Antibiotics in the global river system arising from human consumption

Antibiotics in surface waters pose risks to aquatic ecosystems and human health due to their toxicity and antimicrobial resistance. After human consumption, residues accumulate and decay in wastewater, reaching oceans or sinks. A global contaminant fate model estimates that 29% of annual human consumption of 40 most used antibiotics is released into rivers, with amoxicillin, ceftriaxone, and cefixime being the dominant contributors. Global antibiotic consumption has grown rapidly, particularly in low- and middle-income countries.