Professor Sharon Pfleger (NHS Highland and Robert Gordon University) spoke in The Pharmaceutical Journal podcast “Pandemic plus? The antibiotic resistance lurking in our rivers” with Professor Alistair Boxall (University of York) and Professor Jason Snape (Global Head of Environmental Protection, AstraZeneca) on the issue of pharmaceutical pollution and antimicrobial resistance (AMR) in the environment.
This podcast features a discussion around the environmental risk related to antibiotics in UK rivers, and their contribution to the development and spread of AMR. Antibiotics present in the environment contribute to the risk related to AMR – but knowledge gaps exist on what levels and mixtures of pharmaceuticals drive resistance selection, and cause other eco-toxic effects, in the environment. Researchers at the University of York and University of Exeter seek to fill these knowledge gaps and continue to investigate environmental concentrations and fate of antibiotics (and other pharmaceuticals), and the minimum selective concentrations where an antibiotic could enrich the growth or development of resistant bacterial communities in the environment.
Although there are knowledge gaps on the drivers of environmental AMR, there are known links between resistant bacteria and humans – including exposure in bathing spots, through agriculture/irrigation practices, and leaching to groundwaters.
It is evident that there are different perspectives from researchers and the pharmaceutical industry on the this issue. Professor Jason Snape calls for a move away from the discussion of antibiotic presence in the environment, to the discussion of consequence – which is likely to be most significant in situations with low dilution and high urbanisation and high population density.
However, with climate change impacting water supplies and river levels, low-level but continuous pollution may have a more widespread effect than previously thought. For example, in rural areas and popular tourist destinations which have limited infrastructure and less advanced wastewater treatment facilities to eliminate antibiotics and other micropollutants in wastewater. Monitoring presence and potential impact is key to understand the effects of pollution here.
To tackle this problem, Sharon discussed ongoing PhD research into “at-source” treatment solutions to reduce the number and concentration of pharmaceuticals in wastewater leaving hospitals (or other significant point-sources), and entering wastewater treatment plants. These pre-cautionary approaches are important steps to remove pharmaceuticals before they reach the environment – but preventative measures to reduce the problem “up-stream” may be the most effective and sustainable. Promoting medicine adherence, changing disposal practices, and education were highlighted as “up-stream” ways which can reduce this issue.
Despite knowledge gaps on the evidence of the scale of pharmaceutical pollution and it’s contribution to the development and spread of antimicrobial resistance in the environment – it is evident that the public health issue posed by AMR is an increasing global concern that can’t be ignored.
- AMR is a process where bacteria develop resistance to antibiotics.
- AMR can occur through people not completing a full course of antibiotics, and be spread through human contact.
- AMR can also occur in the environment (for example) through the presence of antibiotic compounds in wastewaters and surface waters, which increase the development and spread of antimicrobial resistance genes in bacterial communities (leading to AMR).
- AMR is impacting healthcare around the world. It is making infections harder to treat, resulting in routine procedures such as hip replacements and caesarean sections becoming more risky and harder to recover from.
- Without action, AMR could cause up to 10 million deaths a year by 2050.
Read more about AMR in our post: Antibiotics & You: OHBP work around antibiotics, AMR & World Antimicrobial Awareness Week 2021