The study focuses on Drug and Therapeutics Committees, or DTCs, multidisciplinary groups typically made up of physicians, pharmacists, nurses and healthcare administrators. Their traditional role is to promote the “rational use” of medicines: giving patients drugs appropriate to their medical needs, at individually suitable doses, for long enough to work, and at the lowest reasonable cost. In Sweden, every one of the country’s 21 regions is required to have at least one such committee. These bodies develop formularies, advise policymakers and clinicians, analyze prescribing data and organize professional education across hospitals and primary-care centers. The new analysis argues that rational prescribing must now include a further consideration: the connection between human health, animals, plants and the shared environment.

That connection is increasingly difficult to ignore. Many active pharmaceutical ingredients are biologically potent by design, and some remain chemically stable after excretion. Conventional wastewater treatment can remove a proportion of these compounds, but not all of them. Residues may therefore reach aquatic ecosystems at concentrations capable of affecting sensitive organisms, particularly when exposure is continuous. Diclofenac, a widely used nonsteroidal anti-inflammatory drug, has become an emblematic example. The drug caused catastrophic declines in vulture populations in South Asia when birds fed on the carcasses of treated livestock and developed fatal kidney failure. Laboratory and field studies have also linked diclofenac exposure to damage in fish tissues, including the liver, kidneys and gills. Swedish authorities classify diclofenac and ciprofloxacin as river-basin-specific pollutants, while several hormones, including estradiol and ethinylestradiol, are also recognized as water contaminants.

The second environmental threat examined in the study comes from fluoroquinolone antibiotics, particularly ciprofloxacin and norfloxacin. These drugs can be persistent in aquatic environments and may exert antibacterial effects far below the concentrations used to treat patients. That matters because low-level antibiotic exposure can create evolutionary pressure favoring resistant bacteria. In effect, wastewater containing pharmaceutical residues may act as a diffuse training ground for microbes, selecting genetic variants able to survive future treatments. Fluoroquinolones also carry important clinical warnings. European regulators have restricted their use because of potentially disabling and long-lasting effects involving connective tissue, including tendon damage and increased risks associated with aortic complications. Unlike diclofenac, however, ciprofloxacin remains essential for some serious infections, including certain upper urinary-tract infections accompanied by fever. The goal is therefore not simple elimination, but precise, evidence-based use.

Researchers conducted an observational case study using official reports, regional and national agency websites, educational materials, communications, presentations and other documents published between 1988 and 2024. They reconstructed how the two DTCs developed environmental policies and compared those activities with sales data for diclofenac, ciprofloxacin and norfloxacin. Prescription and over-the-counter sales were obtained from the Swedish eHealth Agency and converted into kilograms of active substance per year. For systemic diclofenac, the analysis included tablets and capsules; topical products such as gels were assessed separately. Fluoroquinolone calculations covered the two products that were available in Sweden during the period. Measuring mass rather than simply counting prescriptions provides a closer approximation of the amount of pharmaceutical material entering the environment, although it still does not reveal how much was actually consumed or improperly discarded.

Gävleborg began considering the environmental consequences of medicines after a regional political decision in 2002. Over time, the policy became embedded in the region’s formulary, the list of medicines recommended to prescribers. Since 2019, the formulary has included environmental information for every listed drug when such information is available, and medicines with lower environmental impact may be favored when effectiveness, safety and cost-effectiveness are otherwise comparable. The guidance also identifies situations in which non-drug approaches could replace medication. Diclofenac received an explicit “anti-recommendation” in 2018, reflecting both its cardiovascular risks and its ecological effects. The committee also monitored prescribing by individual healthcare centers and hospital clinics, returned the results to clinicians and managers, and used comparisons between providers to encourage improvement.

