaccumulation properties. Overall, our results contribute to an important database on the occurrence, removal, and potential risks of OMPs in Korean WWTPs.

Anaerobic co-metabolic biodegradation of pharmaceuticals and personal care products driven by glycerol fermentation

Anaerobic digestion in two sequential phases, acidogenesis and methanogenesis, has been shown to be beneficial for enhancing the biomethane generation from wastewater. In this work, the application of glycerol (GOH) as a fermentation co-substrate during the wastewater treatment was evaluated on the biodegradation of different pharmaceuticals and personal care products (PPCPs). GOH co-digestion during acidogenesis led to a significant increase in the biodegradation of acetaminophen (from 78 to 89%), ciprofloxacin (from 25 to 46%), naproxen (from 73 to 86%), diclofenac (from 36 to 48%), ibuprofen (from 65 to 88%), metoprolol (from 45 to 59%), methylparaben (from 64 to 78%) and propylparaben (from 68 to 74%). The heterotrophic co-metabolism of PPCPs driven by glycerol was confirmed by the biodegradation kinetics, in which kbio (biodegradation kinetics constant) values increased from 0.18 to 2.11 to 0.27-3.60 L g-1-VSS d-1, for the operational phases without and with GOH, respectively. The assessment of metabolic pathways in each phase revealed that the prevalence of aromatic compounds degradation, metabolism of xenobiotics by cytochrome P450, and benzoate degradation routes during acidogenesis are key factors for the enzymatic mechanisms linked to the PPCPs co-metabolism. The phase separation of anaerobic digestion was effective in the PPCPs biodegradation, and the co-fermentation of glycerol provided an increase in the generation potential of biomethane in the system (energetic potential of 5.0 and 6.3 kJ g-1-CODremoved, without and with GOH, respectively). This study showed evidence that glycerol co-fermentation can exert a synergistic effect on the PPCPs removal during anaerobic digestion mediated by heterotrophic co-metabolism.

Removal of pharmaceutical compounds and toxicology study in wastewater using Malaysian fungal Ganoderma lucidum

Elevated usage of pharmaceutical products leads to the accumulation of emerging contaminants in sewage. In the current work, Ganoderma lucidum (GL) was used to remove pharmaceutical compounds (PCs), proposed as a tertiary method in sewage treatment plants (STPs). The PCs consisted of a group of painkillers (ketoprofen, diclofenac, and dexamethasone), psychiatrists (carbamazepine, venlafaxine, and citalopram), beta-blockers (atenolol, metoprolol, and propranolol), and anti-hypertensives (losartan and valsartan). The performance of 800 mL of synthetic water, effluent STP, and hospital wastewater (HWW) was evaluated. Parameters, including treatment time, inoculum volume, and mechanical agitation speed, have been tested. The toxicity of the GL after treatment is being studied based on exposure levels to zebrafish embryos (ZFET) and the morphology of the GL has been observed via Field Emission Scanning Electron Microscopy (FESEM). The findings conclude that GL can reduce PCs from <10% to >90%. Diclofenac and valsartan are the highest (>90%) in the synthetic model, while citalopram and propranolol (>80%) are in the real wastewater. GL effectively removed pollutants in 48 h, 1% of the inoculum volume, and 50 rpm. The ZFET showed GL is non-toxic (LC50 is 209.95 mg/mL). In the morphology observation, pellets GL do not show major differences after treatment, showing potential to be used for a longer treatment time and to be re-useable in the system. GL offers advantages to removing PCs in water due to their non-specific extracellular enzymes that allow for the biodegradation of PCs and indicates a good potential in real-world applications as a favourable alternative treatment.

