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New EMA Guideline for the environmental risk assessment of medicinal products for human use effective from 2024-09-01

Castillo NA, James WR, Santos RO, et al. Understanding pharmaceutical exposure and the potential for effects in marine biota: A survey of bonefish (Albula vulpes) across the Caribbean Basin. Chemosphere, Volume 349, 2024, 140949, ISSN 0045-6535, https://doi.org/10.1016/j.chemosphere.2023.140949.

Meyer C, Stravs MA, Hollender J. How wastewater reflects human metabolism – suspect screening of pharmaceutical metabolites in wastewater influent. Environ. Sci. Technol. 2024. DOI: 10.1021/acs.est.4c00968

Sanja Riikonen, Johanna Timonen, Tiina Sikanen. Environmental considerations along the life cycle of pharmaceuticals: Interview study on views regarding environmental challenges, concerns, strategies, and prospects within the pharmaceutical industry, European Journal of Pharmaceutical Sciences, Volume 196, 2024, 106743, ISSN 0928-0987, https://doi.org/10.1016/j.ejps2024.106743.

Mark P. Lentz, Duncan J. Graham, Michelle T.H. van Vliet. Drought impact on pharmaceuticals in surface waters in Europe: Case study for the Rhine and Elbe basins, Science of The Total Environment, Volume 922, 2024, 171186, ISSN 0048-9697, https://doi.org/10.1016/j.scitotenv.2024.171186.

Urban wastewater: Council and Parliament reach a deal on new rules for more efficient treatment and monitoring
Council of the European Union


Public consultation on antimicrobial manufacturing effluent guidance

Bengtsson-Palme J, Abramova A, Berendonk TU, et al. Towards monitoring of antimicrobial resistance in the environment: For what reasons, how to implement it, and what are the data needs? Environment International, Volume 178, 2023,108089, ISSN 0160-4120, https://doi.org/10.1016/j.envint.2023.108089.

Kidd KA, Backhaus T, Brodin T, Inostroza PA, McCallum ES. Environmental risks of pharmaceutical mixtures in aquatic ecosystems: reflections on a decade of research. Environ Toxicol Chem. 2023 Aug 2. doi: 10.1002/etc.5726. Epub ahead of print. PMID: 37530415.

Bengtsson-Palme J, Abramova A, Berendonk TU, et al. Towards monitoring of antimicrobial resistance in the environment: For what reasons, how to implement it, and what are the data needs?, Environment International, Volume 178, 2023, 108089, ISSN 0160-4120, https://doi.org/10.1016/j.envint.2023.108089.

Elkanah Linder, Johanna Villén, Marmar Nekoro, Björn Wettermark, Sofia Kälvemark Sporrong. Stakeholders' perspectives and use of web-based knowledge support for environmental information on pharmaceuticals. Exploratory Research in Clinical and Social Pharmacy. Volume 11, 2023, 100303, ISSN 2667-2766, https://doi.org/10.1016/j.rcsop.2023.100303.

Daniela Gildemeister, Caroline T.A. Moermond, Cecilia Berg, Ulrika Bergström, Lucie Bielská, Maria Grazia Evandri, Marco Franceschin, Boris Kolar, Mark H.M.M. Montforts, Christine Vaculik. Improving the regulatory environmental risk assessment of human pharmaceuticals: Required changes in the new legislation. Regulatory Toxicology and Pharmacology, Volume 142, 2023, 105437, ISSN 0273-2300, https://doi.org/10.1016/j.yrtph.2023.105437

Moermond CTA, Berg C, Bergström U, Bielská L, Evandri MG, Franceschin M, Gildemeister D, Montforts MHMM. Proposal for regulatory risk mitigation measures for human pharmaceutical residues in the environment. Regul Toxicol Pharmacol. 2023 Jul 9:105443. doi: 10.1016/j.yrtph.2023.105443. Epub ahead of print. PMID: 37433367.