Västernorrland took a similarly broad approach, beginning environmental work when its DTC was formed in 1997 and creating a dedicated “Pharmaceuticals and Environment” task force in 2021. Its measures included encouraging smaller starter packs for long-term therapies, reassessing treatments when benefits no longer outweighed risks, conducting medication reviews for older patients and promoting the return of unused medicines to pharmacies rather than flushing them into wastewater or placing them in household waste. The regional formulary emphasizes non-pharmacological alternatives such as cognitive behavioral therapy for some mental-health conditions and physiotherapy for some forms of pain. Environmental requirements have also been incorporated into medicine procurement, and the committee works with pharmacies, water and wastewater organizations and healthcare payers. Environmental representatives at healthcare providers receive specialized training, supported by a digital education course.

The prescribing data reveal substantial changes over the 25-year period. Systemic diclofenac sales rose during the first two decades and reached approximately 127 kilograms in Gävleborg and 137 kilograms in Västernorrland in 2011. They then declined rapidly. Over-the-counter systemic sales remained near 20 kilograms per year until 2020, when oral diclofenac was reclassified as prescription-only in Sweden because of cardiovascular concerns. The change did not produce a marked compensatory surge in topical diclofenac sales in either region. Topical products, introduced in 2005, increased for several years, particularly through over-the-counter channels, but their use also began to fall after 2016. The researchers caution that the trends cannot be attributed to the DTCs alone: national regulation, professional campaigns and changes in public awareness also influenced prescribing.

Fluoroquinolone use followed a different trajectory. In 2000, roughly 37 to 50 kilograms each of ciprofloxacin and norfloxacin were sold in each region. Norfloxacin use declined steadily until the product was removed from the Swedish market in 2020. Ciprofloxacin use initially increased as norfloxacin declined, then began falling after 2012, with an especially low level during the COVID-19 pandemic. Gävleborg introduced a fluoroquinolone prescribing target in 2003, while Västernorrland followed in 2005. The latter eventually specified that no more than 10 percent of urinary-tract-infection antibiotic prescriptions for women in primary care should be fluoroquinolones. Gävleborg set a target of fewer than five defined daily doses per 1,000 listed patients per day in primary care. These targets do not prohibit clinically justified treatment; they are intended to make unnecessary prescribing visible and reduce it.

The researchers say the Swedish experience offers a template for healthcare systems facing the same dilemma: how to preserve access to effective medicines while limiting their unintended ecological consequences. The approach begins with a technical challenge that remains unresolved—environmental information is missing for many active pharmaceutical ingredients. Reliable data on persistence, toxicity, bioaccumulation and effects on aquatic species are needed before committees can compare drugs meaningfully, and information about pollution from manufacturing is often absent even when risks from use have been assessed. Better environmental data could allow regulators and DTCs to distinguish drugs that are readily degraded from those that persist, accumulate or disrupt biological processes. Upstream decisions are especially important because wastewater treatment improvements, although necessary, cannot fully compensate for excessive or inappropriate use. The study does not prove that regional policies caused every observed decline, and sales do not equal consumption: medicines may remain unused in homes or be discarded incorrectly. Even so, it demonstrates how environmental stewardship can become part of everyday clinical decision-making, turning a prescription from a purely medical transaction into a One Health decision with consequences beyond the patient.

Antibiotic contamination in aquatic environments has escalated into a pressing global concern due to the increasing consumption of pharmaceuticals and their inefficient removal by conventional wastewater treatment plants. Amoxicillin, with its prevalent therapeutic use, often persists as a micropollutant in water bodies, fostering antibiotic resistance and ecological toxicity. The study underscores the urgent need for sustainable, cost-effective adsorbents capable of sequestering such pharmaceuticals without imposing further environmental burdens.

Activated carbon, renowned for its exceptional adsorption capacities, is a staple in contaminant removal technologies but traditionally relies on non-renewable, fossil-based precursors. By turning to pomegranate peel — a highly abundant, renewable agricultural byproduct — Yilmaz’s approach embodies circular economy principles, significantly reducing the carbon footprint and production costs of activated carbon synthesis. The utilization of fruit peel not only advocates waste valorization but also epitomizes sustainable wastewater treatment innovations.

The methodology section of the study meticulously describes the preparation of the activated carbon. Pomegranate peel underwent a controlled carbonization process followed by chemical activation, optimizing pore structure and surface chemistry essential for effective adsorption. The physicochemical characterization revealed a high surface area and abundant functional groups tailored to interact strongly with amoxicillin molecules, demonstrating the material’s superior affinity toward the antibiotic contaminant.

