Due to the risk of ecotoxicity of amoxicillin in water, the substance is monitored within the framework of EU water legislation to "improve knowledge of the occurrence and spread of antimicrobials in the environment".
Measurements in the Swedish environment/wastewater are lacking, but based on expected concentrations in wastewater treatment plants (based on high usage, high proportion of excreted substance as parent substance, and reported moderate reduction in treatment plants from other countries) there is a risk for selection of antibiotic resistance in treatment plants. That is why amoxicillin is included in the Stockholm County Council's table of pharmaceuticals with risk for a 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.
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 drugs 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 amoxicllin
The risk classification, moderate according to Fass.se, is based on total sold amount (kg) of the substance in Sweden during the year 2014.
Author: Department of Strategic Careers, Stockholm County Council.