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The Fate of Pharmaceuticals After Wastewater Treatment

Jose A. Polar

xpanding cities are shortening the (PhACs) are of special concern because of the lapse between the release of treated volumes introduced to the environment, their Jose A. Polar is a research analyst with Ewastewater into the environment and endocrine disrupting activity, and a potential the Applied Research Center at Florida the uptake by water drinking facilities. Even increase of bacterial resistance. International University though wastewater treatment plants usually It is estimated that hundreds of tons of exceed current discharge standards, the pres- PhACs are produced and consumed in devel- ence of unregulated pollutants in these efflu- oped countries each year (Castiglioni et al., secondary treatment, this has been ents is of concern (Petrovic et al., 2003). 2005, Kosjek et al., 2005, Daughton & Ternes, detected at an average concentration of 0.22 Unregulated contaminants, or emerging 1999, Tauxe et al., 2005). Most of them end up µg/l in treated wastewaters (Ternes, 1998). pollutants of concern (EPOCs), are defined as being excreted completely unchanged or only , ASA metabolite, has been substances that were previously undetected or slightly transformed conjugated to polar mole- detected at very low concentrations in sewage had not been considered as a risk (Daughton, cules. These conjugates are often broken during effluent and surface waters (Ternes et al., 2001). The main sources of non-regulated sewage treatment, releasing the original PhAC, 1998; Quintana & Reemtsma, 2004). contaminants in the environment are waste- so they are constantly introduced into receiving Acetaminophen is also effectively water treatment plant effluents (Duaghton waters (Heberer, 2002a). The following sections degraded and removed by conventional and Ternes, 1999), which are not designed to will describe the fate of the most characteristic sewage treatment. In Germany it was detect- eliminate these compounds. They are present PhACs during and after wastewater treatment. ed in less than 10 percent of sewage effluents in treated wastewaters at trace levels (µg/l to and rivers (Ternes, 1998), and in the U.S. it ηg/l), and include personal care products, PhACs in Wastewater was detected in only 17 percent of the affect- pharmaceuticals, surfactants, flame retar- Treatment Plant Effluents ed surface waters analyzed in a National sur- dants, industrial chemicals, gasoline additives, & Receiving Surface Waters vey (Koplin et al., 2002). and disinfection byproducts. Some PhACs are easily removed and Some antibiotics also exhibit high These contaminants do not need to be degraded during sewage treatment, mainly by removal rates when exposed to conventional persistent in the environment to cause delete- adsorption and bio-degradation; however, activated sludge treatment. During this rious effects, since their high transformation they can still be detected at the low µg/l level process, penicillins are hydrolyzed and tetra- and removal rates can be offset by their con- in treated effluents and receiving waters. This cyclines precipitate with cations (Heberer, tinuous introduction into the environment is the case for the acetylsalicylic 2002b). Amoxicillin is also removed efficient- (Petrovic et al., 2003). Among the various sub- acid (ASA), fenofibrate, and acetaminophen. ly by biological treatment (Morse and stances that can be categorized as emerging Although ASA is easily degraded into its Jackson, 2004). These antibiotics are still pollutants, pharmaceutical active compounds metabolites, which are effectively removed by found in receiving surface waters, however (Koplin et al., 2002). High rates of oxic degradation for during bench scale experiments resembling wastewater treatment conditions (Zweiner et al., 2003), and removals in the order of 96 to 99.9 percent during sewage treatment have been reported (Buser et al., 1999; Quintana and Reemtsma, 2004). In spite of these high removals, Ibuprofen is still detected in sewage effluents and surface waters at the µg/l level (Farre et al., 2002). Synthetic estrogens such as 17a- ethinylestradiol (EE2) and mestranol (used as birth control drugs) are of special concern because of their potent endocrine disrupting activity. Activated sludge treatment was found to reduce influent concentrations of estrone (E1), 17-estradiol (E2), and 17- ethinylestradiol 93 percent, 93 percent, and 82 percent, respectively, but they are fre- quently found in wastewater treatment plant effluents at the ng/l level (Heberer, 2002a, Quanrud et al., 2004 Aguayo et al., 2004, Verstraeten et al., 2003; Koplin et al., 2002). These remaining low concentrations can still

