Hygienic aspects of the problem of pharmaceutical pollution of the environment with wastewater of medical institutions

Introduction. Significant hygiene problems include pollution of the surface and groundwater with medicines and their derivatives, which enter the environment in the conditions of pharmaceutical production, when using medications in medical and veterinary practice, as well as improper disposal of unused or expired medications.

Objective. An assessment of the volumes and composition of discharge of medicines with wastewater of medical institutions from the standpoint of potential risk of environmental pollution.

Materials and methods. There was applied verified information on the use of medicines in the stationary departments of three large medical and preventive medical institutions of the city of Taganrog of the Rostov Region for the period of 2016–2021. When statistical processing the data, specialized software of our own design was used, as well as the professional package of statistical programs IBM SPSS Statistics («Statistical Package for Social Science») version 19.0.

Results. The results of the assessment of the volumes and structure of medicines and their derivatives that fall into the citywide sewer system indicate the potential risk of pharmaceutical pollution of the water of the Taganrog Gulf of the Azov Sea. Taking into account the results of the study, informative indicators of pharmaceutical water pollution in the conduct of socio-hygienic monitoring are the content of antibiotics (Ceftriaxone, Ciprofloxacin), of non-steroidal anti-inflammatory drugs (Metamizole Sodium, Ibuprofen) and of hormonal drugs (Prednisolone).

Limitations. The study is pilot in nature for determining priority indicators of pharmaceutical pollution of the aquatic environment.

Conclusions. There was confirmed the relevance of the quantitative determination of pharmaceutical pollution of water bodies in the conduct of socio-hygienic monitoring, including the study of antibiotic resistance of indicator microorganisms and the assessment of the effectiveness of the applied technologies on treatment sewage facilities.

Compliance with ethical standards. The study does not require the submission of a biomedical ethics committee opinion or other documents.

Contribution:
Marchenko B.I. – research concept and design, statistical processing, writing a text;
Deryabkina L.A. – material collection and processing, editing;
Nazaryants A.A. – material collection and processing, editing.
All authors are responsible for the integrity of all parts of the manuscript and approval of the manuscript final version.

Acknowledgement. The study had no sponsorship.

Conflict of interest. The authors declare no conflict of interest.

Received: June 16, 2024 / Accepted: December 3, 2024 / Published: March 31, 2025

1. Barenboim G.M., Chiganova M.A. Pollution of natural waters with pharmaceuticals [Zagryaznenie prirodnykh vod lekarstvami]. Moscow: Nauka; 2015. https://elibrary.ru/ucvzwi (in Russian)

2. Novikova Yu.A., Markova O.L., Fridman K.B. Main aspects of minimization of population health risks caused by pharmaceutical pollution of surface sources of drinking water supply. Gigiena i Sanitaria (Hygiene and Sanitation, Russian journal). 2018; 97(12): 1166–70. https://elibrary.ru/vqbsob (in Russian)

3. Rakhmanin Yu.A., Onishchenko G.G. Hygienic assessment of drinking water supply of the population of the Russian Federation: problems and the way their rational decision. Gigiena i Sanitaria (Hygiene and Sanitation, Russian journal). 2022; 101(10): 1158–66. https://doi.org/10.47470/0016-9900-2022-101-10-1158-1166 https://elibrary.ru/hkiarc (in Russian)

4. Savostikova O.N., Mamonov R.A., Turina I.A., Alekseeva A.V., Nikolaeva N.I. Xenobiotics and products of their transformation in wastewater (literature review). Gigiena i Sanitaria (Hygiene and Sanitation, Russian journal). 2021; 100(11): 1218–23. https://doi.org/10.47470/0016-9900-2021-100-11-1218-1223 https://elibrary.ru/fivvue (in Russian)

5. Makhmudova O.A., Khaziakhmetova V.N. The pharmaceutical environmental pollution problem: a literature review. Remedium. 2023; 27(1): 76–80. https://doi.org/10.32687/1561-5936-2023-27-1-76-80 https://elibrary.ru/nypglu (in Russian)

6. Kozlova M.A. Research of pharmaceutical pollution of waterbodies in wastewater discharge areas of cities andindustrial enterprises. Voda: khimiya i ekologiya. 2019; (3-6): 30–6. https://elibrary.ru/kahufv (in Russian)

7. Mezrin N., Abramova A., Diagelev M., Isakov V. Estimation of the specific pollutants in municipal wastewater. Vodosnabzhenie i sanitarnaya tekhnika. 2022; (7): 34–41. https://doi.org/10.35776/VST.2022.07.05 https://elibrary.ru/mzbrva (in Russian)

