Evaluation of the Efficiency of Activated Sludge Process in Cefazolin and Doxorubicin Antibiotics Removal from Hospital Wastewater

Document Type : Original Article


Department of Chemical Engineering, Qaemshahr Branch, Islamic Azad University, Qaemshahr, Iran


Antibiotics and anticancer drugs have particular importance because of their environmental pollutants. The efficacy of the activated sludge process in the removal of Cefazolin and Doxorubicin from hospital wastewater in Sari city (Mazandaran Province) was investigated. The hospital effluent was investigated in different months from different parts of the effluent treatment system and their residual amount was determined by HPLC. The residual amounts of Cefazolin and Doxorubicin in the effluent were 1.96 μg. L-1 and 0.95 mg. L-1, respectively. Results showed 36.24% Doxorubicin and 51.6% Cefazolin removal through the activated sludge process. After chlorination, a 45.64% Doxorubicin and 66.42% Cefazolin removal was achieved. It was found that the effect of initial treatment or settling is low in reducing the amount of studied drugs, but the efficacy of different stages of biological treatment varies with the type of contaminant. The effect of the activated sludge process on the polar antibiotic Cefazoline is higher than the anticancer drug Doxorubicin. The unknown risk assessment of these drugs in the environment and the inability of wastewater treatment plants to remove them requires the use of more advanced methods.


1.    Gadipelly, C., Pérez-González, A., Yadav, G. D., Ortiz, I., Ibáñez, R.,  Rathod,  V.  K., & Marathe, K. V., 2014, July 23, Pharmaceutical industry wastewater: Review of the technologies for water treatment and reuse, Industrial and Engineering Chemistry Research, 53(29): 11571-11592. https://doi.org/10.1021/ie501210j
2.    Gunnarsdóttir, R., Jenssen, P. D., Erland Jensen, P., Villumsen, A., & Kallenborn, R., 2013, A review of wastewater handling in the Arctic with special reference to pharmaceuticals and personal care products (PPCPs) and microbial pollution, Ecological Engineering, 50: 76–85. https://doi.org/10.1016/j.ecoleng.2012.04.025
3.    Fadaei-Kermani, E., Barani, G. A., & Memarzadeh, R., 2019, Drought Utilization Management of Surface and Ground Water (Case study: Qaryat-Al-Arab Watershed), Iranian (Iranica) Journal of Energy and Environment, 10(4): 275–280. https://doi.org/10.5829/ijee.2019.10.04.08
4.    Derakhshan, Z., Mokhtari, M., Babaei, F., Ahmadi, R. M., Ehrampoush, M. H., & Faramarzian, M., 2016, Removal Methods of Antibiotic Compounds from Aqueous Environments– A Review, Journal of Environmental Health and Sustainable Development, 1(1): 43–62. Retrieved from http://jehsd.ssu.ac.ir/article-1-26-en.html
5.    Aga, D. S., Lenczewski, M., Snow, D., Muurinen, J., Sallach, J. B., & Wallace, J. S., 2016, Challenges in the Measurement of Antibiotics and in Evaluating Their Impacts in Agroecosystems: A Critical Review, Journal of Environmental Quality, 45(2): 407–419. https://doi.org/10.2134/jeq2015.07.0393
6.    Rahman-Al Ezzi, A. A., & Alhamdiny, S. H., 2019, Elimination of Chloroform (CHCl 3 ) from Drinking Water via a Synergistic Effect of  Stripping,  Oxidation  and  Adsorption  Process  in  Air  Lift Loop Reactor, Iranian (Iranica) Journal of Energy and Environment, 10(2): 85–90. https://doi.org/10.5829/ijee.2019.10.02.03
7.    Guan, Y., Wang, B., Gao, Y., Liu, W., Zhao, X., Huang, X., & Yu, J., 2017, Occurrence and Fate of Antibiotics in the Aqueous Environment and Their Removal by Constructed Wetlands in China: A review, Pedosphere, 27(1): 42–51. https://doi.org/10.1016/S1002-0160(17)60295-9
8.    Carraro, E., Bonetta, S., Bertino, C., Lorenzi, E., Bonetta, S., & Gilli, G., 2016, March 1, Hospital effluents management: Chemical, physical, microbiological risks and legislation in different countries, Journal of Environmental Management, 168: 185-199. https://doi.org/10.1016/j.jenvman.2015.11.021
9.    Liu, H., Liu, W., Zhang, J., Zhang, C., Ren, L., & Li, Y., 2011, Removal of cephalexin from aqueous solutions by original and Cu(II)/Fe(III) impregnated activated carbons developed from lotus stalks Kinetics and equilibrium studies, Journal of Hazardous Materials, 185(2–3): 1528–1535. https://doi.org/10.1016/j.jhazmat.2010.10.081
