There is growing interest in the role of secondary bacterial and fungal infections as a cause of increased morbidity and mortality in COVID-19 patients,1 with reports of up to 95% of COVID-19 inpatients being prescribed antibiotics.2 Concerns have been raised over the environmental implications of such a large-scale drug administration3 and statements made about the potential impacts of COVID-19-related antibiotic prescription on antimicrobial resistance (AMR) and other toxicological effects on the environment.4 The UK National Strategy aims for a world in which AMR is effectively contained, controlled and mitigated by 2040.5 Taking a ‘One Health’ approach to effective stewardship in settings such as those being experienced in the current pandemic will be key to minimizing the negative impacts of antibiotic use. A large proportion of some drugs (and metabolites) are excreted by patients into wastewater treatment works (WwTW), leading to release of drug residues into effluent-receiving rivers and coastal waters. Environmental concentrations and impacts will be greatest where drugs are used in high volumes, pass through WwTW largely undegraded and are discharged into rivers with limited dilution.



Publication Date


Publication Title

Journal of Antimicrobial Chemotherapy



Embargo Period


Organisational Unit

School of Geography, Earth and Environmental Sciences

Creative Commons License

Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License
This work is licensed under a Creative Commons Attribution-NonCommercial-Share Alike 4.0 International License.