8. Gwenzi W., Selvasembian R., Offiong N.A.O., Mahmoud A.EL.D., Sanganyado E., Mal J. COVID-19 drugs in aquatic systems: a review. Environ. Chem. Lett. 2022; 20(2): 1275–94. https://doi.org/10.1007/s10311-021-01356-y

9. Zhuravlev P.V., Khutoryanina I.V., Marchenko B.I. The barrier role of sewage treatment plants in relation to sanitary-indicative and pathogenic bacteria, parasitic agents on the example of the southern zone of Russia. Gigiena i Sanitaria (Hygiene and Sanitation, Russian journal). 2021; 100(10): 1070–6. https://doi.org/10.47470/0016-9900-2021-100-10-1070-1076 https://elibrary.ru/rmypum (in Russian)

10. Zagaynova A.V., Zhuravlev P.V., Morozova M.A., Sedova D.A., Gritsyuk O.V., Pankova M.N., et al. Barrier role of wastewater treatment in wastewater disinfection with respect to E.coli, generalized and total coliform bacteria. Gigiena i Sanitaria (Hygiene and Sanitation, Russian journal). 2022; 101(5): 479–86. https://doi.org/10.47470/0016-9900-2022-101-5-479-486 https://elibrary.ru/nwxqec (in Russian)

11. Barenboim G.M., Kozlova M.A. Pollution of sources of drinking water supply of large cities with pharmaceuticals (the example of Moscow, Russia). Water Resources. 2018; 45(6): 941–52. https://doi.org/10.1134/S0097807818060039

12. Bouzas-Monroy A., Wilkinson J.L., Melling M., Boxall A.B.A. Assessment of the Potential Ecotoxicological Effects of Pharmaceuticals in the World’s Rivers. Environ. Toxicol. Chem. 2022; 41(8): 2008–20. https://doi.org/10.1002/etc.5355

13. Laws M., Shaaban A., Rahman K.M. Antibiotic resistance breakers: current approaches and future directions. FEMS Microbiol. Rev. 2019; 43(5): 490–516. https://doi.org/10.1093/femsre/fuz014

14. Azhogina T.N., Skugoreva S.G., Al-Rammahi A.A.K., Gnennaya N.V., Sazykina M.A., Sazykin I.S. Influence of pollutants on the spread of antibiotic resistance genes in the environment. Teoreticheskaya i prikladnaya ekologiya. 2020; (3): 6–14. https://doi.org/10.25750/1995-4301-2020-3-006-014 https://elibrary.ru/crcfgv (in Russian)

15. Christaki E., Marcou M., Tofarides A. Antimicrobial Resistance in Bacteria: Mechanisms, Evolution, and Persistence. J. Mol. Evol. 2020; 88(1): 26–40. https://doi.org/10.1007/s00239-019-09914-3

16. Zhuravlyov P.V., Panasovets O.P., Aleshnya V.V., Kazachok I.P., Chernogorova T.N., Derevyakina Ye.I. Antibiotic resistence of bacteria isolated from water of the open reservoirs. Zdorov’e naseleniya i sreda obitaniya – ZNiSO. 2015; (5): 24–6. https://elibrary.ru/uchpkp (in Russian)

17. Pay G.V., Rakitina D.V., Sukhina M.A., Yudin S.M., Makarov V.V., Maniya T.R., et al. Study of the relationship between antibiotic resistance markers and virulence markers in NDM-positive klebsiella pneumoniae strains circulating in various waters and human loci. Gigiena i Sanitaria (Hygiene and Sanitation, Russian journal). 2021; 100(12): 1366–71. https://doi.org/10.47470/0016-9900-2021-100-12-1366-1371 https://elibrary.ru/jtomnc (in Russian)

18. Pay G.V., Rakitina D.V., Pankova M.A., Fedets Z.E., Maniya T.R., Zagaynova A.V. Pathogenic potential of enterococcus isolated from healthy people and wastewater. Gigiena i Sanitaria (Hygiene and Sanitation, Russian journal). 2023; 102(12): 1272–80. https://doi.org/10.47470/0016-9900-2023-102-12-1272-1280 https://elibrary.ru/ksnjpx (in Russian)

19. Tyumina E.A., Ivshina I.B., Bazhutin G.A., Cartagena Gómez A.D.P. Nonsteroidal anti-inflammatory drugs as emerging contaminants. Microbiology. 2020; 89(2): 148–163. https://doi.org/10.1134/S0026261720020125 https://elibrary.ru/neiuab

20. Kołecka K., Gajewska M., Caban M. From the pills to environment – prediction and tracking of non-steroidal anti-inflammatory drug concentrations in wastewater. Sci. Total. Environ. 2022; 825(1): 153611. https://doi.org/10.1016/j.scitotenv.2022.153611

