Antibiotic residues and resistant organisms contaminate water and soil

Antibiotic residues, resistant bacteria and resistance genes enter water and soil through pharmaceutical manufacturing effluent, hospital and municipal wastewater, unused medicines, livestock manure, aquaculture, sludge and inadequately treated sewage. Environments containing both bacteria and antibiotic residues can create conditions that select for resistance and allow resistance genes to move between organisms.

The United Nations Environment Programme identifies pollution control as part of the One Health response to antimicrobial resistance. The WHO guidance on antibiotic manufacturing waste notes that high antibiotic concentrations have been documented downstream of manufacturing sites and that antibiotic-specific emissions remain largely unregulated.

This issue concerns environmental release and persistence. It excludes prescribing decisions and infection transmission occurring entirely within healthcare facilities.