10. Rivera-Utrilla, J., Sánchez-Polo, M., Ferro-García, M. Á., Prados-Joya, G., & Ocampo-Pérez, R., 2013, October 1, Pharmaceuticals as emerging contaminants and their removal from water. A review, Chemosphere, 93(7): 1268-1287. https://doi.org/10.1016/j.chemosphere.2013.07.059
11. El-Ghenymy, A., Oturan, N., Oturan, M. A., Garrido, J. A., Cabot, P. L., Centellas, F., … Brillas, E., 2013, Comparative electro-Fenton and UVA photoelectro-Fenton degradation of the antibiotic sulfanilamide using a stirred BDD/air-diffusion tank reactor, Chemical Engineering Journal, 234: 115–123. https://doi.org/10.1016/j.cej.2013.08.080
12. Ngigi, A. N., Magu, M. M., & Muendo, B. M., 2020, Occurrence of antibiotics residues in hospital wastewater, wastewater treatment plant, and in surface water in Nairobi County, Kenya, Environmental Monitoring and Assessment, 192(1): 1–16. https://doi.org/10.1007/s10661-019-7952-8
13. Wang, Q., Wang, P., & Yang, Q., 2018, Occurrence and diversity of antibiotic resistance in untreated hospital wastewater, Science of the Total Environment, 621: 990–999. https://doi.org/10.1016/j.scitotenv.2017.10.128
14. Lien, L., Hoa, N., Chuc, N., Thoa, N., Phuc, H., Diwan, V., … Lundborg, C., 2016, Antibiotics in Wastewater of a Rural and an Urban Hospital before and after Wastewater Treatment, and the Relationship with Antibiotic Use—A One Year Study from Vietnam, International Journal of Environmental Research and Public Health, 13(588): 1–13. https://doi.org/10.3390/ijerph13060588
15. Ledezma Estrada, A., Li, Y. Y., & Wang, A., 2012, Biodegradability enhancement of wastewater containing cefalexin by means of the electro-Fenton oxidation process, Journal of Hazardous Materials, 227–228: 41–48. https://doi.org/10.1016/j.jhazmat.2012.04.079
16. Kumar, M., Jaiswal, S., Sodhi, K. K., Shree, P., Singh, D. K., Agrawal, P. K., & Shukla, P., 2019, March 1, Antibiotics bioremediation: Perspectives on its ecotoxicity and resistance, Environment International, 124: 448-461. https://doi.org/10.1016/j.envint.2018.12.065
17. Ahmed, I., Rabbi, M. B., & Sultana, S., 2019, March 1, Antibiotic resistance in Bangladesh: A systematic review, International Journal of Infectious Diseases, 80: 54-61. https://doi.org/10.1016/j.ijid.2018.12.017
18. Ogawara, H., 2019, Comparison of Antibiotic Resistance Mechanisms in Antibiotic-Producing and Pathogenic Bacteria, Molecules, 24(3430): 1–55. https://doi.org/10.3390/molecules24193430
19. Santiago-Morales, J., Agüera, A., Gómez, M. del M., Fernández-Alba, A. R., Giménez, J., Esplugas, S., & Rosal, R., 2013, Transformation products and reaction kinetics in simulated solar light photocatalytic degradation of propranolol using Ce-doped TiO2, Applied Catalysis B: Environmental, 129: 13–29. https://doi.org/10.1016/j.apcatb.2012.09.023
20. Haidar, M., Dirany, A., Sirés, I., Oturan, N., & Oturan, M. A., 2013, Electrochemical degradation of the antibiotic sulfachloropyridazine by hydroxyl radicals generated at a BDD anode, Chemosphere, 91(9): 1304–1309. https://doi.org/10.1016/j.chemosphere.2013.02.058
21. Kanehisa, M., Furumichi, M., Tanabe, M., Sato, Y., & Morishima, K., 2017, KEGG: New perspectives on genomes, pathways, diseases and drugs, Nucleic Acids Research, 45(D1): D353–D361. https://doi.org/10.1093/nar/gkw1092
22. Alqahtani, S. A., Kleiner, D. E., Ghabril, M., Gu, J., Hoofnagle, J. H., & Rockey, D. C., 2015, Identification and characterization of cefazolin-induced liver injury, Clinical Gastroenterology and Hepatology, 13(7): 1328-1336. https://doi.org/10.1016/j.cgh.2014.11.036
23. Tacar, O., Sriamornsak, P., & Dass, C. R., 2013, February 1, Doxorubicin: An update on anticancer molecular action, toxicity and novel drug delivery systems, Journal of Pharmacy and Pharmacology, 65(2): 157-170. https://doi.org/10.1111/j.2042-7158.2012.01567.x
24. Borišev, I., Mrdanovic, J., Petrovic, D., Seke, M., Jović, D., Srdenović, B., … Djordjevic, A., 2018, June 11, Nanoformulations of doxorubicin: How far have we come and where do we go from here?, Nanotechnology, 29(33): 332002. https://doi.org/10.1088/1361-6528/aac7dd
