Occurrence and toxicity impact of pharmaceuticals in hospital effluents: Simulation based on a case of study

Abstract

In the University Hospital of Albacete (Spain), the distribution of Active Pharmaceutical Ingredients (APIs) was studied to estimate the occurrence of the most prevalent analgesics and anti-inflammatories and antibiotics in patients’ urines. This estimation was based on the consumption amounts of APIs and their pharmacokinetic data. Results showed that metamizole would be the most prevalent drug among analgesics and anti-inflammatories with estimated concentrations ranging 100 – 1000 mg dm−3 in patients’ urines hospitalized in the surgical ICU, followed by around 10 mg dm−3 of acetylcysteine in surgical ICU and paracetamol in geriatrics. Likewise, estimated concentrations of 1–10 mg dm−3 were calculated for the 20 most representative antibiotics. Two β-lactam antibiotics (imipenem, meropenem) and one fluoroquinolone antibiotic (levofloxacin) would be present in patients’ urine from more than 3 surgical and medical areas. Additionally, the simulation of the toxicity impacts of active pharmaceutical ingredients (APIs) in hospital effluents was developed using the SimaPro 9.3.0.3 software and Ecoinvent 3.3 database since few studies were reported based on the real occurrence of drugs in urines. Ibuprofen was observed to have 2.4 times more ecotoxicity in freshwaters than paracetamol, although they did not show human toxicity related to carcinogenic effects. Amoxicillin presented a high potential ecological risk with a 3 kg equivalence of 1.4-DB per gram of drug. Overall, results demonstrate the importance to develop an adequate management and treatment of hospital effluents, including hospital urines, to reduce environmental and sanitary impacts.