Drugs, diagnostic agents and disinfectants in wastewater and water--a review.

After administration pharmaceuticals are excreted by the patients into the aquatic environment via wastewater. Unused medications are sometimes disposed of in drains. The drugs may enter the aquatic environment and eventually reach drinking water, if they are not biodegraded or eliminated during sewage treatment. Additionally, antibiotics and disinfectants are assumed to disturb the wastewater treatment process and the microbial ecology in surface waters. Furthermore, resistant bacteria may be selected in the aeration tanks of sewage treatment plants by the antibiotic substances present. Since the 1980s, data on the occurrence of pharmaceuticals in natural surface waters and the effluents of sewage treatment plants have been reported. More recently, pharmaceuticals have been detected in ground and drinking water. However, only little is known about the risk imposed on humans by pharmaceuticals and their metabolites in surface and drinking water. An overview of input, occurrence, elimination (e.g. biodegradability) and possible effects of different pharmaceutical groups such as anti-tumour drugs, antibiotics and contrast media as well as AOX resulting from hospitals effluent input into sewage water and surface water is presented.