Adsorption of anti-inflammatory and analgesic drugs traces in water on clay minerals

The aim of this study was to assess the adsorption of four non-steroidal anti-inflammatory drugs (NSAIDs), namely Paracetamol (PRC), Diclofenac (DIC), Ibuprofen (IBU), and Ketoprofen (KET), using both batch and continuous experiments with clay. Various analytical techniques, including XRD, FTIR, SEM coupled to EDX, and Zeta potential, were employed to characterize both raw and calcined clay. XRD and FTIR analyses confirmed the kaolinite nature of the clay. SEM data revealed a lamellar structure formed in the clay after calcination at 550 °C. Adsorption tests were conducted to determine the optimal adsorption conditions. Batch kinetics of adsorption demonstrated rapid adsorption of all four NSAIDs, with the highest adsorption occurring at pH 4 (DIC, IBU, and KET) and pH 6 for PRC, using a concentration of 20 mg L-1 of calcined clay. Additionally, the pseudo-second-order model provided the best fit for all NSAIDs adsorption processes. Maximum adsorption capacities, as determined by the Langmuir model, were 80 mg g-1 for PRC, 238 mg -1g for DIC, 138 mg g-1 for IBU, and 245 mg g-1 for KET. In fixed bed column studies, three dynamic models (Thomas, Adams-Bohart, and Yoon-Nelson) were utilized to describe the breakthrough curves, with linear regression used to identify key characteristics for process design. The fixed bed column adsorption study revealed that DIC exhibited the highest removal efficiency at 98%, while KET, IBU, and PRC were more persistent, with removal efficiencies of 77.1%, 76.7%, and 67.1%, respectively. The Thomas model was deemed appropriate for describing the breakthrough curve. These findings offer valuable insights into the interactions between clay and pharmaceuticals with varying physicochemical properties. They also provide information on the adsorption models, saturation, and adsorption capacities of various pharmaceuticals on natural clays, which can be crucial for further research and environmental remediation efforts.

Occurrence, removal, and risk assessment of emerging contaminants in aquatic products processing sewage treatment plants

Emerging contaminants (ECs) in aquatic environments have attracted attention due to their wide distribution and potential ecotoxicities. Sewage treatment plants (STPs) are proven to be the major source of ECs in the aquatic environment, while there remains insufficient understanding of the removal and risk assessment of ECs in STPs. Here, we clarified the degradation and risk impact of 13 ECs in two aquatic product processing sewage treatment plants (APPSTPs) along the southeast coast of China. The concentrations of ECs followed the order: endocrine-disrupting chemicals (1877.85-15,398.02 ng/L in influent, 3.37-44.47 ng/L in effluent) >  > sulfonamide antibiotics (SAs, 75.14-906.19 ng/L in influent, 1.14-15.33 ng/L in effluent) > pharmaceutical and personal care products (PPCPs, 44.47-589.93 ng/L in influent, 2.54-34.16 ng/L in effluent) ≈ fluoroquinolone antibiotic (54.76-434.83 ng/L in influent, 10.75-32.82 ng/L in effluent) > other antibiotics (16.21-51.96 ng/L in influent, 0.68-6.17 ng/L in effluent). Moreover, the concentrations of PPCPs (decreased by 55.33-87.65% in peak fishing season) and antibiotics (increased by 44.99% in peak fishing season) were affected by fishing activities. In particular, the sequencing batch reactor (SBR) process had a better removal effect than the anaerobic-anoxic-oxic (A2/O) process on the treatment of some contaminants (e.g., norfloxacin and nonylphenol). Risk evaluations of ECs demonstrated that nonylphenol and SAs were at high- and low-risk states, respectively. Overall, our results provide important information for the degradation treatment of ECs, which is essential for pollutant management policy formulation.

Evaluation of contaminants of emerging concern attenuation through a vegetation filter managed using different operating conditions

In wastewater treatment using Vegetation Filters (VFs), natural processes reduce contaminants present in water although some of them can reach the environment. In this study, 39 contaminants of emerging concern (CECs) are evaluated in a pilot VF under different operating conditions during almost four years. The use of woodchip amendments and the change from surface irrigation through furrows to drip irrigation (and from weekly to daily water application) provide CEC concentration reductions in the water infiltrating through the vadose zone. Biodegradation is the main process taking place and has been favoured mainly by woodchip soil amendments and the increased residence. Median attenuation percentages of the CECs most frequently detected with highest concentrations in applied wastewater vary between 52% and 100% at the end of the study (at 45 cm depth). Among targeted CECs, caffeine, and its transformation product paraxanthine are the most attenuated. Flecainide and venlafaxine show a persistent behaviour. However, their leaching concentrations are very low (< 31 ng/L). Concerning the underlying aquifer, the groundwater quality in terms of CEC concentrations is conditioned by the surrounding area rather than the operation of the VF. Levels in groundwater are always below those in wastewater and infiltrating water.

