Pivmecillinam
Summary
Persistence. It cannot be excluded that pivmecillinam is persistent, due to the lack of data.
Bioaccumulation. It cannot be excluded that pivmecillinam bioaccumulates, due to the lack of data.
Toxicity. It cannot be excluded that pivmecillinam is toxic, due to the lack of data.
Risk. Pivmecillinam is expected to have low environmental risk for aquatic organisms and low risk of resistance selection in wastewater. However, there is a risk of additive effect with other beta-lactam antibiotics.
Environmental information is missing for pivmecillinam on fass.se (2022-12-19). The risk comes from a report by Goodpoint 2017.
For antibiotics in general, it is recommended that these pharmaceuticals are used as restrictively as possible without jeopardise the patient's health.
Detailed information
Comparison with ciprofloxacin and nitrofurantoin, report Goodpoint 2017
Pivmecillinam is an inactive "prodrug" that is rapidly hydrolyzed to its active form, mecillinam. Pivmecillinam is expected to have low environmental risk for aquatic organisms and low risk of resistance selection in wastewater. However, there is a risk of additive effect with other beta-lactam antibiotics.
Ciprofloxin is present in Swedish watewater treatment plants in concentrations that are likely to select for antibiotic resistance. Risks associated with large emissions of ciprofloxacin to the environment in manufacturing abroad have been detected. Ciprofloxacin is considered to be of greater environmental risk than pivmecillinam.
Nitrofurantoin is considered to be of even less risk to the environment than pivmecillinam.
Comparison with trimethoprim, report Goodpoint 2018
Comparative assessment of environmental risk and risk of resistance selection in the environment using trimethoprim and pivmecillinam in Sweden (Report Goodpoint 2018). From a resistance-selection-risk perspective in wastewater treatment plants, pivmecillinam appears to be a slightly better alternative than trimethoprim.
Other information
For antibiotics in general, it is recommended that these pharmaceuticals are used as restrictively as possible without jeopardise the patient's health.
References
- Jämförande miljöriskbedömningar av möjliga ersättningssubstanser för substanser på Region Stockholms förteckning över miljöbelastande läkemedelssubstanser 2017–2021. Rapport Goodpoint 2017.
- Larsson DG. Pollution from drug manufacturing: review and perspectives. Philos Trans R Soc Lond B Biol Sci. 2014;369:(1656).
- Jämförande bedömning av miljörisk och risk för resistensselektion i miljön vid användning av trimetoprim och pivmecillinam. Rapport Goodpoint 2018.
Author: Health and Medical Care Administration, Region Stockholm