26 • JUNE 2007 • FLORIDA WATER RESOURCES JOURNAL exhibit endocrine disrupting activity (sulfamethoxazole, sulfadimethoxine, sul- µg/l level in the South District Wastewater (Verstraeten et al., 2003). famethazine and sulfathiazole), fluoro- Treatment Plant effluent in the Miami-Dade Some drugs appear to degrade very little quinolones (, , nor- area (Lietz and Meyer, 2006). or none when treated with conventional acti- floxacin, end enrofloxacin), chlorampheni- In general, wastewater treatment plants vated sludge. That is the case for iodinated X- col, tylosin, and trimethoprim (Koplin et al., with higher retention times have a better per- ray contrast media and the analgesic propy- 2002; Heberer., 2002b; Gobel et al., 2004, formance in removing analgesic/anti-inflam- (Ternes et al., 2001). Hirsch et al., 1999, Sedlak et al., 2005). atory drugs and lipid regulators. Tertiary Chemical structure seems to be a signifi- Other such compounds are beta-block- treatment eliminates these drugs more effi- cant factor in determining removal rates. ers such as atenolol, sotalol, celiprolol, meto- ciently than secondary treatment does. Medium polar drugs are removed on average prolol, propanolol, and bisoprolol (Ternes, Granular activated carbon appears to be between 60 and 90 percent (Ternes, 1998), 1998; Sacher et al., 1999; Ternes et al., 2003; effective in removing PhACs completely, while polar compounds exhibit lower Sedlak et al., 2005); the antiepileptic except for antibiotics (Sedlak et al., 2005), removals during wastewater treatment, since (Heberer, 2002b); the psychiatric and none of the previously mentioned com- they are less adsorbed onto activated sludge drugs diazepam and carbamezapine; and the pounds (lipid regulators, antiepileptics, anal- particles (Hirsch et al., 1999). Some of these anti-angina drug nifedipine (Ternes et al., gesics, antibiotics, and anti-inflamatories) polar drugs exhibit a maximum removal of 2001, Ternes et al., 2003). can be detected after treating tertiary effluent only 7 to 10 percent, such as the antiepileptic Blood lipid regulator compounds such with a micro-filtration/reverse osmosis com- (Ternes, 1998; Ternes et al., as bezafibrate, gemfibrozil, fenofibric acid bination (Drewes et al., 2003b). 2003; Heberer, 2002a; Stackelberg et al., 2004). (fenofibrate metabolite), and clofibric acid Not even extended retention times or (clofibrate metabolite) (Ternes, 1998; Ternes PhACs in Groundwater tertiary treatment seems to be effective when et al., 2003; Heberer, 2002b); the anti-diabet- Indirect potable reuse through soil treating this drug. Only micro-filtration fol- ic drug glibenclamide (Ternes et al.,2001); the aquifer treatment (SAT) and bank filtration is lowed by reverse osmosis has been reported X-ray contrast media compounds diatrizoate, a common practice in Europe and in some effective in eliminating anti-epileptics from iopamidol, iopromide, and iomeprol (Ternes regions of the U.S. SAT consists of the appli- the effluents (Drewes et al., 2003b). at al., 2003); and the antineoplastics cation of treated wastewater into the ground Another polar PhAC exhibiting low (chemotherapy drugs) ifosfamide and (usually through infiltration from a pond) removal (17 percent) during sewage treat- cyclophosphamide (associated with hospital with aquifer recharge purposes. Bank filtra- ment is the analgesic . High per- discharges) (Ternes, 1998) are all found in tion consists of the recharge of an aquifer centages (up to 95 percent) have been recov- treated effluents at the low µg/l level, along with water infiltrated from a river bank ered after treatment in traditional municipal with those listed in the preceding three para- before being used as a drinking water source. plants (Zwiener et al., 2003, Koutsouba et al., graphs. These two approaches have been proved 2003), and sometimes higher concentrations South Florida is no exception. effective in reducing total organic carbon are found in the effluents because of desorp- Salbutamol, cimetidine, ranitidine, 1,7- (TOC), pathogens, and disinfection byprod- tion processes (Quintana and Reemtsma, dimethylxanthine, diltiazem, warfarin, dehy- ucts (DBPs) precursors in recharged waters 2004). Despite its poor removal during drodifedipine, thiabendazole, diphenhy- (Weiss et al., 2003). Adsorption to soil parti- sewage treatment, diclofenac seems to be dramine, carbamezapine, and the antibiotics cles during infiltration seems to be a good readily photodegraded (Heberer, 2002a; erythromycin, trimethroprim, ciprofloxacin, barrier for non-polar compounds. This is the Buser et al., 1998). ofloxacin, sulfadiazine, sulfamethoxazole, case for the lipid regulator bezafibrate, which Clofibric acid (the blood lipid regulator and have been detected at the low Continued on page 28 clofibrate polar metabolite) presents a very low to no removal under conventional sewage treatment conditions (Heberer, 2002a; Quintana & Reemstma, 2004, Koutsouba et al., 2003), and can also be found in surface waters affected by treated wastewater (Quintana & Reemstma, 2004). Regardless of the removal efficiency of a conventional activated sludge treatment plant, it is evident that PhACs and their metabolites will be found in the effluents and receiving water bodies. Among these com- pounds, we have analgesics and anti-inflam- matory drugs such as 4-aminoantirpryne, , , , , indometacine, , ibuprofen, diclofenac, , , phenazone, and (Ternes, 1998; Heberer, 2002b; Ternes et al., 2001, Drewes et al., 2002, Sedlak et al., 2005; Quintana & Reemtsma, 2004). Also included are antibiotics such as macrolides (clarithromycin, dehydro-eryth- romycin (erythromycin metabolite), rox- ithromycin, and lincomycin), sulfonamides