The Importance of Humic Substances in Transporting "Chemicals of Emerging Concern" in Water and Sewage Environments

In this study, we examined the sorption of selected "chemicals of emerging concern" (CEC) on humic substances commonly found in water and municipal wastewater. These were ibuprofen, diclofenac, caffeine, carbamazepine, estrone, triclosan, bisphenol A, and isoproturon. The humic substances (HSs) were synthetic and not contaminated by the tested organic substances. The elemental composition and content of mineral micropollutants, gravimetric curves, and the IR spectrum of HSs were determined. We determined a relationship between the process efficiency and the characteristics of a sorbent and sorbate using the properties of organic substances sorbed on HSs. This relationship was confirmed by sorption tests on the HS complex, i.e., the HS-organic micropollutant. It has been shown that the given complexes have a greater affinity for hydrophobic surfaces than hydrophilic surfaces. To confirm the nature of the sorbent surfaces, we determined their zeta potential dependence on the pH of the solution. Studies have shown that HSs are carriers of both mineral substances and CEC in water and sewage environments.

Pharmaceutical waste management system - Are the current techniques sustainable, eco-friendly and circular? A review

Most households and healthcare facilities usually dispose of contaminated, unused, or expired (CUE) medicines with municipal wastes, the disposal of which usually amounts to $790/ton in the USA and £450/ton in the UK. Solid (e.g., tablets, capsules, powders) and semi-solid (e.g., ointment, creams) pharmaceuticals are managed with incineration/pyrolysis, encapsulation, and engineered landfills, whereas wastewater treatment plants (WWTPs) are recommended for liquid pharmaceutical wastes (PWs). However, to date, the sustainability and eco-friendliness profile of these techniques are only subjectively ensured, leading to controversial viewpoints in many guidelines. Each technique has relative strengths and weaknesses, and their comparative weighting to maximize these profiles is sought after. The present comprehensive review aims to fulfil knowledge gaps in this regard. Four electronic databases (e.g., PubMed/MEDLINE, Scopus, and ScienceDirect) were searched for PW management (PWM)-related qualitative and quantitative articles published till December 31, 2022. Articles without details of waste disposal techniques and their health and environmental impacts were excluded. Based on the literature review, we determine that incineration can be considered a sustainable option for solid and semi-solid PWs, and WWTPs can be eco-friendly for liquid PWs, whereas encapsulation and landfilling are less sustainable. It is high time that objectively proven sustainable and eco-friendly techniques be implemented for PWM based on their dosage forms or nature of hazards. Medicine take-back, eco-pharmacovigilance, extended producer responsibility, co-payment, and life cycle analysis of pharmaceuticals focusing on reduction, reuse/re-dispensing can be integrated to make existing models sustainable, circular, and eco-friendly.

Effect of psychoactive substances on cardiac and locomotory activity of juvenile marbled crayfish Procambarus virginalis

Pharmaceutically active compounds are common and increasing in the aquatic environment. Evidence suggests they have adverse effects on non-target organisms, and they are classified as emerging pollutants for a variety of aquatic organisms. To determine the effects of environmentally relevant levels of psychoactive compounds on non-target organisms, we analyzed cardiac and locomotory activity in early developmental stages of marbled crayfish Procambarus virginalis. Responses to sertraline, methamphetamine, and a mixture of citalopram, oxazepam, sertraline, tramadol, venlafaxine, and methamphetamine at a concentration of 1 µg L^-1 of each compound were assessed. On day four of exposure, cardiac activity was recorded for 5 min, and on day eight, locomotory activity was recorded for 15 min. There was a significant increase (p < 0.01) in heart rate in methamphetamine-exposed and Mix-exposed juveniles compared to the unexposed control and there was significant difference (p < 0.01) in proportion of time (activity %) was observed with sertraline-exposed, whereas velocity, and distance moved did not significantly differ (p > 0.05) in exposed and control animals. These findings revealed that low concentrations of chemicals and their mixtures can modify the physiological state of aquatic animals without outward manifestations (activity, distance moved, and velocity). Aquatic animals can be impacted earlier than is visible, but effects can potentially lead to substantial changes in populations and in ecosystem processes. Additional research to investigate chemical combinations, exposure systems, and organism physiological and molecular responses may provide evidence of broad impact of environmental pharmaceuticals.

