In this study, we analyzed 27 pharmaceuticals in liquid and solid phase samples collected from the unit processes of four different sewage treatment plants (STPs) to evaluate their distribution and behavior of the pharmaceuticals. The examination of the relative distributions of various categories of pharmaceuticals in the influent showed that non-steroidal anti-inflammatory drugs (NSAIDs) were the most dominant. While the relative distribution of antibiotics in the influent was not high (i.e., 3%–5%), it increased to 14%–30% in the effluent. In the four STPs, the mass load of the target pharmaceuticals was reduced by 88%–95% mainly in the biological treatment process, whereas the ratio of pharmaceuticals in waste sludge to those in the influent (w/w) was only 2%. In all the STPs, the removal efficiencies for the stimulant caffeine, NSAIDs (acetaminophen, naproxen, and acetylsalicylic acid), and the antibiotic cefradine were high; they were removed mainly by biological processes. Certain compounds, such as the NSAID ketoprofen, contrast agent iopromide, lipid regulator gemfibrozil, and antibiotic sulfamethoxazole, showed varying removal efficiencies depending on the contribution of biodegradation and sludge sorption. In addition, a quantitative meta-analysis was performed to compare the pharmaceutical removal efficiencies of the biological treatment processes in the four STPs, which were a membrane bioreactor (MBR) process, sequencing batch reactor (SBR) process, anaerobic–anoxic–oxic (A2O) process, and moving-bed biofilm reactor (MBBR) process. Among the biological processes, the removal efficiency was in the order of MBR > SBR > A2O > MBBR. Among the tertiary treatment processes investigated, powdered activated carbon showed the highest removal efficiency of 18%–63% for gemfibrozil, ibuprofen, ketoprofen, atenolol, cimetidine, and trimethoprim.

The occurrence of micropollutants, including pharmaceuticals, personal care products, pesticides, and hormones in various aquatic ecosystems is a matter of grave concern due to their possible repercussions on human and wildlife endocrine systems. The wastewater containing pharmaceuticals from various sites is usually introduced to sewage treatment plants (STPs); therefore, monitoring of pharmaceuticals in STPs is crucial. In this study, we determined the occurrence of 58 pharmaceuticals in the influent and effluent of 13 STPs based on regional and linked wastewater differences and investigated their removal rates. Furthermore, we assessed the contribution rates of some STP effluents on pharmaceutical concentration in the upstream and downstream areas of the discharge source. Different kinds of pharmaceuticals were measured in the STPs. The top five pharmaceuticals with high concentrations in the influent of each STP were similar due to the dominance of domestic sewage in the influent. The average concentration of acetaminophen, caffeine, acetylsalicylic acid, naproxen, and ibuprofen in the influent of the STPs was higher than that of other pharmaceuticals, and their removal was 94–100%. In contrast, iopamidol, cimetidine, diphenhydramine, and carbamazepine showed a high average concentration in the effluent. The monitoring results of nine streams near STPs indicated that the effluent could contribute to the increase in the types of pharmaceuticals in the receiving streams. The detected pharmaceuticals’ types were 9–29 and 17–33 in the upstream and downstream areas, respectively, of STP discharge channels. Based on flowrate data, the contribution rate of the STP effluent on the stream was −69–326%.