FLORIDA WATER RESOURCES JOURNAL • JUNE 2007 • 27 Continued from page 27 cent removal can be achieved by percolation the attenuation of polar PhACs. Polar com- is readily adsorbed during bank filtration ponds at a 10m depth, and complete removal pounds show low retardation and are not sig- (Heberer, 2002a). has been reported down gradient infiltration nificantly adsorbed to soil particles leaching A period of six months of groundwater operations (Verstraeten et al., 2003). into groundwater. Soil column experiments transport can completely eliminate acidic From this data, one can infer that have found that clofibric acid presents no sig- drugs, such as diclofenac, ibuprofen, ketopro- groundwater is not significantly affected by nificant adsorption to soil particles (Heberer, fen, naproxen, fenoprofen, and gemfibrozil, non-polar to low-polarity compounds (e.g. 2002a), and therefore it is frequently detected from secondary effluent infiltrated using estrogenic compounds and acidic drugs) in groundwater. The anti-epileptics carba- recharge basins (Drewes et al., 2002, Drewes because they are readily adsorbed onto sedi- mazepine and primidone appear not be et al., 2003a). Bank filtration has also proved ments and subsoil particles preventing them affected by SAT at any extent, since concen- to remove diclofenac efficiently through from polluting drinking water sources; how- trations in samples obtained down-gradient sorption (Heberer, 2002a). Even small dis- ever, even drugs that are efficiently removed recharge operations are very similar to those tances (30.5m) of sub-soil transport can by SAT can be found in groundwater. in the secondary effluent infiltrated even after achieve complete removal of acidic drugs Analgesics such as diclofenac, ibuprofen, six years of transport through the aquifer (Sedlak et al., 2005). ketoprofen, phenazone, propyphenazone, (Sacher et al., 1999, Drewes et al., 2002, Synthetic and human hormones are also and gentisic acid have been detected in Heberer et al., 2002). removed efficiently by SAT. Soil column exper- groundwater samples (Sacher et al., 1999, X-ray contrast media easily percolates iments report 17b-estradiol, estriol, and testos- Heberer, 2002b). The antibiotics trimetho- into groundwater aquifers (Sacher et al., 1999, terone removals in the order of 79 percent, 84.3 prim, sulfadiazine, sulfadimidine, sul- Heberer, 2002a). Polar compounds such as percent, and 97.5 percent, respectively, mainly famethoxazole, sulfamethazine, ronidazol, clofibric acid and carbamazepine have been due to sorption and bio-degradation (Mansell dapson, anhydro-erythromycin, rox- reported at depths ranging from 5 to 80 m at et al., 2004). These compounds exhibit low ithromycin and ciprofloxacin are partially concentrations in the order of 100 to 180 ng/l mobility in subsurface systems. removed by SAT (Sacher et al., 1999, Sedlak et (Verstraeten et al., 2003; Heberer, 2002a). Estriol and testorone can be completely al., 2005). removed (<0.6 ng/l) only after 1.5m of trans- The blood lipid regulators fenofibrate, PhACs in Drinking Water port through porous media; 17b-estradiol is gemfibrozil, and its metabolite, clofibric acid, Eventually, some of the most polar and somehow more mobile. None of these three have been found in groundwater aquifers in persistent PhACs can reach aquifers or sur- compounds, however, is commonly detected Germany at the ng/l level (Heberer, 2002b). face waters used as drinking water sources, in monitoring wells down gradient spreading Beta-blockers are patially removed by SAT, survive treatment, and go through water dis- operations (Mansell and Drewes, 2004). and can also be found in groundwater sam- tribution systems. Estrone is also efficiently removed ples (Sedlak et al., 2005, Sacher et al., 1999). Diatrizoate, iopromide, and iopamidol through percolation. A minimum of 90 per- SAT seems to have little or no effect in (X-ray contrast media) have been detected in