Batch adsorption experiments formed the core of the empirical analyses. These experiments were conducted under varying parameters such as initial amoxicillin concentration, contact time, pH levels, and temperature conditions to simulate realistic wastewater treatment scenarios. The results highlighted a substantial adsorption capacity, indicative of the activated carbon’s robust performance even in complex aqueous matrices. The data showcased rapid initial adsorption kinetics that gradually plateaued, suggesting a multi-phase uptake mechanism.

To decode the adsorption behavior further, Yilmaz applied sophisticated kinetic modeling. The study employed models such as pseudo-first-order and pseudo-second-order kinetics alongside intraparticle diffusion frameworks to ascertain the controlling mechanisms governing amoxicillin adsorption. Findings favored the pseudo-second-order kinetic model, implying chemisorption as the dominant mechanism, where adsorbate molecules form strong chemical bonds with the surface active sites of the carbon material.

Thermodynamic analyses added a critical dimension to the research, elucidating the spontaneity and nature of the adsorption process. Parameters such as Gibbs free energy, enthalpy, and entropy changes were meticulously calculated. Negative Gibbs free energy values confirmed the spontaneous nature of adsorption at examined temperatures, whereas positive enthalpy changes indicated an endothermic process. The increase in entropy suggested enhanced randomness at the solid-liquid interface during adsorption, further supporting efficient pollutant binding.

Complementing kinetic and thermodynamic studies, equilibrium adsorption isotherms were modeled using Langmuir and Freundlich isotherms to describe the interaction between amoxicillin and the activated carbon surface. The Langmuir model, indicative of monolayer adsorption on homogeneous sites, provided the best fit, affirming the formation of uniform adsorbate layers and the high affinity of the prepared carbon for amoxicillin molecules.

Significantly, the investigation also tackled regeneration and reusability, critical for commercial feasibility. Multiple adsorption-desorption cycles using mild elution solvents demonstrated negligible loss in adsorption efficiency, spotlighting the activated carbon’s durability and economic viability for long-term application in water purification systems.

The implications of Yilmaz’s work transcend laboratory boundaries, offering a tangible pathway toward scalable and sustainable pharmaceutical pollution mitigation. By harnessing fruit waste such as pomegranate peels, the study aligns with global initiatives promoting green chemistry and sustainability, providing a double dividend by addressing both agricultural waste management and water quality preservation.

This research adds a vital piece to the puzzle of antibiotic pollution management, as current global strategies urgently require innovative, accessible technologies. The intersection of nanomaterials engineering, environmental chemistry, and waste valorization demonstrated here promises advancements in decentralized water treatment solutions, particularly beneficial for rural and resource-limited communities facing serious water contamination challenges.

Moreover, the study’s comprehensive approach, integrating batch adsorption, kinetic, and thermodynamic modeling, sets a new standard for evaluating novel adsorbents. It emphasizes the necessity of understanding the fundamental mechanisms to optimize adsorbent design and tailor treatment processes for specific pollutants, fostering an evidence-based path towards next-generation water remediation technologies.

As concerns over drug-resistant pathogens continue to escalate globally, removing antibiotic residues from the environment becomes paramount in safeguarding both human health and ecological balance. Yilmaz’s activated carbon derived from pomegranate peel emerges as a promising candidate in this fight, potentially enabling widespread application across various wastewater treatment infrastructures.

Future research directions proposed by the study include the exploration of multi-contaminant systems, scaling up production techniques, and investigating real wastewater matrices to further validate efficacy and resilience. Collaborative efforts among materials scientists, environmental engineers, and policymakers will be fundamental to translating these promising laboratory outcomes into impactful real-world solutions.

In summary, the development of eco-friendly activated carbon from pomegranate peel for amoxicillin removal offers an elegant, sustainable, and highly effective approach to combating one of the most insidious forms of environmental contamination. This breakthrough is expected to reverberate through the scientific community and industry, inspiring a new wave of green technologies designed to protect our planet’s precious water resources.