European Commission. EU steps up the fight against antimicrobial resistance.

Linder E, Wettermark B, Ovesjö ML, Sporrong SK, Ramström H. Knowledge support for environmental information on pharmaceuticals: experiences among Swedish Drug and Therapeutics Committees. BMC Health Serv Res. 2023 Jun 12;23(1):618

European Health Union: EU steps up the fight against antimicrobial resistance
European Commission

Sweden’s successful approach to antibiotic resistance can be used as inspiration in other countries

Inda-Díaz, J.S., Lund, D., Parras-Moltó, M. et al. Latent antibiotic resistance genes are abundant, diverse, and mobile in human, animal, and environmental microbiomes. Microbiome 11, 44 (2023). https://doi.org/10.1186/s40168-023-01479-0

Huch, S., Nersisyan, L., Ropat, M. et al. Atlas of mRNA translation and decay for bacteria. Nat Microbiol (2023). https://doi.org/10.1038/s41564-023-01393-z

Karin Rystedt, Petra Edquist, Christian G Giske, Katarina Hedin, Mia Tyrstrup, Gunilla Skoog Ståhlgren, Pär-Daniel Sundvall, Charlotta Edlund, Effects of penicillin V on the faecal microbiota in patients with pharyngotonsillitis—an observational study, JAC-Antimicrobial Resistance, Volume 5, Issue 1, February 2023, dlad006, https://doi.org/10.1093/jacamr/dlad006

Berglund, F., Ebmeyer, S., Kristiansson, E. et al. Evidence for wastewaters as environments where mobile antibiotic resistance genes emerge. Commun Biol 6, 321 (2023). https://doi.org/10.1038/s42003-023-04676-7

Nozomu Obana, Hiraku Takada, Caillan Crowe-McAuliffe, Mizuki Iwamoto, Artyom A Egorov, Kelvin J Y Wu, Shinobu Chiba, Victoriia Murina, Helge Paternoga, Ben I C Tresco, Nobuhiko Nomura, Andrew G Myers, Gemma C Atkinson, Daniel N Wilson, Vasili Hauryliuk, Genome-encoded ABCF factors implicated in intrinsic antibiotic resistance in Gram-positive bacteria: VmlR2, Ard1 and CplR, Nucleic Acids Research, 2023;, gkad193, https://doi.org/10.1093/nar/gkad193

Hartman E A R, van de Pol A C, Heltveit-Olsen S R, Lindbæk M, Høye S, Lithén S S et al. Effect of a multifaceted antibiotic stewardship intervention to improve antibiotic prescribing for suspected urinary tract infections in frail older adults (ImpresU): pragmatic cluster randomised controlled trial in four European countries BMJ 2023; 380 :e072319 doi:10.1136/bmj-2022-072319

Helle Håkonsen, Simone Dohle, Henric Rhedin, Tove Hedenrud. Preferences for medicines with different environmental impact – a Swedish population-based study. Environmental Advances (2023), doi: https://doi.org/10.1016/j.envadv.2023.10035

Helwig, K, Niemi, L, Stenuick, JY, et al. (2023), Broadening the perspective on reducing pharmaceutical residues in the environment. Environ Toxicol Chem. Accepted Author Manuscript. https://doi.org/10.1002/etc.5563

Blomstrand E, Kumar Rajasekharan A, Atefyekta S, Andersson M. Cross-linked lyotropic liquid crystal particles functionalized with antimicrobial peptides. International Journal of Pharmaceutics 627 (2022) 122215

Stepulane A, Kumar Rajasekharan A, and Andersson M. Multifunctional surface modification of PDMS for antibacterial contact killing and drug-delivery of polar, nonpolar, and amphiphilic drugs. ACS Appl. Bio Mater. 2022, 5, 5289−5301

Nada Hanna, Ashok J Tamhankar, Cecilia Stålsby Lundborg. Antibiotic concentrations and antibiotic resistance in aquatic environments of the WHO Western Pacific and South-East Asia regions: a systematic review and probabilistic environmental hazard assessment. Lancet Planet Health 2023; 7: e45–54.