28 • JUNE 2007 • FLORIDA WATER RESOURCES JOURNAL drinking water wells (Ternes et al., 2001). A PhACs might also have an effect over Quanrud et al., 2004). study performed in the U.S. sampled raw and environmental receptors. Drugs are designed Acute effects are not the only concern treated water at a drinking water treatment to act over certain tissues, yet several side affecting aquatic species. The continuous facility and found that , cotinine effects, not fully understood, might be pres- introduction of these chemicals into the envi- (nicotine metabolite), and the PhACs carba- ent in non-target receptors. In the same man- ronment could elicit imperceptible effects mazepine and dehydronifedipine (nifedipine ner, drugs that reach non-target species that might accumulate over time, causing metabolite) survived a coagulation, floccula- through wastewater discharges might have profound ecological changes such as adapta- tion, activated carbon adsorption, filtration, unpredictable effects (Daughton & Ternes, tion or ecological succession (Daughton & and disinfection train, and these compounds 1999; Gobel et al., 2004). Ternes, 1999). were detected in drinking water samples at Also, pharmaceuticals that modulate the low µg/l level (Stackelberg et al., 2004). endocrine and immune systems have a great Conclusions Analgesics such as diclofenac, ibuprofen, potential of acting as endocrine disruptors It can be concluded that traditional and phenazone, and the lipid regulator (Daughton & Ternes, 1999). Antibiotics and wastewater treatment (activated sludge) does metabolite clofibric acid have been detected antimicrobial agents (e.g. triclosan) are of not eliminate most of the so-called “emerging in drinking water samples in Germany concern because they could have direct pollutants” (they can be removed using (Heberer, 2002b). It must be pointed out that effects over microbial populations, altering advanced treatment, though). Their low con- these sites extract water from aquifers the community structure and increasing the centrations and the abundance of other car- recharged through bank filtration from rivers resistance of human pathogens in the envi- bon sources prevent their complete removal. heavily loaded with wastewater treatment ronment (Daughton & Ternes, 1999; Gobel et They are present in treated sewage generally plant effluents, where municipal sewage can al., 2004; Hirsch et al., 1999). at concentrations ranging from the low ng/l be 40 percent and 80 percent of the river flow Endocrine disrupting compounds to the medium µg/l levels. during wet and dry season, respectively. (EDCs) are chemicals that can either mimic The same can be said about receiving Especially in heavily populated areas, natural hormones or increase or decrease waters, with the difference that several mech- such as Europe, several pharmaceutical com- hormone production (Mansell et al., 2004). anisms tend to decrease these concentrations pounds are in a cycle from human applica- Compounds with estrogenic activity include even more (e.g. biodegradation, sorption, tion via human excretions, wastewater treat- a large number of natural and synthetic hor- photodegradation). Nevertheless, the contin- ment plants, surface waters/groundwater mones, pharmaceuticals, pesticides, and uous introduction of these chemicals in the recharge, and back to humans through drink- industrial/household chemicals (Quanrud et environment makes them “persistent,” ing water (Heberer et al., 2002). al., 2004). regardless of their environmental half life. Estrogens (synthetic and natural) such Some PhACs reach drinking water sup- Effects as 17α-ethinylestradiol (EE2) and 17β- plies at trace levels, and some of these chem- Health effects of the consumption of Estradiol (E2) have been proved to provoke icals survive drinking water treatment to be PhACs at low concentration levels are not feminization of some aquatic species at very introduced in potable water distribution sys- fully understood (Kimura et al., 2004), and it low concentrations (<< 1nM) (Quanrud et tems. Although human exposure to PhACs hasn’t been determined yet if levels of PhACs al., 2004, Mansell & Drewes, 2004). Effects of has been verified by several studies, the effects found in drinking water pose a human health human exposure to EDCs are uncertain, but of this exposure through drinking water con- risk (Richardson, 2003). some types of cancers (testicular and breast) sumption are far from being understood, and PhACs’ effects are tested on humans are suspected to be product of exposure to the fact that these chemicals are not present before being released to the public. These estrogenic compounds (Conroy, et al., 2005; Continued on page 30 studies are characterized by high doses and short terms; however, little is known of the possible effects of long-term exposure at very low dosages (e.g. drinking water). Some research indicates that the low concentrations of PhACs and other contami- nants present in drinking water are not harmful to humans from a toxicological point of view, but their presence is still not desirable as a precautionary principle (Heberer, 2002a). Others express their con- cern about the lifetime ingestion via drinking water of very low sub-therapeutic doses of several pharmaceuticals, which might pose a long-term risk for humans. Not much is known, either, about the possible effects that the combination of sev- eral drugs can have in human health (Stackelberg et al., 2004). Even though drugs are present in aquatic environments at the low or sub ng/l level, there is concern that the presence of several drugs sharing a specific mode of action could lead to significant effects through additive exposures (Daughton & Ternes, 1999).

