A new global study coordinated by the University of York and set to be reported at the Annual Meeting of the Society of Environmental Toxicology and Chemistry in Helsinki on 27 and 28 May, has identified antibiotics in 65% of all rivers tested. The authors looked for the presence of 14 different antibiotics in some of the world’s most iconic rivers, including the Danube, Mekong, Seine, Thames, Tiber and Tigris – altogether sampling water from 72 different countries.

In London’s River Thames, five different antibiotics were identified, with levels of ciprofloxacin three times higher than those considered to be ‘safe’ – as established by the AMR Industry Alliance. In fact, ciprofloxacin was the compound that most frequently exceeded safe levels, surpassing the safety threshold in 51 locations. The most commonly identified antibiotic was trimethoprim, present in 307 of 711 sites tested. The team said that the safe limits were most frequently exceeded in Asia and Africa, with one site in Bangladesh recording levels of metronidazole that were 300 times above the safe level. However, sites in Europe, North America and South America also had high levels of contamination showing that antibiotic contamination was a “global problem”. High-risk sites were typically adjacent to wastewater treatment systems, waste or sewage dumps and in some areas of political turmoil, including the Israeli and Palestinian border.

Professor Alistair Boxall, from the York Environmental Sustainability Institute commented that “Solving the problem is going to be a mammoth challenge and will need investment in infrastructure for waste and wastewater treatment, tighter regulation and the cleaning up of already contaminated sites.”

In our LSHTM spotlight publication in this newsletter, Dr Clare Chandler argues that antibiotics might be considered part of the infrastructure that allows modern life to proceed as we are used to. Now we are finding that the reckless mismanagement of waste antibiotics is undermining a central aspect of our basic infrastructure that more often than not we take for granted. In 2017, Justin Brookes, Director of the Water Research Centre at the University of Adelaide wrote that “safe, clean drinking water defines civilisation” – civilisation must get to grips with the truth of this matter.