## 4 Discussion
### Concentrations of Pharmaceuticals in Influents and Effluents Wastewater
Moreover, degradation products resulting from the breakdown of PRs or conjugated forms, such as the N4-acetylsulfamethoxazole for the sulfamethoxazole, might transform back into the parent compounds under biological activity that occurs during the activated sludge process [15; 36; 39]. To conclude, it may be stated that the ubiquitous and constant presence of ciprofloxacin, clarithromycin, erythromycinycin, sulfamethoxazole, trimethoprim, metronidazoleazole and ofloxacin requires the utmost attention. Indeed, although the first five compounds have already been included in the watch list, specific attention must be given to the other two compounds detected at worrying concentrations. \begin{table}
\begin{tabular}{l l l l l l} \hline \hline \multirow{3}{*}{**Class**} & \multirow{3}{*}{**Pharmaceutical**} & \multicolumn{2}{l}{**No. of Studies in**} & \multirow{3}{*}{**Max. Average Conc.**} & \multirow{3}{*}{**Min. Average Conc.**} & \multirow{3}{*}{**Mean across**} \\  & & **Which the PR** & & **(ng/L) Detected** & & **(ng/L) Detected** \\  & & **(\% of the Total)** & & **in Effluents** & **in Effluents** * & \\ \hline Quinolones & Ciprofloxacinacin & 15 (83.3) & 24,000 [11], H & 0.6 [17] & 1137 \\  & Flumequine & 3 (16.7) & 63 [12] & 3.0 [35], H & 28 \\  & Lomefloxacin & 2 (11.1) & 4.6 [17] & 0.3 [17] & 1.6 \\  & Marbofloxacin & 1 (5.6) & \textless{LOD} [35] & \textless{LOD} & \textless{LOD} \\  & Nalidixic Acid & 2 (11.1) & 50 [10] & 7.8 [49] & 24 \\  & Norfloxacin & 8 (44.4) & 2900 [15] & 0.5 [39] & 221 \\  & Ofloxacin & 12 (66.7) & 200,000 [11], H ** & 2.7 [17] & 7405 \\  & Oxolinite Acid & 3 (16.7) & 60 [12] & 4.6 [12] & 19 \\  & Sparfloxacin & 1 (5.6) & \textless{LOD} [6] & \textless{LOD} [6] & \textless{LOD} \\  & Sulfamerazine & 1 (5.6) & 28 [17] & 0.3 [17] & 8.0 \\ \hline Rifamycins & Rifampicin & 1 (5.6) & 2.9 [13] & 2.9 [13] & 2.9 \\  & Rifaximin & 2 (11.1) & 12 [12] & 3.8 [12] & 7.0 \\ \hline Sulfonamides & Sulfadiazine & 8 (44.4) & 373 [48], H & 0.8 [17] & 53 \\  & Sulfadimidine & 2 (11.1) & 106 [12] & 3 [12] & 54 \\  & Sulfadoxine & 1 (5.6) & \textless{LOD} [35] & \textless{LOD} & \textless{LOD} \\  & Sulfamethhazine & 4 (22.2) & 21 [17] & 0.8 [17] & 7.0 \\  & Sulfamethizole & 2 (11.1) & 19 [17] & 0.04 [23] & 3.6 \\  & Sulfamethoxazole & 16 (88.9) & 21,400 [15] & 1.0 [35], H & 1217 \\  & Sulfamoxole & 1 (5.6) & \textless{LOD} [35] & \textless{LOD} & \textless{LOD} \\  & Sulfathiazole & 1 (5.6) & 138 [17] & 0.9 [17] & 21 \\  & Sulfisoxazole & 1 (5.6) & 20 [17] & 1.6 [17] & 8.1 \\ \hline Tetracyclines & Chlortetracycline & 2 (11.1) & 12 [48], H & 0.5 [17] & 4.0 \\  & Doxycycline & 3 (16.7) & 1500 [15] & 0.4 [17] & 191 \\  & Minocycline & 1 (5.6) & 210 [12] & 21 [12] & 116 \\  & Oxytetracycline & 5 (27.8) & 416 [17] & 0.1 [13] & 65 \\  & Tetracycline & 6 (33.3) & 231 [10] & 0.6 [17] & 41 \\ \hline Thioamides & Ethionamide & 1 (5.6) & 9.3 [39] & 0.2 [39] & 4.8 \\ \hline \hline \end{tabular}  
* LOQ values were not considered; H, Hospital; ** the effluent WW of this facility undergoes treatment in a municipal biological WWTP, of which data were not available [11]. The second-highest concentration of ofloxacin in effluent WW was 3051 ng/L [12].  
\end{table} 
Table 5: _Cont._