Environmental impact assessment of pharmaceutical prescriptions: Does location matter?

• We present a method to compare environmental impacts of pharmaceutical prescriptions.
• Impacts on the aquatic environment and human are included in the method.
• Relative impacts of pharmaceutical prescriptions show spatial variation.
• Spatial variation in sewage sludge disposal mainly influences human health impacts.
• Spatial variation in sewage treatment techniques mainly influences aquatic impacts.

A methodology was developed for the assessment and comparison of the environmental impact of two alternative pharmaceutical prescriptions. This methodology provides physicians with the opportunity to include environmental considerations in their choice of prescription. A case study with the two antibiotics ciprofloxacin and levofloxacin at three locations throughout Europe showed that the preference for a pharmaceutical might show spatial variation, i.e. comparison of two pharmaceuticals might yield different results when prescribed at different locations. This holds when the comparison is based on both the impact on the aquatic environment and the impact on human health. The relative impacts of ciprofloxacin and levofloxacin on human health were largely determined by the local handling of secondary sludge, agricultural disposal practices, the extent of secondary sewage treatment, and local food consumption patterns. The relative impacts of ciprofloxacin and levofloxacin on the aquatic environment were mostly explained by the presence of specific sewage treatment techniques, as effluents from sewage treatment plants (STPs) are the most relevant emission pathway for the aquatic environment.