Pharmaceutical Pollution and Antimicrobial Resistance in the Environment: A Systematic Literature Review

Abstract

Introduction: Pharmaceutical pollution has become a pressing global concern due

to its role in the emergence of antimicrobial resistance in environmental settings.

Objective: to synthesize current evidence on the link between pharmaceutical

residues and resistance dissemination

Method: A systematic literature review was conducted using PubMed, Scopus,

Web of Science, ScienceDirect, and Google Scholar. From an initial pool of

records, ten empirical articles were included. Inclusion criteria required that studies

examined pharmaceutical residues in environmental matrices and reported

associations with antimicrobial resistance genes, were peer-reviewed, and written

in English. Exclusion criteria eliminated reviews, commentaries, conference

abstracts without full text, and studies limited to clinical settings. The reviewed

articles encompassed field investigations, laboratory analyses, and policy

evaluations.

Result: indings revealed that pharmaceutical residues, especially antibiotics such

as fluoroquinolones and sulfonamides, persist in surface waters, sediments, and

soils, exerting continuous selective pressures that foster resistance gene

development. Mobile genetic elements facilitated rapid dissemination of

antimicrobial resistance among microbial populations. Geographic disparities were

evident, with low- and middle-income countries facing disproportionately higher

contamination levels due to weak infrastructure and limited regulation. Mitigation

strategies, including advanced wastewater treatment, constructed wetlands,

medicine take-back programs, and awareness campaigns, showed promise but

were constrained by cost and fragmented implementation. These findings highlight

the urgent need for integrated, One Health approaches to reduce pharmaceutical

pollution and address its contribution to antimicrobial resistance. By consolidating

evidence and identifying gaps,

Conclusion: his review enhances understanding of the environmental dimension

of resistance and informs future research and policy interventions.