Environmental information for azithromycin is missing on fass.se (2021-08-16). It is voluntary for manufacturers to provide information about environmental impact on fass.se. This summary information on persistence, bioaccumulation and toxicity is based on previous environmental information in Fass from 2011. For risk, see the environmental assessment from Goodpoint.
Persistence. Azithromycin is slowly degraded in the environment.
Bioaccumulation. Azithromycin has no potential to bioaccumulate.
Toxicity. Azithromycin has a very high acute toxicity.
Risk. See the environmental assessment from Goodpoint below.
Fass environmental information for Azitromax (azithromycin) from Pfizer (downloaded 2011-03-09).
Persistence: "Ready Biodegradation: None after 28 days (OECD 301D). Sediment binding: 74,2–96,3 % sediment bound azithromycin was solvent non-extractable in an OECD 308 study. This means that a minimum of 74,2 % of the substance volume cannot be stripped from sediment using solvent, it will not release in water, and hence not be bioavailable."
Bioaccumulation: Log Kow at pH 7.0 = 0.534 (FDA TAD 3.02).
Toxicity: There are data for 3 trophic levels, most sensitive blue-green algae EC50 0.94 microg/L.
PEC/PNEC is based on sales data in Sweden in year 2008.
PEC/PNEC = 0.28 which gives the risk low.
Azithromycin has previously been monitored within the framework of EU water legislation. There is now enough data to assess whether azithromycin 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.
Azithromycin may interact in the environment with other macrolide antiobiotics, such as clarithromycin, erythromycin and roxithromycin.
Azithromycin has been found in Swedish waste water treatment plants in concentrations that might select for antibiotic resistance.
Azithromycin is included in Region Stockholm's table of pharmaceuticals with risk for negative environmental impact according to the environmental programme 2017–2021.
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.
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 azithromycin
Author: Health and Medical Care Administration, Region Stockholm