Background and importance Concern about potential deleterious effects of pharmaceuticals in the environment is rapidly growing worldwide, particularly in Europe, which is considered as the front-runner in the field of ‘eco-pharmacovigilance’. The recently approved European ‘Green Deal’ has turned attention on pharmaceuticals as environmental pollutants. The European Commission’s ‘Strategic Approach to Pharmaceuticals in the Environment’ reflects on the importance of effluents from potential hotspots like hospitals and potential additional treatment to this wastewater. In the same vein, the European Association of Hospital Pharmacists (EAHP) published a statement, highlighting the “need for measures to better address pharmaceutical contamination” and “the development of interdisciplinary education, and training programs for healthcare professionals with urgency”. However, we believe that to date, this issue has not been sufficiently considered by healthcare professionals in general and hospital pharmacists in particular.

Aim and objectives We aimed to review published data about the presence of pharmaceuticals in hospital wastewater worldwide, in order to raise awareness among hospital pharmacists about the matter.

Material and methods To this end, we used the Pharmaceutical Database published by the German Environment Agency – Umweltbundesamt, which collects all published information about the presence of pharmaceuticals, including wastewater from hospitals. The database was downloaded on 13 September 2021. ‘Sewage hospital (untreated)’ & ‘Sewage hospital (treated)’ matrices were considered. Metabolites were excluded.

Results A total of 67 publications were found reporting positive detection of 221 different parent drugs in hospital wastewater. These studies were carried out in 27 different countries of which 15 were European, with Portugal, Italy, Switzerland and Norway being the ones with the most published data.

An additional treatment to hospital wastewater was reported in 11 different countries, six of which were European.

The three most frequently detected drugs were ciprofloxacin, sulfamethoxazole and ibuprofen.

Conclusion and relevance A considerable amount of research about the presence of pharmaceuticals in hospital wastewater has been performed, mainly in European countries. We hope our research helps in raising concern in hospital pharmacists about this issue.

References and/or acknowledgements This project has been supported by Fundación Vital Ayuntamiento de Vitoria-Gasteiz and Amvisa, both of them in Vitoria-Gasteiz (Spain).

Conflict of interest No conflict of interest