25. Karami, N., Mohammadi, P., Zinatizadeh, A., Falahi, F., & Aghamohammadi, N., 2018, High rate treatment of hospital wastewater using activated sludge process induced by high-frequency ultrasound, Ultrasonics Sonochemistry, 46: 89–98. https://doi.org/10.1016/j.ultsonch.2018.04.009
26. Baghapour, M. A., Shirdarreh, M. R., & Faramarzian, M., 2015, Amoxicillin removal from aqueous solutions using submerged biological aerated filter, Desalination and Water Treatment, 54(3): 790–801. https://doi.org/10.1080/19443994.2014.888014
27. Lutterbeck, C. A., Wilde, M. L., Baginska, E., Leder, C., Machado, Ê. L., & Kümmerer, K., 2015, Degradation of 5-FU by means of advanced (photo)oxidation processes: UV/H2O2, UV/Fe2+/H2O2 and UV/TiO2 - Comparison of transformation products, ready biodegradability  and  toxicity,  Science  of  the  Total   Environment, 527–528: 232–245. https://doi.org/10.1016/j.scitotenv.2015.04.111
28. Shraim, A., Diab, A., Alsuhaimi, A., Niazy, E., Metwally, M., Amad, M., … Dawoud, A., 2017, Analysis of some pharmaceuticals in municipal wastewater of Almadinah Almunawarah, Arabian Journal of Chemistry, 10: S719–S729. https://doi.org/10.1016/j.arabjc.2012.11.014
29. Kadu, B. S., Wani, K. D., Kaul-Ghanekar, R., & Chikate, R. C., 2017, Degradation of doxorubicin to non-toxic metabolites using Fe-Ni bimetallic nanoparticles, Chemical Engineering Journal, 325: 715–724. https://doi.org/10.1016/j.cej.2017.05.097
30. Kennedy Neth, N. L., Carlin, C. M., & Keen, O. S., 2017, Doxycycline transformation and emergence of antibacterially active products during water disinfection with chlorine, Environmental Science: Water Research and Technology, 3(6): 1086–1094. https://doi.org/10.1039/c7ew00215g
31. Nikolaou, A., Meric, S., & Fatta, D., 2007, Occurrence patterns of pharmaceuticals in water and wastewater environments, Analytical and Bioanalytical Chemistry, 387(4): 1225–1234. Springer. https://doi.org/10.1007/s00216-006-1035-8
32. Moussavi, G., khavanin, A., & Alizadeh, R., 2010, The integration of ozonation catalyzed with MgO nanocrystals and the biodegradation for the removal of phenol from saline wastewater, Applied Catalysis B: Environmental, 97(1–2): 160–167. https://doi.org/10.1016/j.apcatb.2010.03.036
33. Zhang, J., Chang, V. W. C., Giannis, A., & Wang, J. Y., 2013, February 5, Removal of cytostatic drugs from aquatic environment: A review, Science of the Total Environment, 445-446: 281-298. https://doi.org/10.1016/j.scitotenv.2012.12.061
34. Joss, A., Andersen, H., Ternes, T., Richle, P. R., & Siegrist, H., 2004, Removal of estrogens in municipal wastewater treatment under aerobic and anaerobic conditions: Consequences for plant optimization, Environmental Science and Technology, 38(11): 3047–3055. https://doi.org/10.1021/es0351488
35. Joss, A., Keller, E., Alder, A. C., Göbel, A., McArdell, C. S., Ternes, T., & Siegrist, H., 2005, Removal of pharmaceuticals and fragrances in biological wastewater treatment, Water Research, 39(14): 3139–3152. https://doi.org/10.1016/j.watres.2005.05.031
36. Clara, M., Strenn, B., Gans, O., Martinez, E., Kreuzinger, N., & Kroiss, H., 2005, Removal of selected pharmaceuticals, fragrances and endocrine disrupting compounds in a membrane bioreactor and conventional wastewater treatment plants, Water Research, 39(19): 4797–4807. https://doi.org/10.1016/j.watres.2005.09.015
37. Snyder, S. A., Adham, S., Redding, A. M., Cannon, F. S., DeCarolis, J., Oppenheimer, J., Yoon, Y., 2007, Role of membranes and activated carbon in the removal of endocrine disruptors and pharmaceuticals, Desalination, 202(1–3): 156–181. https://doi.org/10.1016/j.desal.2005.12.052
38. Hashemi, H., Bovini, A., Hung, Y., & Amin, M., 2013, A review on wastewater disinfection, International Journal of Environmental Health Engineering, 2(1): 22-30. https://doi.org/10.4103/2277-9183.113209
39.           Emara, Y., Siegert, M.-W., Lehmann, A., & Finkbeiner, M., 2018, Life Cycle Management in the Pharmaceutical Industry Using an Applicable and Robust LCA-Based Environmental Sustainability Assessment Approach, In Designing Sustainable Technologies, Products and Policies (pp. 79–88). Springer International Publishing. https://doi.org/10.1007/978-3-319-66981-6_9