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Low levels of human medicines (pharmaceuticals) have been detected in many countries in sewage treatment plant (STP) effluents, surface waters, seawaters, groundwater and some drinking waters. For some pharmaceuticals effects on aquatic organisms have been investigated in acute toxicity assays. The chronic toxicity and potential subtle effects are only marginally known, however. Here, we critically review the current knowledge about human pharmaceuticals in the environment and address several key questions. What kind of pharmaceuticals and what concentrations occur in the aquatic environment? What is the fate in surface water and in STP? What are the modes of action of these compounds in humans and are there similar targets in lower animals? What acute and chronic ecotoxicological effects may be elicited by pharmaceuticals and by mixtures? What are the effect concentrations and how do they relate to environmental levels? Our review shows that only very little is known about long-term effects of pharmaceuticals to aquatic organisms, in particular with respect to biological targets. For most human medicines analyzed, acute effects to aquatic organisms are unlikely, except for spills. For investigated pharmaceuticals chronic lowest observed effect concentrations (LOEC) in standard laboratory organisms are about two orders of magnitude higher than maximal concentrations in STP effluents. For diclofenac, the LOEC for fish toxicity was in the range of wastewater concentrations, whereas the LOEC of propranolol and fluoxetine for zooplankton and benthic organisms were near to maximal measured STP effluent concentrations. In surface water, concentrations are lower and so are the environmental risks. However, targeted ecotoxicological studies are lacking almost entirely and such investigations are needed focusing on subtle environmental effects. This will allow better and comprehensive risk assessments of pharmaceuticals in the future.
Two cosmetic ingredients (galaxolide, tonalide), eight pharmaceuticals (carbamazepine, diazepam, diclofenac, ibuprofen, naproxen, roxithromycin, sulfamethoxazole and iopromide) and three hormones (estrone, 17beta-estradiol and 17alpha-ethinylestradiol) have been surveyed along the different units of a municipal Sewage Treatment Plant (STP) in Galicia, NW Spain. Among all the substances considered, significant concentrations in the influent were only found for the two musks (galaxolide and tonalide), two anti-inflammatories (ibuprofen and naproxen), two natural estrogens (estrone, 17beta-estradiol), one antibiotic (sulfamethoxazole) and the X-ray contrast medium (iopromide), where the other compounds studied were below the limit of quantification. In the primary treatment, only the fragrances (30-50%) and 17beta-estradiol (20%) were partially removed. On the other hand, the aerobic treatment (activated sludges) caused an important reduction in all compounds detected, between 35% and 75%, with the exception of iopromide, which remained in the aqueous phase. The overall removal efficiencies within the STP ranged between 70-90% for the fragrances, 40-65% for the anti-inflammatories, around 65% for 17beta-estradiol and 60% for sulfamethoxazole. However, the concentration of estrone increased along the treatment due to the partial oxidation of 17beta-estradiol in the aeration tank.
This paper presents a comprehensive review of the current state of research activities on the application of constructed wetlands for removing pharmaceutical contaminants from wastewater. The focus of the review was placed on the application of constructed wetlands as an alternative secondary wastewater treatment system or as a wastewater polishing treatment system. The design parameters of the reported constructed wetlands including the physical configuration, hydraulic mode, vegetation species, and targeting pharmaceuticals were summarized. The removal efficiencies of pharmaceuticals under different conditions in the wetlands were evaluated at the macroscopic level. In addition, the importance of the three main components of constructed wetlands (substrate, plants and microbes) for pharmaceutical removal was analyzed to elucidate the possible removal mechanisms involved. There is a general consensus among many researchers that constructed wetlands hold great potential of being used as an alternative secondary wastewater treatment system or as a wastewater polishing treatment system for the removal of pharmaceuticals, but relevant reported studies are scarce and are not conclusive in their findings. Current knowledge is limited on the removal efficiencies of pharmaceuticals in constructed wetlands, the removal mechanisms involved, the toxicity to constructed wetlands caused by pharmaceuticals, and the influences of certain important parameters (configuration design, hydraulic mode, temperature and seasonality, pH, oxygen and redox potential, etc.). This review promotes further research on these issues to provide more and better convincing evidences for the function and performance of larger laboratory-scale, pilot-scale or full-scale constructed wetlands.
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