Occurrence and removal of 25 antibiotics during sewage treatment processes and potential risk analysis

The occurrence and removal of 25 antibiotics, including ten quinolones (QNs), four macrolides (MLs), four tetracyclines (TCs) and seven sulfonamides (SNs), were analysed at two sewage treatment plants (STPs) with different treatment units in Guangxi Province, China. The results showed that 14 and 16 antibiotics were detected in the influent of the two STPs, with concentrations ranging from 13.7-4265.2 ng/L and 14.5-10761.7 ng/L, respectively. Among the antibiotics, TCs were the main type in the study area, accounting for more than 79% of the total concentration of all antibiotics. The antibiotic removal efficiencies of the different process units ranged from -56.73% to 100.0%. It was found that the SN removal efficiency of the multistage composite mobile bed membrane bioreactor (MBBR) process was better than that of the continuous-flow Intermission biological reactor (IBR) process, while the IBR process was better than the MBBR process in terms of removing TCs and MLs; however, there was no obvious difference in the QN removal efficiencies of these two processes. Redundancy analysis (RDA) showed a strong correlation between antibiotic concentration and chemical oxygen demand (COD). Risk assessments indicated that algae, followed by invertebrates and fish, were the most sensitive aquatic organisms to the detected antibiotics.

Effect of Carbamazepine, Ibuprofen, Triclosan and Sulfamethoxazole on Anaerobic Bioreactor Performance: Combining Cell Damage, Ecotoxicity and Chemical Information

Pharmaceuticals and personal care products (PPCPs) are partially degraded in wastewater treatment plants (WWTPs), thereby leading to the formation of more toxic metabolites. Bacterial populations in bioreactors operated in WWTPs are sensitive to different toxics such as heavy metals and aromatic compounds, but there is still little information on the effect that pharmaceuticals exert on their metabolism, especially under anaerobic conditions. This work evaluated the effect of selected pharmaceuticals that remain in solution and attached to biosolids on the metabolism of anaerobic biomass. Batch reactors operated in parallel under the pressure of four individual and mixed PPCPs (carbamazepine, ibuprofen, triclosan and sulfametoxazole) allowed us to obtain relevant information on anaerobic digestion performance, toxicological effects and alterations to key enzymes involved in the biodegradation process. Cell viability was quantitatively evaluated using an automatic analysis of confocal microscopy images, and showed that triclosan and mixed pollutants caused higher toxicity and cell death than the other individual compounds. Both individual pollutants and their mixture had a considerable impact on the anaerobic digestion process, favoring carbon dioxide production, lowering organic matter removal and methane production, which also produced microbial stress and irreversible cell damage.

A Review of the Occurrence of Pharmaceutical Compounds as Emerging Contaminants in Treated Wastewater and Aquatic Environments

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In recent years, pharmaceutical compounds have emerged as potential contaminants in the aquatic matrices of the environment. High production, consumption, and limited removal through conventional treatment processes/wastewater treatment plants (WWTPs) are the major causes for the occurrence of pharmaceutical compounds in wastewater and aquatic environments worldwide. A number of studies report adverse health effects and risks to aquatic life and the ecosystem because of the presence of pharmaceutical compounds in the aquatic environment. This paper provides a state-of-the-art review of the occurrence of pharmaceutical compounds in treated wastewater from various WWTPs, surface water and groundwater bodies. Additionally, this review provides comprehensive information and pointers for research in wastewater treatment and waterbodies management.