Subject of Research: Development of eco-friendly activated carbon from pomegranate peel for the removal of amoxicillin via adsorption, kinetic, and thermodynamic analysis.

Article Title: Eco-friendly activated carbon derived from pomegranate peel for amoxicillin removal: batch adsorption, kinetic modeling, and thermodynamics.

Article References:
YILMAZ, N. Eco-friendly activated carbon derived from pomegranate peel for amoxicillin removal: batch adsorption, kinetic modeling, and thermodynamics. Sci Rep (2026). https://doi.org/10.1038/s41598-026-51191-w

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Healthcare facilities worldwide have seen an upsurge in the volume of wastewater due to the meteoric rise in patient admissions related to COVID-19. This increase is accompanied by the generation of hazardous materials, including high loads of pathogens, pharmaceuticals, and personal protective equipment (PPE). The unsustainable disposal of such waste poses a significant risk to both human health and ecosystems, underscoring the urgency for innovative treatment methods. The authors emphasize that simply increasing containment procedures is not enough; systemic changes to wastewater treatment practices are crucial.

One of the prime concerns raised in the study is the inadequacy of existing wastewater treatment infrastructure in many regions of India. Many healthcare facilities are equipped with outdated systems ill-suited for handling the complexities posed by COVID-19 related waste. The lack of proper infrastructure means that healthcare facilities are ill-equipped to mitigate the risks associated with the improper treatment and disposal of contaminated water. This shortcoming has exacerbated the challenges faced during the pandemic, highlighting an urgent need for investment in modern treatment technologies.

A promising strategy discussed in the review is the adoption of advanced oxidation processes (AOPs) that have shown efficiency in degrading pharmaceutical compounds and pathogens present in wastewater. By utilizing techniques such as ozonation and UV radiation, healthcare facilities can significantly improve the quality of treated wastewater. These methods not only ensure the elimination of viral loads but also enhance the overall safety of effluents, presenting a viable solution for regions struggling with inadequate treatment facilities.

Furthermore, the review draws attention to the role of decentralized wastewater management systems. Smaller, localized treatment facilities can operate effectively in rural and semi-urban areas, where centralized systems may not be feasible. Such systems can be tailored to specific community needs, enabling quicker responses to treatment demands. Implementing decentralized systems can also enhance public participation in waste management, fostering a sense of responsibility among residents regarding the handling and treatment of healthcare waste.

The authors advocate for interdisciplinary collaborations that bring together experts from various fields including engineering, public health, and environmental science. By fostering diverse perspectives, stakeholders can devise more holistic approaches to healthcare wastewater treatment. This integrated approach is essential for ensuring that treatment systems are not only technically effective but also socially accepted and economically viable.

Another critical element highlighted in the review is the necessity for stringent regulatory frameworks and enforcement mechanisms. The pandemic has revealed loopholes in existing legislation governing wastewater management. As the demand for effective treatment increases, so too does the necessity for robust regulations that ensure compliance from healthcare institutions. Strengthening the regulatory environment is essential for safeguarding public health and ensuring the sustainability of the environment.

Education and training are also vital components of improving healthcare wastewater management. The review emphasizes the need for continual professional development for personnel involved in waste treatment processes. By equipping staff with the latest knowledge and skills, healthcare facilities can better manage wastewater and adhere to new technologies and methods. This investment in human capital is crucial for maintaining high standards in wastewater treatment.

Moreover, public awareness campaigns play a substantial role in mobilizing communities towards better waste management practices. Engaging the public with awareness initiatives can promote understanding of the risks associated with improper waste disposal and the importance of proper treatment. These campaigns can serve as a powerful tool for behavioral change, leading to grassroots support for advanced wastewater treatment strategies.

Innovative financing mechanisms can also pave the way for improved healthcare wastewater management. The review suggests that public-private partnerships and international aid can provide essential funding for deploying advanced treatment technologies. By leveraging financial resources, healthcare facilities can invest in infrastructure upgrades and implement cutting-edge treatment solutions that enhance the efficacy and efficiency of wastewater management.

