Spatially explicit prioritization of human antibiotics and antineoplastics in Europe

This paper presents a screening tool for the location-specific prioritization of human pharmaceutical emissions in Europe, based on risk quotients for the aquatic environment and human health. The tool provides direction towards either monitoring activities or additional research. Its application is illustrated for a set of 11 human antibiotics and 7 antineoplastics. Risk quotients for the aquatic environment were highest for levofloxacin, doxycycline and ciprofloxacin, located in Northern Italy (Milan region; particularly levofloxacin) and other densely populated areas in Europe (e.g. London, Krakow and the Ruhr area). Risk quotients for human health not only depend on pharmaceutical and location, but also on behavioral characteristics, such as consumption patterns. Infants in eastern Spain that consume locally produced food and conventionally treated drinking water were predicted to run the highest risks. A limited comparison with measured concentrations in surface water showed that predicted and measured concentrations are approximately within one order of magnitude.

► We present a spatially explicit environmental prioritization tool for human antibiotics and antineoplastics in Europe. ► Summed risk quotients for aquatic ecosystems were highest in northern Italy, mainly caused by the antibiotic levofloxacin. ► Summed human risk quotients were highest for infants in eastern Spain due to exposure to antibiotics, mainly ciprofloxacin. ► Implementation of the tool primarily guides future monitoring and identifies important gaps of knowledge.