Pharmaceutical contaminants in the environment and human health: A systematic review
TL;DR
The evidence indicates widespread and persistent pharmaceutical pollution with significant implications for One Health, and standardized monitoring protocols, stricter industrial effluent regulations, and integration of environmental surveillance with AMR monitoring are urgently required.
Abstract
Pharmaceutical contaminants are increasingly recognized as emerging pollutants of concern due to their persistence in the environment and potential impacts on ecosystems and human health. This review aimed to synthesize evidence on the occurrence, pathways, health effects, interventions, and regulatory frameworks related to pharmaceutical pollution. We conducted a systematic review in accordance with PRISMA 2020 guidelines. Eligible studies (2018–2025) included peer‐reviewed research and reviews assessing pharmaceutical contaminants in water, soil, food, as well as their health impacts, treatment technologies, and regulatory measures. Databases searched included PubMed, Scopus, Web of Science, and Google Scholar. A total of 20 studies from 6 countries were included. Antibiotics, Non‐Steroidal Anti‐inflammatory drugs (NSAID), hormones, and psychiatric drugs were the most frequently reported contaminants. Geographic hotspots were identified in Asia, particularly India and China, showing intense pharmaceutical manufacturing and inadequate wastewater treatment. Conventional treatment processes were consistently ineffective at removing persistent compounds such as diclofenac and carbamazepine. Health evidence, though limited, highlighted risks of chronic exposure, endocrine disruption, and contribution to Antimicrobial Resistance (AMR). Intervention studies included advanced oxidation processes, membrane filtration, and nanotechnology. The evidence indicates widespread and persistent pharmaceutical pollution with significant implications for One Health. Limitations include geographic bias, lack of long‐term epidemiological data, and reliance on laboratory‐scale intervention studies. Standardized monitoring protocols, stricter industrial effluent regulations, and integration of environmental surveillance with AMR monitoring are urgently required. Future research should prioritize longitudinal studies, field validation of advanced treatment systems, and socio‐economic evaluations of interventions.