FLORIDA WATER RESOURCES JOURNAL • JUNE 2007 • 29 Continued from page 29 • Buser, H., Poiger, T., Muller, M. November 1998. • Farré, M., Klöter, G., Petrovic, M., Alonso, alone makes even harder to understand their Occurrence and fate of the pharmaceutical M.C., López de Alda, M.J., Barceló, D. April possible combined effects. drug Diclofenac in surface waters: Rapid pho- 2002. Identification of toxic compounds in Further removal improvement of these todegradation in a lake. Environmental Science wastewater treatment plants during a field contaminants from treated wastewater is and Technology, v 32, n 22, p 3449-3456 experiment. Analytica Chimica Acta, v 456, n 1, required, particularly in cases where water is • Buser, H., Poiger, T., Muller, M. August 1999. p 19-30 reused for aquifer recharge or released into Occurrence and environmental behavior of the • Gobel, A., McArdell, C., Suter, J., Giger, W. sensitive ecosystems. In South Florida, there chiral pharmaceutical drug ibuprofen in surface 2004. Trace determination of Macrolide and waters and in wastewater. Environmental Sulfonamide antimicrobials, a human are several ongoing reuse projects, and many Science and Technology, v 33, n 15, p 2529- Sulfonamide metabolite, and Trimethoprim in more are being considered. Whatever the 2535 wastewater using Liquid Chromatography cou- intended use for the recycled water (golf • Castiglioni, S., Bagnati, R., Calamari, D., pled to Electrospray Tandem Mass course irrigation, aquifer recharge, or the Fanelli, R., Zuccato, E. October 2005. A mul- Spectrometry. Analytical Chemistry, v 76, n 16, Everglades Restoration Project), it is a neces- tiresidue analytical method using solid-phase p 4756-4764 sity to address the issue of PhACs and EPOCs extraction and high-pressure liquid chro- • Heberer, T. 2002a. Occurrence, fate, and in general. matography tandem mass spectrometry to removal of pharmaceutical residues in the Some reuse facilities are achieving measure pharmaceuticals of different thera- aquatic environment: a review of recent emerging pollutants removals below detec- peutic classes in urban wastewaters. Journal of research data. Toxicology Letters, v 131, p 5-17 tion limits by using advanced oxidation Chromatography A, v 1092, n 2 ,p 206-215. • Heberer, T. 2002b. Tracking persistent pharma- processes or reverse osmosis filtration, but as • Conroy, O., Quanrud, D., Ela, W., Wicke, D., ceutical residues from municipal sewage to long as regulations do not address their pres- Lansey, K., Arnold, R. April 2005. Fate of drinking water. Journal of Hydrology, v 266, p ence in treated effluents, it is expected that wastewater effluent hER-Agonists and hER- 175-189 the use of these advanced technologies will Antagonists during soil aquifer treatment. • Heberer, T., Reddersen, K., Mechlinski, A. 2002. remain relegated to certain specific reuse Environmental Science and Technology, v 39, n From municipal sewage to drinking water: fate operations. 7, p 2287-2293 and removal of pharmaceutical residues in the • Daughton, C., Ternes, T. December 1999. aquatic environment in urban areas. Water References Pharmaceuticals and personal care products in Science and Tecnology, v 3, p 81-88 the environment; agents of subtle change? • Hirsch, R., Ternes, T., Haberer, K., Kratz, K. • Aguayo, S., Muñoz, J., de la Torre, A., Roset, Environmental Health Perspectives, v 107, n 6, 1999. Occurrence of anti-biotics in the aquatic J., de la Peña, E., Carballo., M. July 2004. p 907-938 environment. 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30 • JUNE 2007 • FLORIDA WATER RESOURCES JOURNAL hormones during soil-aquifer treatment. Spectrometry, v 18, p 765-774 water. Vom Wasser, v 90, p 295-309 Ground Water Monitoring and Remediation, v • Richardson, S. 2003. Disinfection by-products • Ternes, T., Bonerz, M., Schmidt, T. 2001. 