Finally, the study underscores the need for continuous monitoring and assessment of wastewater treatment efficacy. Developing robust monitoring frameworks can provide valuable data that inform decision-making processes and policy adaptations. Real-time monitoring can also help identify contamination events swiftly, ensuring that appropriate response measures are implemented.

In conclusion, Gopalakrishnan et al. offer a multidimensional perspective on the critical issue of healthcare wastewater management during and beyond the COVID-19 pandemic. Their narrative review acts as a clarion call for stakeholders to prioritize sustainable practices, ushering in an era of accountability and innovation in waste treatment. By adopting and adapting diverse strategies, the healthcare sector can not only combat the immediate challenges posed by the pandemic but also lay the groundwork for a more resilient and sustainable future in healthcare wastewater management.

Subject of Research: Healthcare wastewater treatment during COVID-19 pandemic in India.

Article Title: Multi-strategic approaches to healthcare wastewater treatment amidst COVID-19 pandemic in India—a narrative review.

Article References:

Gopalakrishnan, M., Sumathi, K.V., Velegatla, S.V. et al. Multi-strategic approaches to healthcare wastewater treatment amidst COVID-19 pandemic in India—a narrative review.
Environ Sci Pollut Res (2025). https://doi.org/10.1007/s11356-025-36869-4

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DOI:

Keywords: Healthcare wastewater, COVID-19, wastewater treatment, India, environmental sustainability.

Chloroquine phosphate, historically used as an antimalarial and immunomodulator, has spurred intense scrutiny in environmental circles because of its widespread usage and documented resistance to conventional wastewater treatments. Undegraded pharmaceutical compounds can bioaccumulate, fostering antibiotic resistance and disrupting aquatic ecosystems. Addressing these challenges, the research team employed advanced oxidation processes (AOPs), specifically utilizing peroxymonosulfate activated by ultraviolet light, to accelerate the oxidative degradation of chloroquine phosphate molecules. The study’s kinetic modeling provides unprecedented clarity on how reactive species interact with chloroquine’s complex molecular structure under UV irradiation.

Central to their approach is the use of peroxymonosulfate, a versatile oxidant increasingly favored for its strong oxidative potential and operational stability. When energized by UV light, PMS generates reactive radicals—primarily sulfate radicals—that act as potent agents in breaking down organic pollutants. Unlike traditional oxidants, these radicals exhibit selectivity and efficiency in cleaving chemical bonds, facilitating the mineralization of toxic compounds into benign end products such as carbon dioxide and water. The research sheds light on the intricate balance of radical formation and competing scavenging reactions, which ultimately govern the degradation kinetics of chloroquine phosphate in aqueous environments.

The kinetic modeling framework incorporated in the study meticulously tracks the concentration changes of chloroquine and intermediate degradation products over time. By integrating experimental data with mechanistic equations, the researchers elucidated rate constants and reaction pathways. Their data reveal that UV-activated PMS generates an initial burst of sulfate radicals that rapidly attack specific sites on the chloroquine molecule, particularly targeting the aromatic rings and side chains vulnerable to oxidative cleavage. This complex cascade proceeds through multiple transient species before complete degradation is achieved, underscoring the necessity of understanding intermediate steps for optimizing treatment conditions.

Moreover, the research explores the role of key parameters such as pH, PMS dosage, and UV intensity in modulating degradation rates. The team observed that acidic to neutral pH conditions favored higher radical generation, enhancing chloroquine breakdown efficiency. This finding aligns with the known chemistry of sulfate radicals, which exhibit prolonged stability and oxidative capacity in lower pH ranges. Adjusting PMS concentration showed a clear dose-response relationship up to a saturation point beyond which radical recombination limited further gains—a critical insight for scaling practical applications while minimizing oxidant wastage.

The mechanistic insights extend to the identification of dominant radical species at different stages of the reaction. While sulfate radicals initiate attack, hydroxyl radicals produced as secondary species contribute synergistically, especially in neutral pH scenarios. The interplay of these reactive oxygen species orchestrates a multifaceted degradation environment, reinforcing the superiority of UV/PMS systems over singular oxidants. By modeling these interactions, the study effectively deciphers the complex chemistry dictating the degradation kinetics, equipping engineers and environmental scientists with tools to tailor processes for diverse water matrices.

