Department of Environmental Chemistry, IDAEA-CSIC, Jordi Girona 18-26, 08034, Barcelona, Catalonia, Spain.
Centro de Investigação e Intervenção Social (CIS-IUL), Instituto Universitário de Lisboa (ISCTE-IUL), Lisbon, Portugal.
Environ Sci Pollut Res Int. 2018 Mar;25(7):6095-6106. doi: 10.1007/s11356-017-9755-1. Epub 2017 Jul 27.
One of the main pursuits, yet most difficult, in monitoring studies is to identify the sources of environmental pollution. In this study, we have identified health-care facilities from south European countries as an important source of pharmaceuticals in the environment. We have estimated that compounds consumed in by the elderly and released from effluents of senior residences can reach river waters at a concentration higher than 0.01 μg/L, which is the European Medicines Agency (EMA) threshold for risk evaluation of pharmaceuticals in surface waters. This study has been based on five health institutions in Portugal, Spain, and France, with 52 to 130 beds. We have compiled the pharmaceuticals dispensed on a daily base and calculated the consumption rates. From 54.9 to 1801 g of pharmaceuticals are consumed daily, with laxatives, analgesics, antiepileptics, antibiotics, and antidiabetic agents being the main drug families administered. According to excretion rates, dilution in the sewerage system, and elimination in wastewater treatment plants, macrogol, metformin, paracetamol, acetylcysteine, amoxicillin, and gabapentin, among others, are expected to reach river waters. Finally, we discuss the risk management actions related to the discharge of pharmaceuticals from senior residences to surface waters.
在监测研究中，一个主要的追求，也是最困难的，是确定环境污染的来源。在这项研究中，我们已经确定了来自南欧国家的医疗机构是环境中药物的一个重要来源。我们估计，老年人消耗的化合物和从养老院的污水中释放出来的化合物可以达到河水中的浓度高于 0.01μg/L，这是欧洲药品管理局（EMA）对地表水药物风险评估的阈值。这项研究基于葡萄牙、西班牙和法国的五家医疗机构，拥有 52 至 130 张病床。我们已经编制了每天发放的药物，并计算了消耗量。每天消耗的药物从 54.9 到 1801g 不等，主要的药物类别是泻药、镇痛药、抗癫痫药、抗生素和抗糖尿病药。根据排泄率、污水系统中的稀释以及废水处理厂的去除，预计包括聚乙二醇、二甲双胍、对乙酰氨基酚、乙酰半胱氨酸、阿莫西林和加巴喷丁在内的药物将进入河流。最后，我们讨论了与养老院向地表水排放药物有关的风险管理措施。