Spatio-Temporal Distribution and Influencing Factors of Human and Veterinary Pharmaceuticals in the Tributary Surface Waters of the Han River Watershed, South Korea

Human and veterinary pharmaceuticals are being increasingly used for disease treatment; hence, their distribution and factors influencing them in the aquatic environment need to be investigated. This study observed the effect of human and animal populations, usage, purchasing criteria (prescription vs. non-prescription), and land use to identify the spatio-temporal distribution of eight pharmaceuticals at twenty-four sites of the tributaries of the Han River watershed. In rural areas, the mean concentration (detection frequency) of non-prescription pharmaceuticals (NPPs) was higher (lower) compared to that of prescription pharmaceuticals (PPs); in urban areas, a reverse trend was observed. Pharmaceutical concentrations in urban and rural areas were mainly affected by wastewater treatment plants (WWTPs) and non-point sources, respectively; concentrations were higher downstream (4.9 times) than upstream of the WWTPs. The concentration distribution (according to the target) was as follows: human–veterinary > human > veterinary. Correlation between total concentration and total usage of the pharmaceuticals was high, except for NPPs. Most livestock and land use (except cropland) were significantly positively correlated with pharmaceutical concentrations. Concentrations were mainly higher (1.5 times) during cold seasons than during warm seasons. The results of this study can assist policymakers in managing pharmaceutical pollutants while prioritizing emerging pollutants.

Industrialization as a source of heavy metals and antibiotics which can enhance the antibiotic resistance in wastewater, sewage sludge and river water

The spread of antibiotic resistance is closely related with selective pressure in the environment. Wastewater from industrialized regions is characterized by higher concentrations of these pollutants than sewage from less industrialized areas. The aim of this study was to compare the concentrations of contaminants such as antibiotics and heavy metals (HMs), and to evaluate their impact on the spread of genes encoding resistance to antimicrobial drugs in samples of wastewater, sewage sludge and river water in two regions with different levels of industrialization. The factors exerting selective pressure, which significantly contributed to the occurrence of the examined antibiotic resistance genes (ARGs), were identified. The concentrations of selected gene copy numbers conferring resistance to four groups of antibiotics as well as class 1 and 2 integron-integrase genes were determined in the analyzed samples. The concentrations of six HMs and antibiotics corresponding to genes mediated resistance from 3 classes were determined. Based on network analysis, only some of the analyzed antibiotics correlated with ARGs, while HM levels were correlated with ARG concentrations, which can confirm the important role of HMs in promoting drug resistance. The samples from a wastewater treatment plant (WWTP) located an industrialized region were characterized by higher HM contamination and a higher number of significant correlations between the analyzed variables than the samples collected from a WWTP located in a less industrialized region. These results indicated that treated wastewater released into the natural environment can pose a continuous threat to human health by transferring ARGs, antibiotics and HMs to the environment. These findings shed light on the impact of industrialization on antibiotic resistance dissemination.

Contribution of sewage to occurrence of phosphodiesterase-5 inhibitors in natural water

Phosphodiesterase-5 inhibitors (PDE-5i, such as Sildenafil, Tadalafil and Vardenafil, mainly prescribed to treat erectile dysfunction) and their generic drug equivalents have been widely marketed and consumed in Korea. From the concentrations detected in wastewater, we could deduce that relatively large amounts of PDE-5i were consumed without a legal prescription. Thus, PDE-5i’s presence in the environment via sewage is unavoidable, and their environmental fate within a sewage treatment plant (STP) should be evaluated. In this study, we investigated the occurrence of three PDE-5i analogs in the influent and effluent of two STPs and the receiving water bodies. The PDE-5i concentration in total reached 62 ± 12 (STP#1) and 88 ± 37 ng L⁻¹ (STP#2) in the sewage influent; about 70% of it was Sildenafil in both STPs. However, they were hardly removed by the STPs as the removal efficiency of the STPs was less than 10% ± 5%. Therefore, the pharmaceuticals were detected in the receiving water (lower than 7 ng L⁻¹as a total amount) and the concentration slightly increased downstream of the STPs. A simple mass balance model applied for the compounds in the STP effluent and receiving water bodies also confirmed that the discharged PDE-5i were quite persistent. Lastly, we identified temporal and regional patterns in the consumption of the drugs from daily variations of PDE-5i in the influent to these two STPs. For instance, the levels of PDE-5i in the sewage significantly increased on weekends (from Friday to Saturday), and especially in the area where adult-entertainment businesses are common. We estimated that the amount of PDE-5i consumption in this area was 31% higher than that in the area with fewer nightlife spots. Considering that they are pharmaceutically active and resistant to treatment processes within an STP, it is advised that a regular monitoring and management program for PDE-5i should be developed to prevent the discharge of the pharmaceuticals into the water environment.

