Antibiotic residues in water a threat to human health

Antibiotic residues in wastewater and wastewater treatment plants in the regions around China and India risk contributing to antibiotic resistance, and the drinking water may threaten human health

Antibiotic residues in wastewater and wastewater treatment plants in the regions around China and India risk contributing to antibiotic resistance, and the drinking water may threaten human health, according to a comprehensive analysis from Karolinska Institutet published in The Lancet Planetary Health. The researchers also determined the relative contribution of various sources of antibiotic contamination in waterways, such as hospitals, municipals, livestock, and pharmaceutical manufacturing.

”Our results can help decision-makers to target risk reduction measures against environmental residues of priority antibiotics and in high-risk sites to protect human health and the environment,” says Nada Hanna, a researcher at the Department of Global Public Health at Karolinska Institutet in Sweden. “Allocating these resources efficiently is especially vital for resource-poor countries that produce large amounts of antibiotics.”

Bacteria resistant to antibiotics are a global threat that can lead to untreatable bacterial infections in animals and humans.

Antibiotics can enter the environment during their production, consumption and disposal. Antibiotic residues in the environment can contribute to the emergence and spread of resistance.

Among the largest producers of antibiotics

The researchers have examined the levels of antibiotic residues likely to contribute to antibiotic resistance from different aquatic sources. Their research focused on the Western Pacific Region (WPR) and the South-East Asia Region (SEAR). Both of these regions are defined by the World Health Organization. These regions include China and India, which are among the world’s largest producers and consumers of antibiotics.

This was done by a systematic review of the literature published between 2006 and 2019. The review included 218 relevant reports from the WPR and 22 from the SEAR. The researchers also used Probabilistic Environmental Hazard Assessment to determine where the concentration of antibiotics is high enough to contribute to antibiotic resistance likely.

Ninety-two antibiotics were detected in the WPR and forty-five in the SEAR. Antibiotic concentrations exceeding the level considered safe for resistance development were observed in wastewater, influents and effluents of wastewater treatment plants. They were also observed in receiving aquatic environments. The highest risk was observed in wastewater and influent of wastewater treatment plants. The relative impact of various contributors, such as hospital, municipal, livestock, and pharmaceutical manufacturing, was also determined.

The potential threat to human health

In receiving aquatic environments, the highest likelihood of levels exceeding the threshold considered safe for resistance development was observed for the antibiotic ciprofloxacin in drinking water in China and the WPR.

”Antibiotic residues in wastewater and wastewater treatment plants may serve as hot spots for developing antibiotic resistance. They pose a potential threat to human health through exposure to different sources of water, including drinking water,” said Nada Hanna.

One limitations to be considered is the need for more data on the environmental occurrence of antibiotics from the regions. An additional limitation is the fact that only studies written in English were included.

The Swedish Research Council has funded the research. The researchers declare no competing interests.

Publication: Antibiotic concentrations and antibiotic resistance in aquatic environments of the Western Pacific and South-East Asia Regions: a systematic review and probabilistic environmental hazard assessment”, Nada Hanna, Ashok J. Tamhankar and Cecilia Stålsby Lundborg. The Lancet Planetary Health, online January 4, 2023.

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