Erythromycin
Summary
Persistence. Erythromycin is potentially persistent.
Bioaccumulation. Erythromycin has low potential for bioaccumulation.
Toxicity. It cannot be excluded that erythromycin is toxic, due to lack of data.
Risk. Erythromycin is included in Region Stockholm's table of pharmaceuticals with risk for negative environmental impact.
This summary information comes from Fass 2021 and the risk is from the report from Goodpoint. Environmental information for erythromycin is missing on fass.se (2026-07-08).
Erythromycin is included in the European Union (EU) the Priority Substances Directive for surface waters (2008/105/EC) and is subject to an environmental quality standard (EQS).
Detailed information
Fass environmental information 2021-08-16
Fass environmental information for Abboticin (erythromycin) from Amdipharm (downloaded 2021-08-16).
Hazard
Persistence: No data.
Bioaccumulation: No data.
Toxicity: No data.
Risk
PEC = 0.055558 microg/L. The environmental risk could not be calculated since ecotoxicity data are missing.
The manufacturer, Amdipharm, has on fass.se (2021-08-16) stated that data about the environmental impact is missing for the substance so that the environmental risk cannot be calculated.
EU water legislation
Erythromycin has previously been monitored within the framework of EU water legislation. There is now enough data to assess whether erythromycin is to be proposed as a priority substance when the European parliament and the Council next time proposes a revised directive regarding priority substances in the field of water policy.
European Union Priority Substances Directive
Erythromycin is included in the Priority Substances Directive for surface waters (2008/105/EC) and is subject to an environmental quality standard (EQS).
Low concentrations of antibiotics
Studies have shown that even low concentrations of antibiotics in the environment may trigger antibiotic resistance and therefore, as little as possible should end up in our environment.
Report Goodpoint
There is a risk of selection for antibiotic resistance with the concentrations measured in Swedish wastewater treatment plants.
Erythromycin is included in Region Stockholm's table of pharmaceuticals with risk for negative environmental impact according to the environmental programme 2017–2021. Erythromycin has been detected in treated wastewater in Region Stockholm.
The Wise list
Erythromycin is recommended in the Wise list. Environmental classification of pharmaceuticals is taken into consideration, sometimes with other environmental aspects, when selecting pharmaceuticals for the Wise list. When comparable pharmaceuticals are equivalent to medical effects, safety and pharmaceutical efficacy, environmental impact and price are considered.
Suggestions on how to reduce the emissions of erythromycin
Concrete proposals on how to work to reduce emissions of environmentally harmful pharmaceuticals on the list have been developed in close cooperation with the Stockholm Drug and Therapeutics Committee's expert groups. The action proposals were developed from an environmental perspective. The patient's best always goes first and several pharmaceuticals on the list are also included in the Wise list. However, for such pharmaceuticals, there may be measures that could reduce the environmental impact.
Concrete proposal for erythromycin
- Eryhtromycin is recommended in the Wise list.
- For antibiotics, the general rule is as restrictive use as possible without risking the patient's health. Relevant cultivation is important in order to choose antibiotics that have a good effect with as narrow spectrum as possible.
References
- Fass för vårdpersonal.
- Directive 2008/105/EC of the European Parliament and of the Council.
- Gullberg E, Cao S, Berg OG, Ilbäck C, Sandegren L, Hughes D et al. Selection of resistant bacteria at very low antibiotic concentrations. PLoS Pathog. 2011;7:e1002158.
- Goodpoint. Prioritering av läkemedel med miljörisk inom SLL. Stockholm: Goodpoint; 2016. Rapport LS 2016–0634.
- Isidori M, Lavorgna M, Nardelli A, Pascarella L, Parrella A. Toxic and genotoxic evaluation of six antibiotics on non-target organisms. Sci Total Environ. 2005;346:87-98.
- Bengtsson-Palme J, Larsson DG. Concentrations of antibiotics predicted to select for resistant bacteria: Proposed limits for environmental regulation. Environ Int. 2016;86:140-9.
- Provtagningar av läkemedelsrester i vatten, sediment och fisk för Region Stockholm.
- Region Stockholm. Förteckning över miljöbelastande läkemedel med åtgärdsförslag framtagen inom ramen för Region Stockholms miljöprogram 2017–2021.
- Region Stockholm's Drug and Therapeutics Committee. Kloka listan (Wise list).
- Region Stockholm's Drug and Therapeutics Committee. The Wise list 2015.
Author: Health and Medical Care Administration, Region Stockholm