Clarithromycin is on the EU list of substances whose concentrations in surface water should be monitored in the Member States for environmental reasons.
Studies have shown that even low concentrations of antibiotics in the environment may contribute to antibiotic resistance and therefore measures should be taken to ensure that as little as possible ends up in our environment.
Concentrations in Swedish wastewater treatment plants are at risk of selecting antibiotic resistance. May interact in the environment with other macrolide antiobiotics, such as azithromycin, erythromycin and roxithromycin.
Clarithromycin is included in the Stockholm County Council's table of pharmaceuticals with risk for negative environmental impact according to the environmental program 2017–2021. This also takes into account the risk of antibiotic resistance selection and environmental interaction between other macrolide antibiotics. Clarithromycin has been detected in treated wastewater in Stockholm County in the last five years (2012–2016).
Clarithromycin 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 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 clarithromycin
The risk classification low, according to Fass.se, is based on total sold amount (kg) of the substance in Sweden during the year 2011 and toxicity of the substance, i.e. consideration has not been given to measured levels in the environment.
Author: Department of Strategic Careers, Stockholm County Council.