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Prioritization of Active Pharmaceutical Ingredients in Hospital Wastewater

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Hospital Wastewaters

Part of the book series: The Handbook of Environmental Chemistry ((HEC,volume 60))

Abstract

A large amount of residues from active pharmaceutical ingredients (API) that are currently in use are known to reach aquatic ecosystems and have potentially adverse effects on living organisms. Prioritization methods are useful tools for both regulation and surveillance purposes in the environmental policy of APIs. Their use has largely increased over the last decade, and the different existing methodologies can lead to large discrepancies between the highlighted substances. This chapter aims at discussing studies conducted in the context of hospitals. Perhaps more important than the results themselves, the methodologies with the set of selected criteria are discussed, as well as their advantages and associated uncertainties. A case study of API prioritization applied to a Swiss university hospital is presented with two different approaches: a ranking-based OPBT approach (Occurrence, Persistence, Bioaccumulation, and Toxicity) and an environmental risk assessment (ERA), with the calculation of risk quotient (RQ). The ERA results combined with those of other studies dealing with ERA-based API prioritization in hospitals highlighted several compounds presenting high risks for the aquatic ecosystems (RQ > 1): antibiotics (ciprofloxacin, amoxicillin, piperacillin, azithromycin), anti-inflammatory drugs (diclofenac, mesalazine), as well as the hormone estradiol and the antidiabetic metformin. Nevertheless, only the antibiotic ciprofloxacin was commonly determined as problematic. Finally, the most critical issues for API prioritization in hospitals were identified from the literature overview and the results of the presented case study: handling of the consumption data, involvement of expert judgment, uncertainties linked with the predicted environmental concentration (PEC) calculation, and quality of the hazard evaluation. Although prioritization procedures applied to hospitals can be burdensome to apply in practice and many associated uncertainties remain, they represent essential tools to establish lists of priority molecules to follow via monitoring programs and allow their theoretical risk assessment.

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Notes

  1. 1.

    http://www.janusinfo.se/Beslutsstod/Environment-and-Pharmaceuticals/Dokument/Classification/.

  2. 2.

    DDD “is the assumed average maintenance dose per day for a drug used for its main indication in adults. DDDs only give a rough estimate of consumption and not an exact picture of actual use” (Source: www.whocc.no).

  3. 3.

    Nonsteroidal anti-inflammatory drug.

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Acknowledgments

We would like to thank R. Aebersold, P. Bonnabry, P. Dayer, A. Perrier, and A. Samson from the Geneva University Hospitals (HUG), as well as M. Enggist and F. Pasquini from the Water Ecology Service of the Geneva State (SECOE) for their support in this project.

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Authors and Affiliations

  1. Pharmacy, Geneva University Hospitals (HUG), Geneva, Switzerland

    Silwan Daouk & Sandrine Fleury-Souverain

  2. Swiss Water Association (VSA), Water Quality Platform, EAWAG, Dübendorf, Switzerland

    Silwan Daouk

  3. Institute of Earth Surface Dynamics, University of Lausanne (UNIL), Lausanne, Switzerland

    Nathalie Chèvre

  4. Medical Direction, Geneva University Hospitals (HUG), Geneva, Switzerland

    Nathalie Vernaz

  5. Clinical Pharmacology and Toxicology, Geneva University Hospitals (HUG), Geneva, Switzerland

    Youssef Daali

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  1. Silwan Daouk
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  2. Nathalie Chèvre
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  3. Nathalie Vernaz
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  4. Youssef Daali
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  5. Sandrine Fleury-Souverain
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Correspondence to Silwan Daouk .

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  1. Department of Engineering, University of Ferrara , Ferrara, Italy

    Paola Verlicchi

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Daouk, S., Chèvre, N., Vernaz, N., Daali, Y., Fleury-Souverain, S. (2017). Prioritization of Active Pharmaceutical Ingredients in Hospital Wastewater. In: Verlicchi, P. (eds) Hospital Wastewaters. The Handbook of Environmental Chemistry, vol 60. Springer, Cham. https://doi.org/10.1007/698_2017_14

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