21. Rastogi A., Tiwari M.K., Ghangrekar M.M. A review on environmental occurrence, toxicity and microbial degradation of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs). J. Environ. Manage. 2021; 300(6): 113694. https://doi.org/10.1016/j.jenvman.2021.113694

22. Park M.J., Chae J.P., Woo D., Kim J.Y., Bae Y.C., Lee J.Y., et al. Ibuprofen-induced multiorgan malformation during embryogenesis in Xenopus laevis (FETAX). Biochem. Biophys. Res. Commun. 2024; 703: 149565. https://doi.org/10.1016/j.bbrc.2024.149565

23. Popova A.Yu., Kuzmin S.V., Gurvich V.B., Kozlovskikh D.N., Romanov S.V., Dikonskaya O.V., et al. Data-driven risk management for public health as supported by the experience of implementation for development concept of the social and hygienic monitoring framework in the Russian Federation up to 2030. Zdorov’e naseleniya i sreda obitaniya – ZNiSO. 2019; (9): 4–12. https://doi.org/10.35627/2219-5238/2019-318-9-4-12 https://elibrary.ru/tzkwsa (in Russian)

24. Popova A.Yu., Kuzmin S.V., Zaitseva N.V., May I.V. Priorities in scientific support provided for hygienic activities accomplished by a sanitary and epidemiologic service: how to face known threats and new chnallanges. Health Risk Analysis. 2021; (1): 4–14. https://doi.org/10.21668/health.risk/2021.1.01.eng https://elibrary.ru/xmvvjb

25. Rakhmanin Yu.A., Levanchuk A.V., Kopytenkova O.I. Improvement of the system of social and hygienic monitoring of territories of large cities. Gigiena i Sanitaria (Hygiene and Sanitation, Russian journal). 2017; 96(4): 298–301. https://elibrary.ru/ykuqgx (in Russian)

26. Kozlova M.A., Gal’vidis I.A., Burkin M.A. Features of pharmaceutical pollution of water bodies-sources of drinking water supply in Moscow (a case study for some antibiotics). Meteorologiya i gidrologiya. 2020; (8): 87–91. https://elibrary.ru/iqjwtd (in Russian)

27. Lykov I.N. Pharmaceutical environmental pollution. Problemy regional’noi ekologii. 2020; (3): 23–7. https://elibrary.ru/zfjjcd (in Russian)

28. Alsowaidi A.K.M., Karavaeva O.A., Guliy O.I. Methods and approaches for antibiotics deteсtion. Antibiotiki i khimioterapiya. 2022; 67(1-2): 53–61. https://doi.org/10.37489/0235-2990-2022-67-1-2-53-61 https://elibrary.ru/sekfzi (in Russian)

29. Song Z., Ma Y.L., Li C.E. The residual tetracycline in pharmaceutical wastewater was effectively removed by using MnO2/graphene nanocomposite. Sci. Total. Environ. 2019; 651(Pt. 1): 580–90. https://doi.org/10.1016/j.scitotenv.2018.09.240

30. Ribeiro A.R., Sures B., Schmidt T.C. Cephalosporin antibiotics in the aquatic environment: A critical review of occurrence, fate, ecotoxicity and removal technologies. Environ. Pollut. 2018; 241: 1153–66. https://doi.org/10.1016/j.envpol.2018.06.040

31. Gunnarsson L., Snape J.R., Verbruggen B., Owen S.F., Kristiansson E., Margiotta-Casaluci L., et al. Pharmacology beyond the patient – the environmental risks of human drugs. Environ. Int. 2019; 129: 320–32. https://doi.org/10.1016/j.envint.2019.04.075

32. Lykov I.N., Kusacheva S.A., Safronova M.E., Loginova A.Yu. Environmental pollution by pharmaceuticals. Ekologiya i promyshlennost’ Rossii. 2020; 24(8): 51–5. https://doi.org/10.18412/1816-0395-2020-8-51-55 https://elibrary.ru/feprtc (in Russian)

33. Zheng W., Wen X., Zhang B., Qiu Y. Selective effect and elimination of antibiotics in membrane bioreactor of urban wastewater treatment plant. Sci. Total Environ. 2019; 646: 1293–303. https://doi.org/10.1016/j.scitotenv.2018.07.400

34. Kozlova M.A. Pharmaceutical pollution of natural and waste waters: treatment methods and research results. Ekologicheskii vestnik Severnogo Kavkaza. 2020; 16(1): 77–80. https://elibrary.ru/azrnvn (in Russian)