Ecotoxicity and carbon footprint of commonly used antibiotics: Moving towards environmentally sustainable use

Introduction The environmental impact of antibiotics is described as high, although it has never been precisely assessed. We evaluated the environmental impact of some antibiotics.Methods Environmental impact was measured by (i) carbon footprint (CF) through Life Cycle Assessment and (ii) ecotoxicity, assessed by the Risk Quotients for the risk of antimicrobial resistance development (RQ-R), calculated from median environmental concentrations and theoretical Predicted No-Effect Concentrations (PNECs).Results Production of antibiotics in Europe reduces CF compared to production in Asia. Intravenous (IV) levofloxacin has a higher CF than per os levofloxacin. IV push has a lower CF than IV drip administration. Ceftriaxone and azithromycin have respectively a lower CF than cefotaxime and clarithromycin. Although co-trimoxazole CF is higher than that of fluoroquinolones, its RQ-R is lower.Conclusion Although discrepancies between CF and eco-toxicity limit recommendations, these two parameters may guide decisions to reduce environmental footprint in a One-Health approach.