Importantly, the research confronts the challenges of real-world water treatment by considering the influence of co-existing constituents such as natural organic matter and inorganic ions. These substances can act as radical scavengers or catalysts, affecting degradation rates. The authors demonstrated that humic substances, ubiquitous in natural waters, tend to inhibit chloroquine degradation by competing for radicals, implying that pretreatment or process adjustments may be necessary for effective remediation in complex matrices. Such applied knowledge is vital for transitioning from laboratory experiments to scalable, field-deployable water purification systems.

Beyond the fundamental chemical insights, the study offers a timely solution to an evolving environmental dilemma. Pharmaceutical residues like chloroquine phosphate have been detected in various water sources worldwide, posing ecological and public health risks. Conventional wastewater treatment plants often lack the means to fully eliminate such micropollutants. By leveraging UV-activated PMS, this research proposes a viable and energy-efficient technology to not only degrade chloroquine but potentially other structurally related pharmaceuticals. This approach aligns with increasing regulatory pressures and societal demands for cleaner water resources.

The implications extend into the realm of sustainable water management, where the integration of advanced oxidation with renewable energy sources could revolutionize decentralized treatment systems. UV/PMS technology, with its modularity and rapid reaction kinetics, could be adapted for use in hospitals, pharmaceutical industries, and municipal wastewater facilities. The kinetic models provided serve as design blueprints enabling precise control over treatment parameters, reducing chemical usage, and ensuring compliance with burgeoning water quality standards.

Furthermore, the study’s detailed exploration of degradation intermediates provides a safety net ensuring no harmful byproducts persist post-treatment. Mass spectrometry and chromatographic analyses confirm that the UV/PMS system drives chloroquine molecules toward complete mineralization over optimized reaction times, mitigating the risk of secondary pollution. This comprehensive approach addresses a critical knowledge gap in the field, where incomplete degradation can generate toxic transformation products posing unknown hazards.

From a mechanistic standpoint, the research exemplifies how coupling empirical data with rigorous modeling unravels the complexity of advanced oxidation systems. This paradigm transcends chloroquine phosphate degradation, offering a blueprint for studying other recalcitrant organic pollutants threatening water safety. The integration of kinetic parameters with radical chemistry understanding paves the way for predictive models that can streamline pilot testing and full-scale implementations, accelerating the adoption of cutting-edge water treatment technologies globally.

As the demand for pharmaceuticals continues to grow alongside urbanization, the environmental footprint of these compounds warrants urgent attention. The present study’s innovative use of UV-activated peroxymonosulfate not only advances remediation science but also embodies a holistic approach intertwining chemistry, environmental engineering, and sustainability. It epitomizes the interdisciplinary efforts required to safeguard aquatic ecosystems and public health in the face of mounting chemical pollution challenges.

In conclusion, this pioneering work presents a comprehensive kinetic and mechanistic framework for the effective degradation of chloroquine phosphate by UV-activated PMS. The multifactorial analysis encompassing radical formation, reaction pathways, and environmental influences sets a new standard for evaluating and optimizing advanced oxidation processes. Given the urgency to address emerging micropollutants, such research offers critical tools for future environmental stewardship, promising cleaner waterways and healthier communities worldwide. The adoption of these findings could significantly enhance the arsenal of technologies combating pharmaceutical contamination, marking a key milestone in modern environmental chemistry.

Subject of Research: Kinetic modeling and mechanistic investigation of chloroquine phosphate degradation using UV-activated peroxymonosulfate in aqueous systems.

Article Title: Kinetic modeling and mechanistic insights into chloroquine phosphate degradation by UV-activated peroxymonosulfate.

Article References:
Jiang, T., Li, Y., Xia, M. et al. Kinetic modeling and mechanistic insights into chloroquine phosphate degradation by UV-activated peroxymonosulfate. Environ Earth Sci 84, 482 (2025). https://doi.org/10.1007/s12665-025-12487-8

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