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Review
. 2014 Nov 19;369(1656):20130586.
doi: 10.1098/rstb.2013.0586.

Potential ecological footprints of active pharmaceutical ingredients: an examination of risk factors in low-, middle- and high-income countries

Rai S Kookana  1 , Mike Williams  2 , Alistair B A Boxall  3 , D G Joakim Larsson  4 , Sally Gaw  5 , Kyungho Choi  6 , Hiroshi Yamamoto  7 , Shashidhar Thatikonda  8 , Yong-Guan Zhu  9 , Pedro Carriquiriborde  10
Affiliations
Review

Potential ecological footprints of active pharmaceutical ingredients: an examination of risk factors in low-, middle- and high-income countries

Rai S Kookana et al. Philos Trans R Soc Lond B Biol Sci. .

Abstract

Active pharmaceutical ingredients (APIs) can enter the natural environment during manufacture, use and/or disposal, and consequently public concern about their potential adverse impacts in the environment is growing. Despite the bulk of the human population living in Asia and Africa (mostly in low- or middle-income countries), limited work relating to research, development and regulations on APIs in the environment have so far been conducted in these regions. Also, the API manufacturing sector is gradually shifting to countries with lower production costs. This paper focuses mainly on APIs for human consumption and highlights key differences between the low-, middle- and high-income countries, covering factors such as population and demographics, manufacture, prescriptions, treatment, disposal and reuse of waste and wastewater. The striking differences in populations (both human and animal), urbanization, sewer connectivity and other factors have revealed that the environmental compartments receiving the bulk of API residues differ markedly between low- and high-income countries. High sewer connectivity in developed countries allows capture and treatment of the waste stream (point-source). However, in many low- or middle-income countries, sewerage connectivity is generally low and in some areas waste is collected predominantly in septic systems. Consequently, the diffuse-source impact, such as on groundwater from leaking septic systems or on land due to disposal of raw sewage or septage, may be of greater concern. A screening level assessment of potential burdens of APIs in urban and rural environments of countries representing low- and middle-income as well as high-income has been made. Implications for ecological risks of APIs used by humans in lower income countries are discussed.

Keywords: antibiotics; developing countries; ecological risks; sewage; wastewater.

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Figures

Figure 1.
Figure 1.
The relative proportion and volumes of seven common NSAIDs in some Asian countries and Australia. Note: Each ring represents a logarithmic increase, with the innermost ring representing 0.1 tonnes and the outermost ring representing 1000 tonnes. (Adapted from McGettigan & Henry [36].)
Figure 2.
Figure 2.
Usage rates of carbamazepine and NSAIDs (total) in a number of Asian and Australasian countries. (No NSAID data are available for India, Japan and Korea.) Lower income countries are represented by Bangladesh to Vietnam and higher income countries by Australia and Taiwan (based on World Bank classification). (Adapted from Zhang & Geißen [47] and World Bank [48].)
Figure 3.
Figure 3.
A comparison of total populations of selected countries with those that are likely to contribute to point-source discharge of APIs through sewage treatment plants. The CPE is calculated as a multiple of total population × urbanization × sewer connectivity. Note: Some countries such as Indonesia and Vietnam rely on septic-tank systems rather than sewerage systems. For data sources, please refer to table 1. (Adapted from [36,47].)
Figure 4.
Figure 4.
Box plots of monitoring data of selected APIs in the receiving environments (surface water) in Asia in comparison with Europe and North America; panel (a) represents European region, panel (b) represents North America and panel (c) represents Asia. The horizontal line represents the median value, box represents the interquartile range, whiskers show the data range and asterisk the outlier. The values on x-axes represent the number of records used. (Adapted from Hughes et al. [20] with permission from the American Chemical Society 2013.)
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