Abstract
The occurrence of residual antifungal agents through indiscriminate prophylactic use and inappropriate disposal has been reported in wastewater treatment plants (WWTPs), surface water, and groundwater environments. Opportunistic pathogenic aquatic yeasts develop resistance to commonly used antifungal agents through continued exposure to residual antifungal agents in environmental waters. This poses a major public health concern. The present review attempts to provide a brief description of antifungal drugs, with a focus on the most widely used class of antifungal drugs, the azoles, as emerging contaminants in environmental water. Routes of exposure of azole antifungal drugs in wastewater treatment plants, surface water, and groundwater are discussed. The presence of pathogenic yeasts in environmental water, the associated azole resistance, and the risk of exposure to humans and microbiota are highlighted. Management actions needed to curtail the spread and minimise the risks are also indicated. Further research on the occurrence of antifungal agents in wastewater and environmental water is vital to better understand and mitigate the associated health-related risks.
Highlights
Environmental water pollution by pharmaceutical drugs from human activities is a matter of great concern [1]
Pharmaceutical drugs as emerging contaminants in environmental water pose a threat to the aforementioned Sustainable Development Goals (SDGs) target
Contrary to a report from the WHO information sheet [46], which stated that not more than 100 ng/L of pharmaceutical drugs have been detected from surface, ground, and partly treated water, this review shows detected concentrations above 100 ng/L for some antifungal agents, with levels up to 13,200 ng/L for fluconazole reported by Velpandian et al [29]. e abundance of fluconazole, in particular, can be explained by the fact that its underlying safety makes it the most extensively used antifungal agent [47]
Summary
Environmental water pollution by pharmaceutical drugs from human activities is a matter of great concern [1]. Residual drugs are frequently detected in environmental matrices and may present potential health risks in different water resources Pharmaceutical drugs such as antifungal agents, which are used to prevent or treat human and animal diseases as well as to improve livestock production [6] can reach environmental water bodies through wastewater treatment systems, industrial discharges, aquaculture practices, and agricultural and veterinary runoffs [7, 8] (Figure 1). E current review aims to address the presence of residual antimicrobial agents (especially azole antifungals) and the resulting formation of ARGs by microbes in wastewater treatment plants (WWTPs) and environmental waters (surface and groundwater), as well as the unavoidable development of AMR. Online search was conducted to consult documents from national and international organizations
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