Substance Flows Associated with Medical Care – Significance of Different Sources

Removal of 28 human and veterinary antibiotics was assessed in a conventional (activated sludge) and advanced (microfiltration/reverse osmosis) wastewater treatment plant (WWTP) in Brisbane, Australia. The dominant antibiotics detected in wastewater influents were cephalexin (med. 4.6 microg L(-1), freq. 100%), ciprofloxacin (med. 3.8 microg L(-1), freq. 100%), cefaclor (med. 0.5 microg L(-1), freq. 100%), sulphamethoxazole (med. 0.36 microg L(-1), freq. 100%) and trimethoprim (med. 0.34 microg L(-1), freq. 100%). Results indicated that both treatment plants significantly reduced antibiotic concentrations with an average removal rate from the liquid phase of 92%. However, antibiotics were still detected in both effluents from the low-to-mid ng L(-1) range. Antibiotics detected in effluent from the activated sludge WWTP included ciprofloxacin (med. 0.6 microg L(-1), freq. 100%), sulphamethoxazole (med. 0.27 microg L(-1), freq. 100%) lincomycin (med. 0.05 microg L(-1), freq. 100%) and trimethoprim (med. 0.05 microg L(-1), freq. 100%). Antibiotics identified in microfiltration/reverse osmosis product water included naladixic acid (med. 0.045 microg L(-1), freq. 100%), enrofloxacin (med. 0.01 microg L(-1), freq. 100%), roxithromycin (med. 0.01 microg L(-1), freq. 100%), norfloxacin (med. 0.005 microg L(-1), freq. 100%), oleandomycin (med. 0.005 microg L(-1), freq. 100%), trimethoprim (med. 0.005 microg L(-1), freq. 100%), tylosin (med. 0.001 microg L(-1), freq. 100%), and lincomycin (med. 0.001 microg L(-1), freq. 66%). Certain traditional parameters, including nitrate concentration, conductivity and turbidity of the effluent were assessed as predictors of total antibiotic concentration, however only conductivity demonstrated any correlation with total antibiotic concentration (p=0.018, r=0.7). There is currently a lack of information concerning the effects of these chemicals to critically assess potential risks for environmental discharge and water recycling.

After administration, pharmaceuticals are excreted by the patients into wastewater. Unused medications are sometimes disposed of in drains. The drugs enter the aquatic environment and eventually reach drinking water if they are not biodegraded or eliminated during sewage treatment. Additionally, antibiotics and disinfectants are supposed to disturb the wastewater treatment process and the microbial ecology in surface waters. Furthermore, resistant bacteria may be selected in the aeration tanks of STPs by the antibiotic substances present. Recently, pharmaceuticals have been detected in surface water, ground water and drinking water. However, only little is known about the significance of emissions from households and hospitals. A brief summary of input by different sources, occurrence, and elimination of different pharmaceutical groups such as antibiotics, anti-tumour drugs, anaesthetics and contrast media as well as AOX resulting from hospital effluent input into sewage water and surface water will be presented.

A pilot plant for ozonation and UV-disinfection received effluent from a German municipal sewage treatment plant (STP) to test the removal of pharmaceuticals, iodinated X-ray contrast media (ICM) and musk fragrances from municipal wastewater. In the original STP effluent, 5 antibiotics (0.34-0.63 microgl(-1)), 5 betablockers (0.18-1.7 microgl(-1)), 4 antiphlogistics (0.10-1.3 microgl(-1)), 2 lipid regulator metabolites (0.12-0.13 microgl(-1)), the antiepileptic drug carbamazepine (2.1 microgl(-1)), 4 ICM (1.1-5.2 microgl(-1)), the natural estrogen estrone (0.015 microgl(-1)) and 2 musk fragrances (0.1-0.73 microgl(-1)) were detected by LC-electrospray tandem MS and/or GC/MS/MS. ICM, derived from radiological examinations, were present with the highest concentrations (diatrizoate: 5.7 microgl(-1), iopromide: 5.2 microgl(-1)). By applying 10-15 mgl(-1) ozone (contact time: 18 min), all the pharmaceuticals investigated as well as musk fragrances (HHCB, AHTN) and estrone were no longer detected. However, ICM (diatrizoate, iopamidol, iopromide and iomeprol) were still detected in appreciable concentrations. Even with a 15 mgl(-1) ozone dose, the ionic diatrizoate only exhibited removal efficiencies of not higher than 14%, while the non-ionic ICM were removed to a degree of higher than 80%. Advanced oxidation processes (O(3)/UV-low pressure mercury arc, O(3)/H(2)O(2)), which were non-optimized for wastewater treatment, did not lead significantly to a higher removal efficiency for the ICM than ozone alone.