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Hazard 6 P 3 B 0 T 3 Risk See below


Azithromycin is on the EU list of substances whose concentrations in surface water should be monitored in the Member States for environmental reasons. May interact in the environment with other macrolide antiobiotics, such as clarithromycin, erythromycin and roxithromycin.

Has been found in Swedish waste water treatment plants in concentrations that might select for antibiotic resistance.

Azithromycin is included in the Stockholm County Council's table of pharmaceuticals with risk for negative environmental impact according to the environmental programme 2017–2021. Measurements in the aquatic environment in Stockholm County are missing during the last five-year period (2012–2016).

Studies have shown that even low concentrations of antibiotics in the environment may trigger antibiotic resistance and therefore measures should be taken to ensure that as little as possible ends up in our environment.

Azithromycin 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 release of azithromycin

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 advice. 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 azithromycin

  • Azithromycin is recommended in the Wise list for the treatment of Mycoplasma genitalium.
  • 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.

Author: Health and Medical Care Administration, Region Stockholm