Community infectious disease treatment with antimicrobial agents – A longitudinal one year study of antimicrobials in two cities via wastewater-based epidemiology

Natalie Sims, Elizabeth Holton, Kishore Jagadeesan, Richard Standerwick, Ruth Barden, Barbara Kasprzyk-Hordern

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4 Citations (SciVal)


Antimicrobial resistance (AMR) is one of the most significant global health threats. Inappropriate and over-usage of antimicrobial agents (AAs) is a major driver for AMR. Wastewater-based epidemiology (WBE) is a promising tool for monitoring AA usage in communities which is, for the first time, explored in this large scale, longitudinal study. Two contrasting urban catchment areas have been investigated: one city and one small town in the Southwest of the UK over a 13-month period in 2018–2019. Per capita daily intake of 17 AAs and metabolites has been estimated and obtained estimates were triangulated with catchment specific AA prescription data to understand AA usage patterns (both seasons driven prescription and AA prescription compliance). Results have demonstrated positive correlations for all quantifiable parent AAs and metabolites in wastewater, and spatial variability in AA usage was observed even in neighbouring urban areas. WBE and catchment specific prescription data showed similar seasonal trends but with low correlation in intake. The reasons might be variable prescribing patterns, prescription/intake outside the studied catchment, and/or lack of patient compliance. WBE proved useful in differentiating between consumption vs topical usage and/or direct disposal of unused AA. WBE is considered superior to prescription data as it provides information on AAs prescribed outside of the monitoring catchment, e.g. HIV antivirals and TB drugs. However, data triangulation, of both prescription data and wastewater data, provides the most comprehensive approach to understanding AA usage in communities.

Original languageEnglish
Article number131461
Number of pages18
JournalJournal of Hazardous Materials
Early online date21 Apr 2023
Publication statusPublished - 15 Jul 2023

Bibliographical note

Funding Information:
The support of Engineering and Physical Sciences Research Council (EP/P028403/1), Wessex Water Services Ltd and EPSRC Impact Acceleration Account (Project number: EP/R51164X/1, ENTRUST IAA) is greatly appreciated. The authors would like to thank EPSRC Centre for Sustainable Circular Technologies for their support. The support of Wessex Water is also greatly appreciated.

Data Availability:
Data is available in Si.


  • Antibiotics
  • Antimicrobial resistance (AMR)
  • Antivirals
  • Data triangulation
  • Direct disposal
  • Prescription
  • WBE

ASJC Scopus subject areas

  • Environmental Engineering
  • Environmental Chemistry
  • Waste Management and Disposal
  • Pollution
  • Health, Toxicology and Mutagenesis


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