Brandis G, Larsson J, Elf J. Antibiotic perseverance increases the risk of resistance development. PNAS 2023 Vol. 120 No. 2 e2216216120.


Bose APH, McCallum ES, Avramovic M, et al. Pharmaceutical pollution disrupts the behavior and predator-prey interactions of two widespread aquatic insects. iScience 25, 105672, December 22, 2022.

15 things that need to happen in 2023 – for a robust response on antibiotic resistance!

GBD 2019 Antimicrobial Resistance Collaborators. Global mortality associated with 33 bacterial pathogens in 2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet 2022; 400: 2221–48. https://doi.org/10.1016/S0140-6736(22)02185-7

Hammel E, Webster TF, et al. Implications of PFAS definitions using fluorinated pharmaceuticals. iScience 25, 104020, april 15, 2022.

Munk P, Brinch C, et al. Genomic analysis of sewage from 101 countries reveals global landscape of antimicrobial resistance. Nature communications. 2022.13:7251.

Antimicrobial resistance best practices working group report and case studies
November 2022

Assessing the health burden of infections with antibiotic-resistant bacteria in the EU/EEA, 2016–2020
European Centre for Disease Prevention and Control
November 2022

Sales of veterinary antimicrobial agents in 31 European countries in 2021
European Medicines Agency

Modin O, Fuad N, Abadikhah M, et al. A relationship between phages and organic carbon in wastewater treatment plant effluents. Water Research X, Volume 16, 1 August 2022, 100146.

European Commission. European Green Deal: Commission proposes rules for cleaner air and water.

European Commission. Proposal for a Directive amending the Water Framework Directive, the Groundwater Directive and the Environmental Quality Standards Directive.

Munthe C, Malmqvist E, Rönnerstrand B (2022) Non-prescription acquisition of antibiotics: Prevalence, motives, pathways and explanatory factors in the Swedish population. PLoS ONE 17(9): e0273117. https://doi.org/10.1371/journal.pone.0273117

Moermond CTA, de Rooy M. The Dutch chain approach on pharmaceuticals in water: stakeholders acting together to reduce the environmental impact of pharmaceuticals. Br J Clin Pharmacol. 2022 https://doi.org/10.1111/bcp.15509

John P. Sumpter, Andrew. C. Johnson, Tamsin, J. Runnalls. Pharmaceuticals in the aquatic environment: No answers yet to the major questions. Environmental Toxicology and Chemistry, https://doi.org/10.1002/etc.5421

EMA guidance supports development of new antibiotics
European Medicines Agency

Recommendations for greener human medicines in the revision of the EU general pharmaceuticals legislation
Health Care Without Harm

Environmental dimensions of antimicrobial resistance summary for policymakers
UN environment programme

Sedvall E. Pharmaceuticals are identified in insects in River Fyris – A study with both tandem quadrupole and quadrupole-time-of-flight mass spectrometry. Environmental Advances
Volume 8, July 2022, 100194.

Wilkinson JL et al. Pharmaceutical pollution of the world’s rivers. PNAS 2022 Vol. 119 No. 8 e2113947119

Antimicrobial resistance surveillance in Europe
European Centre for disease prevention and control
World Health Organization

Malnes D et al. Occurrence and mass flows of contaminants of emerging concern (CECs) in Sweden's three largest lakes and associated rivers. Chemosphere Volume 294, May 2022, 133825. https://doi.org/10.1016/j.chemosphere.2022.133825

Reducing antimicrobial resistance in food production: How healthcare professionals can help
Health Care Without Harm

Antimicrobial resistance collaborators. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis
Lancet, DOI:https://doi.org/10.1016/S0140-6736(21)02724-0


