Sulfamethoxazole
Summary
The data on hazard are based on previous environmental information on fass.se. Environmental information is missing (2021-09-10). It is voluntary for manufacturers to provide information about environmental impact on fass.se. For risk, see the report from Goodpoint. Sulfamethoxazole is monitored within the framework of EU water legislation.
Persistence. Sulfamethoxazole is potentially persistent.
Bioaccumulation. Sulfamethoxazole has low potential for bioaccumulation.
Toxicity. Sulfamethoxazole has very high chronic toxicity.
Risk. See the report from Goodpoint.
Detailed information
Fass environmental information
Fass environmental information for Bactrim (sulfamethoxazole, trimethoprim) from Roche (downloaded 2019-06-14).
Hazard
Persistence: "Biotic Degradation:
Ready biodegradability:
4% after 28 days of incubation BOD/ThOD (OECD 301 D)
13% after 28 days of incubation BOD/ThOD (OECD 301 D with co-metabolism)
Inherent biodegradability:
-10% after 28 days of incubation CO2/TOC (OECD 302 B)
13% after 28 days of incubation DOC (OECD 302 B)
0% after 28 days of incubation DOC (OECD 302 B).
Sulfamethoxazole is neither readily, nor inherently biodegradable. This justifies the phrase 'Sulfamethoxazole is potentially persistent.'"
Bioaccumulation: Log KOW 0.89 experimental, method unknown. Log KOW 0.48 QSAR. Sulfamethoxazole has low potential for bioaccumulation (log KOW <4).
Toxicity: There are data for 3 trophic levels, most sensitive Cyanobacteria (Synechococcus leopoliensis) NOEC 96 h = 0.0059 mg/l (method not specified)".
Risk
PEC/PNEC is based on sales data in Sweden in year 2017. PEC/PNEC = 0.440 which gives the risk low.
Report Goodpoint
Good margin between occurrences in Swedish waters and concentration for effect. Low risk for selection of antibiotic resistant bacteria.
Pharmaceutial residues in the aquatic environment
Sulfamethoxazole has been detected in treated wastewater in Region Stockholm and in the aquatic environment elsewhere in Sweden.
EU water legislation
Sulfamethoxazole is monitored within the framework of EU water legislation. "Substances for which doubt exists about their toxicity, or for which the sensitivity, reliability or comparability of the available monitoring methods are not adequate, should not be included in the watch list. The sulfonamide antibiotic sulfamethoxazole and the diaminopyrimidine antibiotic trimethoprim, the antidepressant venlafaxine and its metabolite O-desmethylvenlafaxine, a group of three azole pharmaceuticals (clotrimazole, fluconazole and miconazole) ... The inclusion of the various pharmaceuticals is consistent with the EU Strategic Approach to Pharmaceuticals in the Environment, and the inclusion of the two antibiotics is also consistent with the European One Health Action Plan against Antimicrobial Resistance (AMR), which supports the use of the watch list to ‘improve knowledge of the occurrence and spread of antimicrobials in the environment’."
In general
For antibiotics in general, it is recommended that these drugs are used as restrictively as possible without risking the patient's health.
References
- Fass.se för vårdpersonal
- Goodpoint. Prioritering av läkemedel med miljörisk inom SLL. Stockholm: Goodpoint; 2016. Rapport LS 2016–0634.
- Provtagningar av läkemedelsrester i vatten, sediment och fisk för Region Stockholm.
- IVL Swedish Environmental Research Institute Ltd. Fick J, Lindberg RH, Kaj L, Brorström-Lundén E. Results from the Swedish National Screening Programme 2010. Subreport 3, B 2014 Pharmaceuticals.
- IVL Swedish Environmental Research Institute Ltd Fick J, Lindberg RH, Fång J, Magnér J, Kaj L, Brorström-Lundén E. Screening 2014. Analysis of pharmaceuticals and hormones in samples from WWTPs and receiving waters. Rapport C 135.
- Hillis DG, Antunes P, Sibley PK, Klironomos JN, Solomon KR. Structural responses of Daucus carota root-organ cultures and the arbuscular mycorrhizal fungus, Glomus intraradices, to 12 pharmaceuticals. Chemosphere. 2008;73:344-52.
- Official Journal of the European Union. Commission implementing decision (EU) 2020/1161 of 4 August 2020.
- Official Journal of the European Union. Commission implementing decision (EU) 2022/1307 of 22 July 2022.
- 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.
Author: Health and Medical Care Administration, Region Stockholm