Pharmaceutical pollution of the world's rivers

John L. Wilkinson*, Alistair B.A. Boxall, Dana W. Kolpin, Kenneth M.Y. Leung, Racliffe W.S. Lai, Cristobal Galban-Malag, Aiko D. Adell, Julie Mondon, Marc Metian, Robert A. Marchant, Alejandra Bouzas-Monroy, Aida Cuni-Sanchez, Anja Coors, Pedro Carriquiriborde, Macarena Rojo, Chris Gordon, Magdalena Cara, Monique Moermond, Thais Luarte, Vahagn PetrosyanYekaterina Perikhanyan, Clare S. Mahon, Christopher J. McGurk, Thilo Hofmann, Tapos Kormoker, Volga Iniguez, Jessica Guzman-Otazo, Jean L. Tavares, Francisco Gildasio de Figueiredo, Maria T.P. Razzolini, Victorien Dougnon, Gildas Gbaguidi, Oumar Traore, Jules M. Blais, Linda E. Kimpe, Michelle Wong, Donald Wong, Romaric Ntchantcho, Jaime Pizarro, Guang Guo Ying, Chang Er Chen, Martha Paez, Jina Martınez-Lara, Jean Paul Otamonga, John Pote, Suspense A. Ifo, Penelope Wilson, Silvia Echeverrıa-Saenz, Nikolina Udikovic-Kolic, Milena Milakovic, Despo Fatta-Kassinos, Lida Ioannou-Ttofa, Vladimıra Belusova, Jan Vymazal, Marıa Cardenas-Bustamante, Bayable A. Kassa, Jeanne Garric, Arnaud Chaumot, Peter Gibba, Ilia Kunchulia, Sven Seidensticker, Gerasimos Lyberatos, Halldor P. Halldorsson, Molly Melling, Thatikonda Shashidhar, Manisha Lamba, Anindrya Nastiti, Adee Supriatin, Nima Pourang, Ali Abedini, Omar Abdullah, Salem S. Gharbia, Francesco Pilla, Benny Chefetz, Tom Topaz, Koffi Marcellin Yao, Bakhyt Aubakirova, Raikhan Beisenova, Lydia Olaka, Jemimah K. Mulu, Peter Chatanga, Victor Ntuli, Nathaniel T. Blama, Sheck Sherif, Ahmad Zaharin Aris, Ley Juen Looi, Mahamoudane Niang, Seydou T. Traore, Rik Oldenkamp, Olatayo Ogunbanwo, Muhammad Ashfaq, Muhammad Iqbal, Ziad Abdeen, Aaron O'Dea, Jorge Manuel Morales-Saldaña, Marıa Custodio, Heidi de la Cruz, Ian Navarrete, Fabio Carvalho, Alhaji Brima Gogra, Bashiru M. Koroma, Vesna Cerkvenik-Flajs, Mitja Gombac, Melusi Thwala, Kyungho Choi, Habyeong Kang, John L. Celestino Ladu, Andreu Rico, Priyanie Amerasinghe, Anna Sobek, Gisela Horlitz, Armin K. Zenker, Alex C. King, Jheng Jie Jiang, Rebecca Kariuki, Madaka Tumbo, Ulas Tezel, Turgut T. Onay, Julius B. Lejju, Yuliya Vystavna, Yuriy Vergeles, Horacio Heinzen, Andres Perez-Parada, Douglas B. Sims, Maritza Figy, David Good, Charles Teta

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

451 Scopus citations


Environmental exposure to active pharmaceutical ingredients (APIs) can have negative effects on the health of ecosystems and humans. While numerous studies have monitored APIs in rivers, these employ different analytical methods, measure different APIs, and have ignored many of the countries of the world. This makes it difficult to quantify the scale of the problem from a global perspective. Furthermore, comparison of the existing data, generated for different studies/regions/continents, is challenging due to the vast differences between the analytical methodologies employed. Here, we present a global-scale study of API pollution in 258 of the world's rivers, representing the environmental influence of 471.4 million people across 137 geographic regions. Samples were obtained from 1,052 locations in 104 countries (representing all continents and 36 countries not previously studied for API contamination) and analyzed for 61 APIs. Highest cumulative API concentrations were observed in sub-Saharan Africa, south Asia, and South America. The most contaminated sites were in low- to middle-income countries and were associated with areas with poor wastewater and waste management infrastructure and pharmaceutical manufacturing. The most frequently detected APIs were carbamazepine, metformin, and caffeine (a compound also arising from lifestyle use), which were detected at over half of the sites monitored. Concentrations of at least one API at 25.7% of the sampling sites were greater than concentrations considered safe for aquatic organisms, or which are of concern in terms of selection for antimicrobial resistance. Therefore, pharmaceutical pollution poses a global threat to environmental and human health, as well as to delivery of the United Nations Sustainable Development Goals.

Original languageAmerican English
Article numbere2113947119
JournalProceedings of the National Academy of Sciences of the United States of America
Issue number8
StatePublished - 22 Feb 2022

Bibliographical note

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  • Antimicrobials
  • Aquatic contamination
  • Global pollution
  • Pharmaceuticals
  • Wastewater


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