Predicted Environmental Risk Assessment of Antimicrobials with Increased Consumption in Portugal during the COVID-19 Pandemic; The Groundwork for the Forthcoming Water Quality Survey

Abstract

The environmental release of antimicrobial pharmaceuticals is an imminent threat due to ecological impacts and microbial resistance phenomena. The recent COVID-19 outbreak will likely lead to greater loads of antimicrobials in the environment. Thus, identifying the most used antimicrobials likely to pose environmental risks would be valuable. For that, the ambulatory and hospital consumption patterns of antimicrobials in Portugal during the COVID-19 pandemic (2020–2021) were compared with those of 2019. A predicted risk assessment screening approach based on exposure and hazard in the surface water was conducted, combining consumption, excretion rates, and ecotoxicological/microbiological endpoints in five different regions of Portugal. Among the 22 selected substances, only rifaximin and atovaquone demonstrated predicted potential ecotoxicological risks for aquatic organisms. Flucloxacillin, piperacillin, tazobactam, meropenem, ceftriaxone, fosfomycin, and metronidazole showed the most significant potential for antibiotic resistance in all analysed regions. Regarding the current screening approach and the lack of environmental data, it is advisable to consider rifaximin and atovaquone in subsequent water quality surveys. These results might support the forthcoming monitorisation of surface water quality in a post-pandemic survey.

Survey of Antifungal in Surface- and Groundwater: A Portuguese Environmental Case Study

“…Regarding the correlation between sale figures and environmental detection, it is justifiable to consider the compound use profile on the market [41]. Thus, the consumption of antifungals (2.4 tones, 2019 in Portugal) and the number of primer chemical groups used in human and animal clinics (polyenes, azoles, allylamines, pyrimidine analogues and echinocandins) are explicitly smaller compared with fungicides, showing a value of 2000 tones (2019 in Portugal), and a diversity of chemical groups from which outstand the amides, azoles, benzimidazoles, carbamates, morpholines and strobilurins [1,3,5,7].…”

Assessing the environmental impact of medicines in Italy using data from the Italian Medicines Agency

“…Also, the antiprotozoal atovaquone has been identified as posing a high environmental risk. While these latter two medicines have been identified as potential high-risk emerging contaminants on the basis of PNEC values obtained in experimental conditions, their effects on real aquatic ecosystems have not been thoroughly studied [35][36][37] .…”