Pharmaceutical pollution of the world’s rivers
Authors: Wilkinson John L. , Boxall Alistair B. A. , Kolpin Dana W. , Leung Kenneth M. Y. , Lai Racliffe W. S. , Galbán-Malagón Cristóbal , Adell Aiko D. , Mondon Julie , Metian Marc , Marchant Robert A. , Bouzas-Monroy Alejandra , Cuni-Sanchez Aida , Coors Anja , Carriquiriborde Pedro , Rojo Macarena , Gordon Chris , Cara Magdalena , Moermond Monique , Luarte Thais , Petrosyan Vahagn , Perikhanyan Yekaterina , Mahon Clare S. , McGurk Christopher J. , Hofmann Thilo , Kormoker Tapos , Iniguez Volga , Guzman-Otazo Jessica , Tavares Jean L. , Gildasio De Figueiredo Francisco , Razzolini Maria T. P. , Dougnon Victorien , Gbaguidi Gildas , Traoré Oumar , Blais Jules M. , Kimpe Linda E. , Wong Michelle , Wong Donald , Ntchantcho Romaric , Pizarro Jaime , Ying Guang-Guo , Chen Chang-Er , Páez Martha , Martínez-Lara Jina , Otamonga Jean-Paul , Poté John , Ifo Suspense A. , Wilson Penelope , Echeverría-Sáenz Silvia , Udikovic-Kolic Nikolina , Milakovic Milena , Fatta-Kassinos Despo , Ioannou-Ttofa Lida , Belušová Vladimíra , Vymazal Jan , Cárdenas-Bustamante María , Kassa Bayable A. , Garric Jeanne , Chaumot Arnaud , Gibba Peter , Kunchulia Ilia , Seidensticker Sven , Lyberatos Gerasimos , Halldórsson Halldór P. , Melling Molly , Shashidhar Thatikonda , Lamba Manisha , Nastiti Anindrya , Supriatin Adee , Pourang Nima , Abedini Ali , Abdullah Omar , Gharbia Salem S. , Pilla Francesco , Chefetz Benny , Topaz Tom , Yao Koffi Marcellin , Aubakirova Bakhyt , Beisenova Raikhan , Olaka Lydia , Mulu Jemimah K. , Chatanga Peter , Ntuli Victor , Blama Nathaniel T. , Sherif Sheck , Aris Ahmad Zaharin , Looi Ley Juen , Niang Mahamoudane , Traore Seydou T. , Oldenkamp Rik , Ogunbanwo Olatayo , Ashfaq Muhammad , Iqbal Muhammad , Abdeen Ziad , O’Dea Aaron , Morales-Saldaña Jorge Manuel , Custodio María , de la Cruz Heidi , Navarrete Ian , Carvalho Fabio , Gogra Alhaji Brima , Koroma Bashiru M. , Cerkvenik-Flajs Vesna , Gombač Mitja , Thwala Melusi , Choi Kyungho , Kang Habyeong , Ladu John L. Celestino , Rico Andreu , Amerasinghe Priyanie , Sobek Anna , Horlitz Gisela , Zenker Armin K. , King Alex C. , Jiang Jheng-Jie , Kariuki Rebecca , Tumbo Madaka , Tezel Ulas , Onay Turgut T. , Lejju Julius B. , Vystavna Yuliya , Vergeles Yuriy , Heinzen Horacio , Pérez-Parada Andrés , Sims Douglas B. , Figy Maritza , Good David , Teta Charles 
Published: February 2022

Environmental exposure to active pharmaceutical ingredients (APIs) can have negative effects on the health of ecosystems and humans. While numerous studies have monitored APIs in rivers, these employ different analytical methods, measure different APIs, and have ignored many of the countries of the world. This makes it difficult to quantify the scale of the problem from a global perspective. Furthermore, comparison of the existing data, generated for different studies/regions/continents, is challenging due to the vast differences between the analytical methodologies employed. Here, we present a global-scale study of API pollution in 258 of the world’s rivers, representing the environmental influence of 471.4 million people across 137 geographic regions. Samples were obtained from 1,052 locations in 104 countries (representing all continents and 36 countries not previously studied for API contamination) and analyzed for 61 APIs. Highest cumulative API concentrations were observed in sub-Saharan Africa, south Asia, and South America. The most contaminated sites were in low- to middle-income countries and were associated with areas with poor wastewater and waste management infrastructure and pharmaceutical manufacturing. The most frequently detected APIs were carbamazepine, metformin, and caffeine (a compound also arising from lifestyle use), which were detected at over half of the sites monitored. Concentrations of at least one API at 25.7% of the sampling sites were greater than concentrations considered safe for aquatic organisms, or which are of concern in terms of selection for antimicrobial resistance. Therefore, pharmaceutical pollution poses a global threat to environmental and human health, as well as to delivery of the United Nations Sustainable Development Goals.