In recent years, there is a growing concern about the alarming spread of antimicrobial resistance (AMR) in different environments. Increasingly, many species of bacteria, fungi and viruses are becoming immune to the most commonly used pharmaceuticals. One of the causes of the development of the resistance is the persistence of these drugs, excreted by humans, in municipal and hospital wastewater (WW). Consequently, wastewater treatment plants (WWTPs) are a primary source of antimicrobial resistance genes as novel pollutants. This systematic review sought to examine the relevant literature on pharmaceutical residues (PRs) responsible for AMR in municipal and hospital WW in order to propose a classification of the PRs of greatest concern and provide an updated source for AMR management in WWTPs. Among 546 studies collected from four databases, 18 were included in the present review. The internal and external validity of each study was assessed, and the risk of bias was evaluated on a 20-parameter basis. Results were combined in a narrative synthesis discussing influent and effluent PR concentrations at 88 WWTPs, seasonal variations, differences between hospital and municipal WW, environmental risk assessment values of antimicrobial substances and treatment facilities removal efficiencies. Among the 45 PRs responsible for AMR evaluated in this study, the antibiotics ciprofloxacin, clarithromycin, erythromycin, metronidazole, ofloxacin, sulfamethoxazole and trimethoprim constitute a considerable risk in terms of ubiquitous distribution, worrying concentrations, risk quotient values and resistance to removal treatments. Gaps in knowledge, data and information reported in this review will provide a valuable source for managing AMR in WWTPs.

Micropollutants in aquatic resources have raised global concerns regarding the conservation of ecosystems. Although they are usually found in the environment at trace concentrations to a maximum of several µg/L, it is still necessary to address the potential risks these pollutants may represent to organisms. A multifactor analysis was conducted using two algae as bioindicators. Four different pharmaceuticals were chosen based on their occurrence in domestic wastewaters and persistency after biological treatment processes ranging from 1/8th to four-fold representative environmental concentrations over 96 h exposure. The present multifactor analysis evaluated cell size, photosynthetic capacity and growth rate. These data were later combined into a simplified single entity: “the index effect”. The results obtained showed that, even at concentrations below the environmentally relevant concentrations (ERC), the pharmaceuticals’ residues (PRs), caused a cellular behavioural variation in both organisms. In addition, the algae cultures’ response to exposure to these stressors was generally dependent on the concentration over time. By examining four different PR over three different characteristics of two types of algal bioindicators, this work covers significant and specific responses on the algae exposure cycle. This is unique research since most studies do not consider multiple parameters in the assessment of the environment risk for bioindicators.