Pharmaceuticals in Wastewater Treatment Plants: A Systematic Review on the Substances of Greatest Concern Responsible for the Development of Antimicrobial Resistance

In recent years, there is a growing concern about the alarming spread of antimicrobial resistance (AMR) in different environments. Increasingly, many species bacteria, fungi and viruses are becoming immune to most commonly used pharmaceuticals. One causes development persistence these drugs, excreted by humans, municipal hospital wastewater (WW). Consequently, treatment plants (WWTPs) primary source genes as novel pollutants. This systematic review sought examine relevant literature on pharmaceutical residues (PRs) responsible for AMR WW order propose classification PRs greatest provide an updated management WWTPs. Among 546 studies collected from four databases, 18 were included present review. The internal external validity each study was assessed, risk bias evaluated 20-parameter basis. Results combined narrative synthesis discussing influent effluent PR concentrations at 88 WWTPs, seasonal variations, differences between WW, environmental assessment values substances facilities removal efficiencies. 45 this study, antibiotics ciprofloxacin, clarithromycin, erythromycin, metronidazole, ofloxacin, sulfamethoxazole trimethoprim constitute considerable terms ubiquitous distribution, worrying concentrations, quotient treatments. Gaps knowledge, data information reported will valuable managing