For the first time, a global sampling and research of the content of rivers were carried out to analyse the presence of active pharmaceutical ingredients in rivers worldwide.

What are active pharmaceutical ingredients (APIs) and how did they end up in the environment?

Active pharmaceutical ingredients are the active components in both prescription and non-prescription drugs. Due to the overconsumption of drugs for various symptoms and diseases, often unjustified, river and wastewater pollution rates have risen, as well as antimicrobial resistance. In addition, pharmaceutical waste reaches the environment during production and disposal, especially in regions where production is high but environmental awareness is low. Luckily, there are various scientists and organizations that devote their time to this public health threat.

Recent research

A group of international scientists published a report on the pharmaceutical pollution of rivers in 2022. The study was conducted on a global scale and was the only one in which the samples were analysed equally in the same laboratory. Previous studies mainly focused on Western European and North American regions and used different analytical methods.

This report’s sampling was conducted in 1052 places, from 258 global rivers spreading through 104 countries. The report covered the pharmaceutical waste of 471,4 million people and analysed 61 active ingredients.

Who is the main polluter?

The samples were taken from 24 African and 24 Asian countries, 37 European countries, 6 North American countries, 9 South American countries, 3 Oceanian countries, and Antarctica. The report covered high and low-population areas, inaccessible territories due to physical barriers, and even a part of the Amazon River inhabited by communities that don’t rely on modern medicine.

The highest mean cumulative concentration was found in Lahore, Pakistan at 70,8 mg of active pharmaceutical ingredients per litre of water (mg/L), with one site reaching a concentration of 189 mg/L. The following location is La Paz, Bolivia with a mean cumulative concentration of 68,9 mg/L and a maximum on-site concentration of 297 mg/L. High concentrations of pollutants are associated with sewage discharge and garbage disposal on the river shores. Other highly polluted areas were in Africa and Asia, while the most polluted place in Europe was Madrid with 17,1 mg/L of active pharmaceutical ingredients.

A correlation was observed between water pollution and country development. The highest pollution was found in low to medium-developed countries due to the lack of sophisticated sewage infrastructure despite their ability to provide necessary drugs.

Which APIs were found?

Caffeine, nicotine, paracetamol, and cotinine were detected in every location, including Antarctica. 14 APIs were found in every continent except for Antarctica: atenolol (β-blocker), carbamazepine (antiepileptic), cetirizine (antihistamine), citalopram (antidepressant), desvenlafaxine (antidepressant), fexofenadine (antihistamine), gabapentin (anticonvulsant), lidocaine (anesthetic), metformin (antihyperglycemic), naproxen (anti-inflammatory), sitagliptin (antihyperglycemic), temazepam (benzodiazepine for insomnia treatment), trimethoprim (antimicrobial), and venlafaxine (antidepressant).

The APIs with the highest concentrations were paracetamol, caffeine, metformin, fexofenadine, sulfamethoxazole, metronidazole, and gabapentin. These APIs correspond to the list of the most prescribed drugs for the year 2022.

What about bacteria?

Antimicrobial resistance is the logical course of events for the bacteria – after repeated exposure to a drug, bacteria evolve and develop a survival mechanism. The presence of pharmaceutical waste is a factor that contributes to antimicrobial resistance. This is an important issue since the golden age of antibiotics has passed, without any major development of new antibiotics, and with a growing list of superbugs.

Translated by: Lara Mužević

Literature

https://www.pharmaceutical-technology.com/features/antimicrobial-resistance-superbugs/?cf-view&cf-closed pristupljeno: 15. prosinca 2023.

https://www.singlecare.com/blog/most-prescribed-drugs-2022/ pristupljeno 16. prosinca 2023.

Wlikinson et al. Pharmaceutical pollution of the world’s rivers, 2022, 119

Salam MA et al. Antimicrobial Resistance: A Growing Serious Threat for Global Pulic Health. Healthcare, 2023, 11, 1946.

Photography source

Image by PublicDomainPictures from Pixabay