Occurrence of antibacterials, antivirals, and anti-inflammatory pharmaceuticals for COVID-19 treatment as emerging contaminants in the Chinese freshwater environment before, during and after the pandemic: the need for dynamic eco-pharmacovigilance.

BACKGROUND

Global epidemic diseases such as COVID-19 have driven both the excessive use of pharmaceuticals and shifts in their usage spectrum. Consequently, the profile of pharmaceuticals in the environment (PiE) may undergo dynamic temporal changes, posing a significant challenge to eco-pharmacovigilance (EPV), a specialized branch of pharmacovigilance focused on detecting, evaluating, understanding, and preventing the adverse environmental effects of pharmaceuticals.

METHODS

Based on data extracted from 89 studies published between 2014 and 2025, this review conducts a focused comparison of the occurrence patterns of 43 selected typical anti-COVID-19 drugs (20 antibacterials, 11 antivirals, and 12 anti-inflammatory pharmaceuticals) as contaminants in distinct regions across China's seven major river basins before, during, and after the pandemic. The need of dynamic EPV was then analyzed.

RESULTS

Before the COVID-19 outbreak, erythromycin, ampicillin, roxithromycin, and acetaminophen dominated the PiE profile in terms of reported maximum residual concentrations; during the pandemic lockdown, ciprofloxacin, ofloxacin, azithromycin, and ketoprofen were identified as the top-priority anti-COVID-19 PiE; after the pandemic, azithromycin, norfloxacin, ofloxacin, ciprofloxacin, and roxithromycin remained the dominant PiE. Residual levels of individual PiE at the same location varied noticeably across the three periods.

CONCLUSIONS

Results revealed highly distinct regional and temporal variations in surface freshwater pollution by these COVID-19-associated PiE across the three periods, with no consistent regularity observed, thereby further highlighting the necessity of implementing EPV in a "dynamic" manner. Drawing on the framework of dynamic pharmacovigilance, the implementation of dynamic EPV can be promoted by establishing a dynamic watch-list mechanism, clarifying stakeholder roles, and advancing supportive policies and technological platforms, so as to enable adaptive interventions for the timely management of event-driven pharmaceutical pollution.