24, n 2, p 94-101 and other emerging contaminants in drinking Determination of neutral pharmaceuticals in • Mansell, J., Drewes, J., Rauch T. 2004. water. Trends in Analytical Chemistry, v 22, n wastewater and rivers by liquid chromatogra- Removal mechanisms of endocrine disrupting 10, p 666-684 phy-electrospary tandem mass spectrometry. compounds (steroids) during soil aquifer treat- • Sacher, F., Lange, T., Brauch, H., Balnkenhorn, Journal of Chromatography A, v 938, p 175-185 ment. Water Science and Technology, v 50, n I. 1999. Pharmaceuticals in groundwaters. • Ternes, T., Stuber, J., Herrmann, N., McDowell, 2, p 229-237 Analytical methods and results of a monitoring D., Ried, A., Kapmann, M., Teiser, B. 2003. • Morse, A., Jackson, A. September 2004. Fate program in Baden-Wurttemberg, Germany. Ozonation: a tool for removal of pharmaceuticals, of amoxicillin in two water reclamation sys- Journal of Chromatography A, v 938, p 199-210 contrast media, and musk frgances form waste- tems. Water, Air, and Soil Pollution, v 157, n 1- • Sedlak, D., Pinkston, K., Huang, C. 2005. water? Water Research, v 37, p 1976-1982 4, p 117-132 Occurrence survey of pharmaceuticals active • Verstraeten, I., Heberer, T., Vogel, J., Speth, T., • Petrovic, M., Gonzales, S., Barcelo, D. 2003. compounds. AWWA Research Foundation and Zuehlke, S., Duennbier, U. October 2003. Analysis and removal of emerging contami- American Water Works Association, 91051 Occurrence of endocrine-disrupting and other nants in wastewater and drinking water. Trends • Stackelberg, P., Furlong, E., Meyer, M., Zaugg, wastewater compounds during water treat- in Analytical Chemistry, v 22, n 10, p685-696 S., Henderson, A., Reissman, D. 2004. ment with case studies from Lincoln, Nebraska • Quanrud, D., Carroll, S., Gerba C., Arnold., R. Persistenece of pharmaceutical compounds and and Berlin, Germany. Practice Periodical of February 2003. Virus removal during simulated other organic wastewater contaminants in a con- Hazardous, Toxic, and Radioactive Waste soil-aquifer treatment. Water Research, v 37, n ventional drinking water treatment plant. Science Management, v 7, n 4, p 253-263 4, p 753-762 of the Total Environment, v 329, p 99-113 • Weiss, J., Bouwer, E., Ball, W., O’Melia, C. • Quanrud, D., Quast, K., Conroy, O., Karpiscak, • Tauxe-Wuersch, A., De Alencastro, L., October 2003. Riverbank filtration-fate of DBP M., Gerba, C., Lansey, K., Ela, W., Arnold, R. Grandjean, D., Tarradellas. J. May 2005. precursors and selected microorganisms. Spring 2004. Estrogenic activity and volume Occurrence of several acidic drugs in sewage American Water Works Association. Journal, v fraction of waste water origin in monitoring treatment plants in Switzerland and risk 95, n 10, p 68-80 wells along the Santa Cruz River, Arizona. assessment. Water Research, v 39, n 9, p • Zwiener, C., Frimmel, F. 2003. Short-term tests Ground Water Monitoring and Remediation, v 1761-1772 with a pilot sewage plant and biofilm reactors 24, n 2, p 86-93 • Ternes, T. 1998. Occurrence of drugs in for the biological degradation of the pharma- • Quinata, J., Reemstsma, T. 2004. Sensitive German sewage treatment plants and rivers. ceutical compounds clofibric acid, ibuprofen, determination of acidic drugs and triclosan in Water Research, v 32, n 11, p 3245-3260 and diclofenac. The Science of the Total surface and wastewater by ion-pair reverse- • Ternes, T., Stumpf, M., Schuppert, B., Heberer, Environment, v 309, p 201-211 S phase liquid chromatography/tandem mass K. 1998. Simultaneous determination of anti- spectrometry. Rapid Communications in Mass septics and acidic drugs in sewage and river

FLORIDA WATER RESOURCES JOURNAL • JUNE 2007 • 31