The occurrence of anti-inflammatory and analgesic pharmaceuticals (AIAPs) in the effluents of 16 hospitals, influent and effluent of wastewater treatment plant (WWTP), the contribution and mass load of each hospital to WWTP influent, and the removal efficiencies in WWTP were investigated. Environmental risk was also evaluated by toxicity tests using organisms from three different trophic levels. Acetaminophen had the highest concentration in summer and winter samples, followed by ketoprofen, ibuprofen, and naproxen. The total daily load of AIAPs detected in influent of WWTP was 1677 mg/day/1000 inhabitants in summer and 5074 mg/day/1000 inhabitants in winter. The contribution of 16 hospitals to the total AIAP load in influent of WWTP was 11.30% in summer and 7.09% in winter. The highest mass loads were calculated as 203 mg/bed.day in general hospital in summer and 300 mg/bed.day in pediatric hospital in winter. The removal efficiencies of AIAPs in WWTP ranged between 13% and 100% in summer and 0.88% and 99% in winter. WWTP is not sufficient to remove all the AIAPs. Diclofenac (in summer), mefenamic acid, indomethacin, and phenylbutazone exhibited poor removal below 50%. The effluents of the WWTP exhibited a low risk for fish and Daphnia magna and an insignificant risk for algae.
Keywords: Analgesics; Anti-inflammatories; Environmental risk; Hospital effluents; Wastewater treatment plant.