A growing number of published studies indicate high levels of antibiotics, antibiotic-resistant bacteria and antibiotic resistance genes in various environments around the world. This accumulation creates the conditions for resistant bacteria to proliferate and transmit from the environment directly to humans as well as through the selection and horizontal gene transfer from commensal to pathogenic bacteria (PDF).
Read Antibiotic Resistance in the Environment on the Houses of Parliament website.
While it is unclear what the significance of the impact manufacturing waste might have on the environment, there is potential for high levels of localised contamination. This is because of the large quantity of antimicrobial waste generated during the production process relative to the diffuse environmental exposure that may result from patient or animal use.
Recent studies have shown that wastewater effluents from antibiotic manufacturing units contain a substantial amount of antibiotics. This leads to rivers and lakes becoming contaminated. The manufacturing process can also potentially contaminate environments through vaporisation or other solid waste disposal methods.
Current global discharge standards for antimicrobial manufacturing effluent do not include antibiotic residues, and consensus around safe limits for antibiotic discharge has yet to emerge. Through the Antimicrobial Resistance (AMR) Industry Alliance, the pharmaceutical industry is taking voluntary action to reduce the environmental impact from antimicrobial manufacturing.
In September 2018, the AMR Industry Alliance published science-driven, risk-based targets for discharge concentrations of antibiotics, which will be updated periodically as new, reliable and robust data become available.
Download AMR Industry Alliance Antibiotic Discharge Targets List of Predicted No-Effect Concentrations (PDF, 199KB) from their website.
The Access to Medicines Foundation’s AMR benchmark provides an independent evaluation of how pharmaceutical companies are halting the rise of drug resistance. The 2018 benchmark includes environmental stewardship metrics and will be updated for release in 2020. However, significant knowledge gaps remain around the scale of contamination and the risk presented to the environment and humans to determine appropriate discharge targets.