Ranking prescribed pharmaceuticals in terms of environmental risk: Inclusion of hospital data and the importance of regular review

Abstract

A newly available dataset on pharmaceuticals used in Scottish hospitals enabled an environmental risk assessment that includes hospital consumption of pharmaceuticals, as previous United Kingdom rankings have been based on community prescriptions only. Although health and the environment are devolved issues for the Scottish government, it is merited to consider a Scottish ranking separately; regional differentiation is particularly relevant in the spatial context of the European Commission's Water Framework Directive. Nine pharmaceuticals are identified as having a risk quotient greater than 1. Four of these, the antibacterials piperacillin, tazobactam, flucloxacillin, and ciprofloxacin, had high hospital contributions and had not been highlighted previously in rankings based on community prescriptions. Some drugs with a risk quotient < 0.1 are used almost exclusively in hospitals and could be more concentrated near effluents carrying hospital wastewater, where they may be of local concern. Although treating hospital effluents separately is a policy option, specifically including hospital consumption is important. Continually increasing the availability of ecotoxicological data and trends in consumption further contributes to a substantially different prioritization than in previous rankings. This leads the authors to conclude that regular review of risk is necessary.

Comparison of Prioritisation Schemes for Human Pharmaceuticals in the Aquatic Environment

“…Of the compounds which were ranked in the top 10 across all schemes, metformin, amoxicillin, naproxen and ibuprofen have previously occurred on many priority lists (Burns et al 2018b). Gabapentin and flucloxacillin have only been listed of concern in one prioritisation exercise each (Helwig et al 2013; Ortiz de García et al 2013) and, as a result, monitoring studies including these compounds are much lower. PEC D results were less closely related with the amount of compound dispensed, as this was not included in the calculation.…”

“…A read-across approach can be used in assessing the potential risk of pharmaceuticals to invertebrates and algae. Fish share 86% of targets with humans, 61% have been found to be conserved in daphnia and 35% in algae (Gunnarsson et al 2008). There is particular concern surrounding the toxicity of antibiotics and statins to algae, in part due to conserved pathways, but also due to the inhibition of symbiotic bacteria (Guo et al 2015).…”

Spatially Explicit Large-Scale Environmental Risk Assessment of Pharmaceuticals in Surface Water in China

“…5), the top of the whisker shows the maximum RQ. Some are extremely high but will only likely occur with low probability when the excreted APIs are discharged with untreated wastewater to remarkably dry regions without surface water (DF = 1 54 AMI, DCF and IBPF were ranked top among a number of APIs (over 42 compounds)…”

Photocatalytic Degradation of Pharmaceuticals Using TiO₂ Based Nanocomposite Catalyst-Review

“…This is followed by private household consumption of pharmaceuticals. Human excreted residue (feces and urines) may then enter sewage treatment plants (STPs) either in their parent compound or metabolite (Helwig et al, 2016). Depending on the STPs and properties of pharmaceuticals, only parts of the PhACs are treated, whereas the remaining residues are introduced into the aquatic environment (Lee et al, 2017b), such as surface and ground water.…”