A Nigerian’s leading public health researchers, Dr Victor Oluwatomiwa Ajekiigbe, has warned that antibiotic pollution from pharmaceutical waste is fuelling the rapid rise of antimicrobial resistance (AMR), threatening the effectiveness of antibiotics and making infectious diseases increasingly difficult to treat worldwide.
The warning is based on a widely cited research published in Discover Public Health titled, “The Increasing Burden of Global Environmental Threats: Role of Antibiotic Pollution from Pharmaceutical Wastes in the Rise of Antibiotic Resistance.”
The study was led by Dr Victor Ajekiigbe, a medical doctor, public health researcher, and research leader at Imperial Academy of Researchers and Helix Biogen Institute, alongside other researchers.
The research team reported that antimicrobial resistance was responsible for about 4.92 million deaths worldwide in 2019, while projections suggest resistant infections could cause up to 10 million deaths each year in the coming decades if urgent action is not taken.
The review explained that pharmaceutical waste includes expired, unused, contaminated, recalled, and damaged medicines, as well as waste generated during pharmaceutical manufacturing.
It noted that 30 to 90 per cent of antibiotics used by humans and animals are excreted unchanged or as active metabolites, allowing these drugs to enter wastewater systems, rivers, and soil, where they encourage the development and spread of antibiotic-resistant bacteria.
Dr Ajekiigbe said the findings highlight the need for stronger regulation of pharmaceutical waste and greater investment in public health systems to slow the spread of antimicrobial resistance, especially in low- and middle-income countries. He noted that addressing antibiotic pollution requires collaboration among researchers, governments, healthcare professionals, industry, and the public to protect the effectiveness of antibiotics.
The research team observed that households account for a significant proportion of pharmaceutical residues entering the environment through wastewater, while hospitals, pharmaceutical manufacturing plants, and veterinary practices also contribute substantially to environmental contamination.
They cited previous studies showing exceptionally high concentrations of antibiotics in water bodies around pharmaceutical manufacturing facilities, particularly in Hyderabad, India, where environmental contamination has been linked to the emergence of multidrug-resistant bacteria.
The researchers explained that bacteria develop resistance through genetic mutations, reduced drug uptake, antibiotic-degrading enzymes, and the transfer of resistance genes through mobile genetic elements such as plasmids, allowing resistant organisms to spread among humans, animals, and the environment.
According to Dr Ajekiigbe and his colleagues, low- and middle-income countries remain particularly vulnerable because of weak wastewater treatment systems, poor pharmaceutical waste management, and inadequate enforcement of environmental regulations.
Beyond environmental impacts, the research team said antimicrobial resistance is making common infections such as pneumonia, urinary tract infections, typhoid, and respiratory diseases increasingly difficult and expensive to treat.
They added that AMR also threatens cancer chemotherapy, organ transplantation, and routine surgical procedures that depend on effective antibiotics to prevent secondary infections.
The review further warned that antibiotic resistance could worsen future epidemics and pandemics by increasing the severity of bacterial co-infections associated with viral diseases such as influenza.
Although several countries have introduced medicine take-back programmes and regulations on antibiotic use, He and his team reported global efforts remain fragmented.
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They highlighted the World Health Organization’s 2024 guidance on wastewater and solid waste management for antibiotic manufacturers as an important step towards reducing pharmaceutical pollution but stressed that effective implementation is essential.
To address the growing challenge, the research team recommended stronger regulation of pharmaceutical manufacturing waste, improved wastewater treatment technologies, expanded medicine take-back programmes, responsible antibiotic prescribing, and sustained public education to discourage self-medication and improper disposal of medicines.
He and his team said adopting a One Health approach, which brings together human, animal, and environmental health, is essential to preserving the effectiveness of antibiotics and preventing antimicrobial resistance from becoming an even greater global health challenge.
Dr Ajekiigbe is a medical doctor, public health researcher, and scientific author with more than 70 peer-reviewed publications. He serves in a research leadership role at Helix Biogen Institute and is a co-founder of the Imperial Academy of Researchers, where he has led research training and mentorship initiatives to strengthen research capacity across Africa.
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