Occurrence and Risk Assessment of Pharmaceuticals in Surface Waters of the Middle East and North Africa

Abstract

Pharmaceuticals are classified as contaminants of emerging concern due to their occurrence and persistence in aquatic environment. However, scarce information is currently available about the long term-impacts and the associated environmental and human health risk of a large number of pharmaceuticals. In an attempt to address this issue, this study reviewed all openly published research conducted on the occurrence of pharmaceuticals in different water compartments from 2006 to 2022, with a primary focus on the MENA region. The review systematically identified, quantified, and categorized pharmaceutical compounds present in MENA water compartments, detailing their names, numbers, concentrations, and therapeutic groups.

In fact, 159 pharmaceutically active ingredients were detected in at least one of 14 MENA countries, with antibiotics being the most frequently detected therapeutic class (0.1–99,636 ng/L). To better understand the impact of this occurrence, an ecological, human health and antimicrobial risk assessment using minimum, median and maximum measured concentrations. 39 detected pharmaceuticals in MENA surface waters posed a possible ecological risk whereas a possible human health risk was registered for 8 out of 159 detected pharmaceuticals. 17β estradiol, diclofenac, metoprolol, ethinylestradiol, and carbamazepine calculated an alarming environmental risk (>1000), the magnitude of which will definitely needs further investigations and regulatory actions. Of all therapeutic classes, hormones registered the highest health risk quotient via both pathways: drinking water and fish ingestion. Moreover, among the antibiotics detected, ciprofloxacin and norfloxacin showed the highest antimicrobial resistance risk in the order of 40. Based on this data compilation, the highest frequently detected pharmaceuticals were to be selected for fate modeling in one of the most polluted MENA rivers using available software. This modeling effort aimed to assess the impact of pharmaceutical contamination in regions lacking expertise and economic resources. However, due to the insufficient geo-processed information available, the research was unable to progress beyond the review stage with the intention to further developing the model and expanding the analysis once the necessary data becomes available.