Pharmaceutical effluent: a critical link in the interconnected ecosystem promoting antimicrobial resistance

Abstract

Antimicrobial resistance (AMR) is a complex global health issue and will push twenty-four million people into extreme poverty by 2030, risking the sustainable development goals (SDGs) 2, 3, 6, 9, 12, and 17 if not addressed immediately. Humans, animals, and the environment are the reservoirs that contribute and allow AMR to propagate in interconnected ecosystems. The emergence of antibiotic-resistant bacteria and antibiotic-resistant genes in the water environment has become an important environmental health issue. One of the major influencers from environment sector is the pharmaceutical industry which is growing globally to meet the ever-increasing demand of antibiotics, especially in low-and middle-income countries. The pharmaceutical effluent has a mix of large concentrations of antibiotics and antibiotic resistance genes, and these sites act as hotspots for environmental contamination and the spread of AMR. Inadequate treatment of the effluent and its irresponsible disposal leads to unprecedented antibiotic contamination in the environment and their persistent presence in the environment significantly modulates the bacterial genomes' expression that is responsible for increase and spread of AMR. However, not much interventions are suggested in the National Action Plan developed on AMR by many countries. There are no regulations across the globe till date for the level of antibiotic residues in pharmaceutical effluent for the growing pharmaceutical industry. This review put together the work done showing several detrimental effects of the antimicrobial residues in the pharmaceutical effluent which leads to rise in development of AMR. The environment risk approach and need to have indicators to measure environment risk is a way forward for all countries engage in antibiotic manufacturing. Overall, efforts to address the problem are isolated and fragmented. Policymakers, regulators, manufacturers, researchers, civil society, and the community need to collaborate so that antibiotics are produced sustainably and continue to stay effective in treating bacterial infections.

Antimicrobial Resistance Development Pathways in Surface Waters and Public Health Implications

“…Over the years, the increasing need for life-saving antibiotics has resulted in the large-scale use of varieties of pharmaceutically active compounds (PhACs) to produce drugs across the world. Consequently, the increase in antibiotic production has been accompanied by an increase in the number of pharmaceutical industry effluents, many of which are generated from both active pharmaceutical ingredient (API) manufacturing units and finished pharmaceutical products (FPP), which contain antibiotic residues in significant amounts [ 52 ]. Recent studies have identified pharmaceutical industry sites as the primary source of antibiotics and hotspots for the spread of AR in the environment and among humans and animals due to the presence of high concentrations of ARGs from pharmaceutical effluents [ 53 , 54 ].…”

A strategy design based on antibiotic‑resistance and plasmid replicons genes of clinical Escherichia coli strains

“…In 2016, the United Nations High-Level meeting had declared that progress toward achieving several of the Sustainable Development Goals (SDGs) is threatened by AMR [ 1 ]. In 2020, the World Health Organization (WHO) had announced the launch of 2 new AMR indicators in the monitoring framework of the SDGs linked to the health target 3, which monitor proportion of bloodstream infections (BSIs) due to 2 typical Super-bugs, Escherichia coli and Staphylococcus aureus [ 2 ]. Consequently, in this study, a strategy design based on multiplex amplification and further application for rapid detection on antimicrobial resistance and β-lactam resistance genes had been performed on a large scale of clinical Escherichia coli strains [ 3 ].…”

Europium Fluorescent Nanoparticles-Based Multiplex Lateral Flow Immunoassay for Simultaneous Detection of Three Antibiotic Families Residue

“…Unfortunately, the excessive and indiscriminate use of antibiotics in interconnected ecosystems around the world had led to a dramatic rise in drug resistance. This concern had been listed by the World Health Organisation as one of the top ten public health threats ( Anita et al, 2021 ). A number of veterinary antibiotics, including tetracyclines (TCs), fluoroquinolones (FQs) sulphonamides (SAs) and macrolides (MLs), were used to improve feed efficiency and promote growth rates.…”