title: Environmental impact assessment of pharmaceutical prescriptions: Does location matter?
abstract: A methodology was developed for the assessment and comparison of the environmental impact of two alternative pharmaceutical prescriptions. This methodology provides physicians with the opportunity to include environmental considerations in their choice of prescription. A case study with the two antibiotics ciprofloxacin and levofloxacin at three locations throughout Europe showed that the preference for a pharmaceutical might show spatial variation, i.e. comparison of two pharmaceuticals might yield different results when prescribed at different locations. This holds when the comparison is based on both the impact on the aquatic environment and the impact on human health. The relative impacts of ciprofloxacin and levofloxacin on human health were largely determined by the local handling of secondary sludge, agricultural disposal practices, the extent of secondary sewage treatment, and local food consumption patterns. The relative impacts of ciprofloxacin and levofloxacin on the aquatic environment were mostly explained by the presence of specific sewage treatment techniques, as effluents from sewage treatment plants (STPs) are the most relevant emission pathway for the aquatic environment.
authors: Department of Environmental Science, Institute for Water and Wetland Research, Radboud University Nijmegen, P.O. Box 9010, 6500 GL Nijmegen, The Netherlands. Electronic address: R.Oldenkamp@science.ru.nl.
authors: Rik
authors: R
authors: Oldenkamp
authors: Department of Environmental Science, Institute for Water and Wetland Research, Radboud University Nijmegen, P.O. Box 9010, 6500 GL Nijmegen, The Netherlands.
authors: Mark A J
authors: MA
authors: Huijbregts
authors: Department of Environmental Science, Institute for Water and Wetland Research, Radboud University Nijmegen, P.O. Box 9010, 6500 GL Nijmegen, The Netherlands; Department of Ecological Risk Assessment, National Institute for Public Health and The Environment, P.O. Box 1, 3720 BA Bilthoven, The Netherlands.
authors: Anne
authors: A
authors: Hollander
authors: Department of Environmental Science, Institute for Water and Wetland Research, Radboud University Nijmegen, P.O. Box 9010, 6500 GL Nijmegen, The Netherlands.
authors: Ad M J
authors: AM
authors: Ragas
mesh_terms: D000383:Agriculture; D000900:Anti-Bacterial Agents / Q000032:analysis*; D002939:Ciprofloxacin / Q000032:analysis*; D004777:Environment; D004784:Environmental Monitoring / Q000379:methods; D005060:Europe; D006801:Humans; D064704:Levofloxacin / Q000032:analysis*; D012722:Sewage / Q000032:analysis; D014874:Water Pollutants, Chemical / Q000032:analysis*
chemical_list: D000900:Anti-Bacterial Agents; D012722:Sewage; D014874:Water Pollutants, Chemical; D002939:Ciprofloxacin; D064704:Levofloxacin
keywords: Aquatic environment; Human health; Medical prescriptions; Pharmaceuticals; Risk assessment; Spatial variation