**4. New antibiotics synthetic molecules**

In the race for the discovery of antibiotics some molecules paid a high price since they never reached the consumer, others on the contrary were the panacea to fight hundreds of pathogens [30]. However, the development of resistance from pathogens to antibiotics and their irresponsible use have led to the discouragement of production by pharmaceutical companies [31], while bioaccumulation and biodegradation are the new challenges added to new antibiotics [32]. In addition to fighting the same pathogens, new antibiotics shall aim to preserve soil and water quality and will prevent their accumulation and bioaccumulation. It is likely that the same active principle is used [33], perhaps better than synthesizing new molecules that are more complex to degrade. Anyway, new antibiotics must also fight against the same pathogens; nonetheless, they must also preserve soil and water quality, avoiding its accumulation and bioaccumulation, and perhaps that will be the hardest task, but it is worth it. "Even with more appropriate prescribing, it seems likely that

**169**

*Pharmaceutical Antibiotics at a Significant Level in Nature: From Hospitals, Livestock…*

antibacterial resistance will continue to accumulate in many pathogens and settings,

As emphasized in **Figure 1**, some hospitals around the world have their wastewater treatment plant (WWTP). However, the vast majority in the world in both developed [35] and developing countries [36] or in poor countries [37], hospitals water goes directly into the sewers, which in many cases reach the rivers and the sea carrying a huge load of antibiotics. Even, the larger hospitals in many towns dumped antibiotics are into the sewers. Recently, Bansal [38] published an excellent review about hospital effluents, proposing finally bioremediation for control and lowing the multidrug-resistant bacteria, and author concludes with the sentence: "Antibiotic compounds have a suspicious reputation among the class of pollutants referred to as 'emerging contaminants' as the biological activity of antibiotics is an intrinsic characteristic of their functional design". Then actually, there are two concerns: first the resistant bacteria [39] and second the antibiotic pollutant. Consequently, both problems would be repaired by not throwing more antibiotics

The Antibiotics' ecotoxicological risks over the effluent discharge on the aquatic

Hocquet et al. [40] say that in France and worldwide a few countries demand or recommend previous treatment of hospital effluents before discharge into the main wastewater stream for treatment at municipal WWTP. There are well-known cases such as those of the city of Montreal related at the St. Lawrence River [41]. In Norway Langford & Thomas [42] study by LCMS two antibiotics (clotrimazole and other not specified) among 38 pharmaceutical compounds, showing that perhaps the use of antibiotics in that country has already begun to be discouraged or used with responsibly in hospitals, not being the case for most of the remaining compounds. Santos et al. [43] made a biggest elaborated work where they found in WWTP 4 antibiotics as follow: fluoroquinolone, macrolide, sulfamethoxazole, trimethoprim calculated by mg per day per 1000 inhabitant were ranged between 19 and 1337,24–53, 75–199, and n.d.–43 respectively. The total antibiotics calculated by mg per day per 1000 inhabitant was ranged between 174 and 1612 and other

ecosystem is the main concern. Aydin et al. [36] found azithromycin, clarithromycin, and ciprofloxacin as most abundant in WWTP with seasonal differences ranged from 21.2 ± 0.13 to 4886 ± 3.80 ng/L in summer and from 497 ± 3.66 to 322,735 ± 4.58 ng/L in winter analyzing WWTP from some hospitals in Turkey. The total antibiotic load to the influent in those WWTP was 3.46 g/day in summer and

*DOI: http://dx.doi.org/10.5772/intechopen.95368*

**5. Antibiotics in wastewater from hospital**

especially in hospitals" [34].

into the environment.

303.2 g/day in winter.

antibiotics were ranged between 2 and 67.

**6. Antibiotics in drinking water, farm water, and aquifers**

Perhaps one of the most worrisome issues with non-treatment of hospital water is that water with antibiotics can reach farms and/or water for human or animal consumption and even plant irrigation. In Kumasi, a big city in Ghana, the hospital wastewater and effluents from waste stabilization ponds, are directly discharged as low-quality water into nearby streams which are eventually used to irrigate vegetables. The presence of 12 commonly used antibiotics was detected: metronidazole, ciprofloxacin, erythromycin, trimethoprim, ampicillin, cefuroxime, sulfamethoxazole, amoxicillin, tetracycline, oxytetracycline, chlortetracycline,

antibacterial resistance will continue to accumulate in many pathogens and settings, especially in hospitals" [34].