Wolfram, J., Stehle, S., Bub, S., Petschick, L.L. and Schulz, R. (2021) Water quality and ecological risk in European surface waters – Monitoring improves while water
quality decreases. Environment International 152: 106479. doi:10:1016/j.envint.2021.106479

Responsible Antibiotics Manufacturing Platform (RAMP)

Reithuber E, et al. THCz: Small molecules with antimicrobial activity that block cell wall lipid intermediates. PNAS November 23, 2021 118 (47) e2108244118. https://doi.org/10.1073/pnas.2108244118

Reported decrease in antibiotic consumption across EU/EEA during COVID-19 pandemic
European Centre for Disease Prevention and Control

Antimicrobial consumption in the EU/EEA (ESAC-Net) - Annual Epidemiological Report for 2020
European Centre for Disease Prevention and Control

World antimicrobial awareness week
18–24 November

OECD Health at a Glance 2021

Larsson, D.G.J., Flach, CF. Antibiotic resistance in the environment. Nat Rev Microbiol (2021). https://doi.org/10.1038/s41579-021-00649-x

Edlund C, et al. The clinical and microbiological efficacy of temocillin versus cefotaxime in adults with febrile urinary tract infection, and its effects on the intestinal microbiota: a randomised multicentre clinical trial in Sweden. Lancet Infectious diseases. Published:October 28, 2021. DOI: https://doi.org/10.1016/S1473-3099(21)00407-2

Kanwischer M, et al. Substances of emerging concern in Baltic Sea water: Review on methodological advances for the environmental assessment and proposal for future monitoring. Ambio. 2021 Oct 12.

Pharmaceuticals and endocrine disruptors: transfer from water to land ecosystems
European Commission

Swedres-Svarm 2020. Sales of antibiotics and occurrence of
resistance in Sweden. Solna/Uppsala ISSN1650-6332.

Möller V, et al. Antibiotic resistance among major pathogens compared to hospital treatment guidelines and antibiotic use in Nordic hospitals 2010–2018. Infectious diseases 2021, VOL. 53, NO. 8, 607–618.

Use of antibiotics in animals is decreasing

Cerveny D, Fick J, Klaminder J, et al. Water temperature affects the biotransformation and accumulation of a psychoactive pharmaceutical and its metabolite in aquatic organisms. Environment International, Volume 155, October 2021.

Cars O, Chandy SJ, Mpundu M, et al. Resetting the agenda for antibiotic resistance through a health systems perspective. Lancet Glob Health 2021; 9: e1022–27.

G7 ministers commit to combat antibiotic pollution from drug manufacturing.
University of Gothenburg

S Svebrant, R Spörndly, RH Lindberg, et al. On-site pilot testing of hospital wastewater ozonation to reduce pharmaceutical residues and antibiotic-resistant bacteria. Antibiotics. 2021, 10(6), 684.

Nada H. Integrated assessment of environmental and human health risks of antibiotic residues and resistance for environmental and health policy. Thesis for doctoral degree (Ph.D.). Karolinska Institutet 2021.

AS Bruun Rasmussen, A Hammou, T Fyhn Poulsen, et al. Definition, categorization, and environmental risk assessment of biopharmaceuticals. Science of The Total Environment
Volume 789, 1 October 2021, 147884.

ReAct Europe. Ensuring sustainable access to effective antibiotics for everyone ‒ everywhere. March 2021.

Vinterstare J. Defence on Demand. A physiological perspective on phenotypic plasticity in anti-predator traits. Lund University. Doctoral dissertation. 2021. ISBN 978-91-7895-756-9

Kraupner N, Hutinel M, Schumacher K, et al. Evidence for selection of multi-resistant E. coli by hospital effluent.Environment International Volume 150, May 2021, 106436. https://doi.org/10.1016/j.envint.2021.106436

Pinheiro, F., Warsi, O., Andersson, D.I. et al. Metabolic fitness landscapes predict the evolution of antibiotic resistance. Nat Ecol Evol (2021). https://doi.org/10.1038/s41559-021-01397-0

