ReviewPhilosophical transactions of the Royal Society of London. Series B, Biological sciences2014
Potential ecological footprints of active pharmaceutical ingredients: an examination of risk factors in low-, middle- and high-income countries.
Review in Philosophical transactions of the Royal Society of London. Series B, Biological sciences, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 38 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
38 citing papers in PubMed, 173 citations in OpenAlex.
- Environmentally Safe and Just Pharmacy: A Framework and Action Plan for Operating within the Earth System Boundary for Novel Entities.Environmental science & technology · 2026Article
- Invisible Engines of Resistance: How Global Inequities Drive Antimicrobial Failure.Antibiotics (Basel, Switzerland) · 2025Review
- Inhibition of Fin Regeneration in Fathead Minnow (Environmental science & technology · 2025Article
- The Potential Role of Ecotoxicological Data in National Essential Medicine Lists: A Cross-Sectional Analysis.International journal of environmental research and public health · 2025Article
- Optimizing Bioaugmentation for Pharmaceutical Stabilization of Sewage Sludge: A Study on Short-Term Composting Under Real Conditions.Journal of fungi (Basel, Switzerland) · 2025Article
- Mitigating Contaminant-Driven Risks for the Safe Expansion of the Agricultural-Sanitation Circular Economy in an Urbanizing World.ACS ES&T water · 2024Article
- Antibiotic resistance in livestock, environment and humans: One Health perspective.Journal of animal science and technology · 2024Review
- Exploring the antibiogram of soil isolates from an indian hospital precinct: link to antibiotic usage.BMC research notes · 2023Article
- The Research Status, Potential Hazards and Toxicological Mechanisms of Fluoroquinolone Antibiotics in the Environment.Antibiotics (Basel, Switzerland) · 2023Review
- A Review on Graphene (GN) and Graphene Oxide (GO) Based Biodegradable Polymer Composites and Their Usage as Selective Adsorbents for Heavy Metals in Water.Materials (Basel, Switzerland) · 2023Review
- Impact of Fluoxetine on Herbivorous Zooplankton and Planktivorous Fish.Environmental toxicology and chemistry · 2023Article
- Impact of the microbiome on human, animal, and environmental health from a One Health perspective.Science in One Health · 2023Review
- Antibiotic resistance in the environment.Nature reviews. Microbiology · 2022Review
- Pharmaceutical pollution of the world's rivers.Proceedings of the National Academy of Sciences of the United States of America · 2022Article
- Warmer temperatures limit the effects of antidepressant pollution on life-history traits.Proceedings. Biological sciences · 2022Article
- One planet: one health. A call to support the initiative on a global science-policy body on chemicals and waste.Environmental sciences Europe · 2022Article
- Article
- Sustainable waste management of medical waste in African developing countries: A narrative review.Waste management & research : the journal of the International Solid Wastes and Public Cleansing Association, ISWA · 2021Review
- Fluoxetine results in misleading conclusions on fish behavior.Ecology and evolution · 2021Article
- Disposal Practices of Unused and Leftover Medicines in the Households of Dhaka Metropolis.Pharmacy (Basel, Switzerland) · 2021Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
10 authors at 9 institutions in 9 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Active pharmaceutical ingredients (APIs) can enter the natural environment during manufacture, use and/or disposal, and consequently public concern about their potential adverse impacts in the environment is growing. Despite the bulk of the human population living in Asia and Africa (mostly in low- or middle-income countries), limited work relating to research, development and regulations on APIs in the environment have so far been conducted in these regions. Also, the API manufacturing sector is gradually shifting to countries with lower production costs. This paper focuses mainly on APIs for human consumption and highlights key differences between the low-, middle- and high-income countries, covering factors such as population and demographics, manufacture, prescriptions, treatment, disposal and reuse of waste and wastewater. The striking differences in populations (both human and animal), urbanization, sewer connectivity and other factors have revealed that the environmental compartments receiving the bulk of API residues differ markedly between low- and high-income countries. High sewer connectivity in developed countries allows capture and treatment of the waste stream (point-source). However, in many low- or middle-income countries, sewerage connectivity is generally low and in some areas waste is collected predominantly in septic systems. Consequently, the diffuse-source impact, such as on groundwater from leaking septic systems or on land due to disposal of raw sewage or septage, may be of greater concern. A screening level assessment of potential burdens of APIs in urban and rural environments of countries representing low- and middle-income as well as high-income has been made. Implications for ecological risks of APIs used by humans in lower income countries are discussed.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.