Determination of pharmaceuticals in solid samples in municipal wastewater treatment plants by online SPE LC-MS/MS using QuEChERS extraction

In this study, a pretreatment method based on the QuEChERS method has been applied for simultaneously extracting 27 residual pharmaceuticals from wastewater solids. The extracted compounds have been analyzed using online solid-phase extraction (SPE) coupled to liquid chromatography with tandem mass spectrometry (LC-MS/MS). A recovery test was conducted according to the absorbent type, and buffers were added in the sample extraction step. The highest recovery efficiency could be observed when Na₂SO₄ was used as an absorbent and Na₂EDTA was injected during the extraction process; the recovery efficiencies of the proposed method for the target compounds ranged from 61.3 to 137.2%, and the repeatability was 6.8%. These recovery and repeatability data showed that the proposed method could reliably analyze the 27 target residual pharmaceuticals. The concentrations of the target compounds were all below the limits of quantification: 830 ng g^-1 for the target compounds in suspended solids, 2353 ng g^-1 in activated sludge, and 1929 ng g^-1 in waste sludge. The analytical method established in this study can be applied to quantify residual pharmaceuticals in solid samples and to investigate their behaviors in a municipal wastewater treatment plant.

Occurrence and Removal of Veterinary Antibiotics in Livestock Wastewater Treatment Plants, South Korea

In this study, livestock wastewater treatment plants in South Korea were monitored to determine the characteristics of influent and effluent wastewater, containing four types of veterinary antibiotics (sulfamethazine, sulfathiazole, chlortetracycline, oxytetracycline), and the removal efficiencies of different treatment processes. Chlortetracycline had the highest average influent concentration (483.7 μg/L), followed by sulfamethazine (251.2 μg/L), sulfathiazole (230.8 μg/L) and oxytetracycline (25.7 μg/L), at five livestock wastewater treatment plants. Sulfathiazole had the highest average effluent concentration (28.2 μg/L), followed by sulfamethazine (20.8 μg/L) and chlortetracycline (11.5 μg/L), while no oxytetracycline was detected. For veterinary antibiotics in the wastewater, a removal efficiency of at least 90% was observed with five types of treatment processes, including a bio-ceramic sequencing batch reactor, liquid-phase flotation, membrane bioreactor, bioreactor plus ultrafiltration (BIOSUF) and bio best bacillus systems. Moreover, this study evaluated the removal efficiency via laboratory-scale experiments on the conventional contaminants, such as organic matter, nitrogen, phosphorus and veterinary antibiotics. This was done using the hydraulic retention time (HRT), under three temporal conditions (14 h, 18 h, 27 h), using the anaerobic–anoxic–oxic (A2O) process, in an attempt to assess the combined livestock wastewater treatment process where the livestock wastewater is treated until certain levels of water quality are achieved, and then the effluent is discharged to nearby sewage treatment plants for further treatment. The removal efficiencies of veterinary antibiotics, especially oxytetracycline and chlortetracycline, were 86.5–88.8% and 87.9–90.8%, respectively, exhibiting no significant differences under various HRT conditions. The removal efficiency of sulfamethazine was at least 20% higher at HRT = 27 h than at HRT = 14 h, indicating that sulfamethazine was efficiently removed in the A2O process with increased HRT. This study is expected to promote a comprehensive understanding of the behavior and removal of veterinary antibiotics in the livestock wastewater treatment plants of South Korea.