Antibiotics: even low levels found in the environment might drive resistance
European Commission

Waste water treatment pains
Svenskt Vatten


Cerveny D, Grabic R, Grabicová K et al. Neuroactive drugs and other pharmaceuticals found in blood plasma of wild European fish. Environment International 146 (2021). https://doi.org/10.1016/j.envint.2020.106188

Näslund J, Asker N, Fick J, Larsson J, Norrgren L. Naproxen affects multiple organs in fish but is still an environmentally better alternative to diclofenac. Aquatic Toxicology, Volume 227, October 2020. https://doi.org/10.1016/j.aquatox.2020.105583

Fahlman J. The fate and effect of pharmaceuticals in boreal surface waters. Dissertation for PhD. Department of Ecology and Environmental Science Umeå 2020.

Reducing emissions from antibiotic production

Faisal Ahmad Khan. Carbapenemase-producing Enterobacteriaceae in wastewater-associated aquatic environments. Doctoral dissertation 2020. ISBN 978-91-7529-334-9.

Ramström, H., Martini, S., Borgendahl, J. et al. Pharmaceuticals and Environment: a web-based decision support for considering environmental aspects of medicines in use. Eur J Clin Pharmacol (2020). https://doi.org/10.1007/s00228-020-02885-1

The health paradox. Report #96.

Rutgersson C, Ebmeyer S, Lassen SB, Karkman A, Fick J, Kristiansson E, Brandt KK, Flach C-F, Larsson DGJ. Long-term application of Swedish sewage sludge on farmland does not cause clear changes in the soil bacterial resistome. Environmental International 137 (2020) 105339. https://doi.org/10.1016/j.envint.2019.105339

Nijsingh N, Munthe C and Larsson DGJ. Managing pollution from antibiotics manufacturing: charting actors, incentives and disincentives. Environmental Health (2019) 18:95 https://doi.org/10.1186/s12940-019-0531-1.

Tepper V, Nykvist M, Gillman A, Skog E, Wille M, Lindström HS, Tang C, Lindberg RH, Lundkvist Å, Järhult JD. Influenza A/H4N2 mallard infection experiments further indicate zanamivir as less prone to induce environmental resistance development than oseltamivir. J Gen Virol. 2019 Dec 19. doi: 10.1099/jgv.0.001369.


‘Dump it down the drain’: How contaminants from prescription-drug factories pollute waterways
Gilbert N

Pharmaceutical Residues in Freshwater. Hazards and Policy Responses.

Carter LJ, Agatz A, Kumar A, Williams M. Translocation of pharmaceuticals from wastewater into beehives. Environ Int. 2019 Nov 8;134:105248. doi: 10.1016/j.envint.2019.105248.

Abbey-Lee RN, Kreshchenko A, Fernandez Sala X, Petkova I, Løvlie H. Effects of monoamine manipulations on the personality and gene expression of three-spined sticklebacks. Journal of Experimental Biology 2019 222: jeb211888 doi: 10.1242/jeb.211888.

Sales of veterinary antimicrobial agents in 31 European countries in 2017
European Medicines Agency

Pharmaceutical residues in freshwater. Hazards and Policy Responses.

Bengtsson-Palme J, Milakovic M, Švecová H, et al. Industrial wastewater treatment plant enriches antibiotic resistance genes and alters the structure of microbial communities. Water Res. 2019 Oct 1;162:437-445. doi: 10.1016/j.watres.2019.06.073.

