Public Health Care Management of Water Pollution with Pharmaceuticals: Environmental Classification and Analysis of Phar
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Public Health Care Management of Water Pollution with Pharmaceuticals: Environmental Classification and Analysis of Pharmaceutical Residues in Sewage Water
Ake Wennmolm, MD, PLD Environmental Director at Stockholm County Council, Stockholm, Sweden l o Gunnarsson, Or Med Sc Environmental Manager at Apoteket AB, Stockholm. Sweden
Key Words Environment; Pharmaceuticals; Biodegradation; Classification; Public health Correspondence Address Prof. Ake Wennmalm, PO Box 22550, s-104 22 Stockholm. Sweden (e-mail: [email protected]).
Ihe occurrence of pharmaceuticals in surface water is an mqhg p d m in dcvdoped counirics. If mdr polhdim is imnsjhd to drinking watw the d t i a g invosmtay aorr* dosc mcdiccIfion of large ppukiim pwps may cmpmnise public heuhh. k aquatic life mcly be compromised. 3he stodrhdm County Cosmcil, the provider of p&ic hcalthcme in the Stodahdm, Sweden ngion, has intrOmtceda dassijicatimof pkmmacattid d n r g s accodiw to thcirpotmtialfaraccumulation in surfhcc water and interfcr#rct with aquatic life. Thedassificationutilizes pmduce~ supplied data on bidegmdation, bi-htion, and eco-taricity. nte purpose ofthe cla98ificat’on is to inmuse the awarcn~ssof patients, doctors, and producers that pharmaceuticals
I NTR 0 D U CTI 0 N The consumption of pharmaceuticals is increasing worldwide, due both to continued population growth and increased consumption of pharmaceuticals per capita (1).Since consumed pharmaceuticals are, to a considerable fraction, excreted via the urine-as intact bioactive chemicals or as metabolite(s)-there is a large flux of their excretion products into the sewage treatment plants (2). In addition, unused pharmaceutical products may be discarded in toilets, thereby enhancing this flux. The ability of the sewage treatment plants to eliminate drugs and their metabolites from the sewage varies with respect to the chemical character of the pharmaceutical product, and the number and types of processes occurring in the plant. The efflux of pharmaceuticals from sewage treatment plants may result in chemical pollution of surface and ground water, and even tap
effeds outside the patient. Hence, doctors mrd patients may make a mure mUtti--fddids$cction of drug in cases where d thmp&i+equivdent alternatives may have side
tuvawihdk Ihc pRgmna will be evailfated by a n d ofphmmacarticals in regional surface lvater and sewage treatment plant t$hents. In thefirst dassijkution, I2 of22 antibioticsand virus inhibitom w m Considered to pose little
ris&toputrlich&viamrfacewateracmulation ar to aqclatic ife. Detectable lev& of qI&&”S,d w - e , trimethcpim, and rt~&~~idazdc m f i m n d in all sewer treatment plant effluentsinvestigated. In the surfacewater samples phannacattid m*dueswere observed ~occasiondy.
water, as observed in studies in Europe (3,4)and North America (5). The reported pollution of tap water is usually in the nanogramhtre or low microgram/litre range, implying that immediate pharmacological effects in the exposed population should hardly be expected. Nevertheless, the p
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