Last week, the WHO launched the first edition of its Guidance on wastewater and solid waste management for the manufacturing of antibiotics in recognition of the important role antibiotic production may have on the emergence and spread of antibiotic resistance in the environment. Environmental discharges of waste from antibiotic manufacturing remain largely unregulated despite increasing evidence that antibiotic residues and antibiotic resistance genes are often detected in abundance in proximity to manufacturing plants and their discharge sites. The continued unregulated release of pollutants into our environment may undermine the utility of the very drugs being produced.

The report was developed by the WHO and the United National Environmental Programme (UNEP) in response to increasingly urgent global calls for guidance on how to regulate antibiotic manufacturing facilities. The guidance provides a One Health framework for establishing and applying targets for the responsible handling and disposal of liquid and solid waste products from antibiotic manufacturing facilities to reduce environmental pollution and its potential downstream effects. It also describes the need and process for manufacturers to develop risk assessment and management plans to meet targets.

The report also provides guidance on how external audits may be designed and implemented to ensure targets are consistently met. Given the importance of antibiotic production, the guidance allows for flexibility in the roll out of risk management plans by manufacturers, stating such plans may be progressively realised over time. Finally, the WHO and UNEP have identified several priorities for future research in this area including the need for studies on the risks associated with environmental pollution with other types of antimicrobials and on the selection potential of drug intermediates and active degradation products which may also be released in waste effluents.

This guidance represents an important first step towards regulation of antibiotic manufacturing and its potential as a driver of the emergence of AMR in the environment, while the collaboration between WHO and UNEP is an important reminder of the necessity of working across sectors to tackle AMR.