Khan FA, Söderquist B, Jass J. Prevalence and Diversity of Antibiotic Resistance Genes in Swedish Aquatic Environments Impacted by Household and Hospital Wastewater.
Front. Microbiol., 04 April 2019

Consumption of antibiotics and occurrence of antibiotic resistance in Sweden
Public Health Agency of Sweden and National Veterinary Institute

New database for pharmaceutical in the environment initiatives
Safer Pharma

No time to wait: securing the future from drug-resistant infections
Interagency Coordination Group on Antimicrobial Resistance

New report calls for urgent action to avert antimicrobial resistance crisis

Pribis JP, García-Villada L, Zhai Y, et al. Gamblers: An Antibiotic-Induced Evolvable Cell Subpopulation Differentiated by Reactive-Oxygen-Induced General Stress Response. Molecular Cell. Available online 1 April 2019. https://doi.org/10.1016/j.molcel.2019.02.037

European Union Strategic Approach to Pharmaceuticals in the Environment
European Commission

The European Union summary report on antimicrobial resistance in zoonotic and indicator bacteria from humans, animals and food in 2017
EFSA Journal 2019;17(2):5598.

Nicoloff H, Hjort K, Levin BR, Andersson DI. The high prevalence of antibiotic heteroresistance in pathogenic bacteria is mainly caused by gene amplification
Nat Microbiol. 2019 Feb 11. doi: 10.1038/s41564-018-0342-0.

The Infectious Diseases Society of America’s 10 × ’20 Initiative (Ten New Systemic Antibacterial Agents FDA-approved by 2020): Is 20 × ’20 a Possibility?
Clinical Infectious Diseases

Pharmaceutical industry lacks a clear and transparent commitment to environmental protection
Health Care Without Harm

Revised guideline aims to strengthen global approach to development of new antibacterial medicines
European Medicines Agency

New hope to rescue the livesaving antibiotics
SIWI Stockholm International Water Institute

Karkman, A., K. Pärnänen, and D.G.J. Larsson. Fecal pollution can explain antibiotic resistance gene abundances in anthropogenically impacted environments.
Nature Communications, 2019. 10(1): p. 80.


Karkman, A., K. Pärnänen, and D.G.J. Larsson. Fecal pollution can explain antibiotic resistance gene abundances in anthropogenically impacted environments.
Nature Communications, 2019. 10(1): p. 80.

Antimicrobial resistance. World antibiotic awareness week 2018 (12-18 november) - Think twice. Seek Advice.

A diverse suite of pharmaceuticals contaminates stream and riparian food webs
Nature Communications

Attributable deaths and disability-adjusted life-years caused by infections with antibiotic-resistant bacteria in the EU and the European Economic Area in 2015: a population-level modelling analysis
Lancet Infect Dis

Antimicrobials in sewage treatment plants - Occurrence, fate and resistance
Dissertation for PhD

A microsimulation model projecting the health care costs for resistance to antibacterial drugs in Sweden
European Journal of Public Health

Public awareness and individual responsibility needed for judicious use of antibiotics: a qualitative study of public beliefs and perceptions
BMC Public Health

Fish on Drugs: Behaviour Modifying Contaminants in Aquatic Ecosystems
Dissertation for PhD

New Alternatives to Combat Listeria monocytogenes and Chlamydia trachomatis
Design, Synthesis, and Evaluation of Substituted Ring-Fused 2-Pyridones as Anti-Virulent Agents
Dissertation for PhD

New treatment system able to remove at least 95% of pharmaceuticals from waste water
European Commission

Environmentally relevant exposure to an antidepressant alters courtship behaviours in a songbird

EU:s Watch list
Commission implementing decision (EU) 2018/840 of 5 June 2018

Joint Statement | Europe must align policies to tackle Pharmaceuticals in the Environment and Antimicrobial Resistance
European public health alliance (epha)

Industry need to accept responsibility for their pharmaceutical pollution
Health Care Without Harm

Joint Declaration on Pharmaceuticals in the Environment
European Federation of Pharmaceutical Industries and Associations (EFPIA)

Antimicrobial resistance in zoonotic bacteria still high in humans, animals and food, say ECDC and EFSA
European Food Safety Authority

Threats to global antimicrobial resistance control Centrally approved and unapproved antibiotic formulations sold in India
British Journal of Clinical Pharmacology

Tracking progress to address AMR
AMR Industry Alliance

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