A rugged and specific method based on tandem solid-phase extraction and liquid chromatography-tandem mass spectrometry for the determination of anti-infectives in raw sewage and wastewater plant effluents was developed. Analyte recoveries from spiked effluents ranged from 68 to 104%. Two specific selected reaction monitoring transitions and their peak area ratios were used to avoid false positives and confirm the presence of the targeted substances. Detection limits allowed low nanogram per litre detection (0.3-22 ng L(-1)). The method was successfully applied to real samples from the Montréal wastewater treatment plant. All the studied anti-infectives were found in the wastewater samples in concentrations ranging from 39 to 276 ng L(-1). Mean flows of anti-infectives were estimated from effluent concentrations and it was found that large amounts (>118 g day(-1) up to 830 g day(-1)) are discharged in the receiving waters of the St Lawrence River.