Quantifying community-wide antimicrobials usage via wastewater-based epidemiology

Area of Science:

• Environmental Science
• Public Health
• Pharmacology

Background:

• Antimicrobial resistance (AMR) is a growing public health threat driven by increased antimicrobial use.
• Wastewater-based epidemiology (WBE) offers a method to monitor public health by analyzing chemical and biological markers in wastewater.
• Antibiotics in wastewater can serve as indicators of community drug consumption patterns.

Purpose of the Study:

• To evaluate the accuracy of estimating community-wide drug intake using wastewater analysis.
• To determine correction factors (CFs) for human drug excretion based on pharmacokinetic data.
• To assess the stability of various antimicrobials and their metabolites in wastewater.

Main Methods:

• A systematic literature review was conducted to determine pharmacokinetic correction factors for drug excretion.
• The stability of sixteen antimicrobials and their metabolites was assessed over a 24-hour period.
• Community drug intake estimations from wastewater data were compared with prescription records.

Main Results:

• Antimicrobials excreted unchanged in wastewater often led to overestimations of daily intake, potentially due to drug metabolism or disposal of unused medication.
• Acetyl-sulfonamides, trimethoprim, hydroxy-metronidazole, clarithromycin, ciprofloxacin, ofloxacin, tetracycline, and oxytetracycline demonstrated reliable estimation of drug intake compared to prescription data.
• Low prevalence of quinolone and trimethoprim metabolites, and poor nitrofurantoin stability, hindered the evaluation of these specific compounds and their CFs.

Conclusions:

• WBE is a valuable tool for estimating community drug intake, but requires careful consideration of drug excretion forms and stability.
• Correction factors derived from pharmacokinetic data are crucial for accurate WBE interpretation.
• Further research is needed to address limitations in analyzing certain antimicrobial metabolites and compounds with low stability.