An Evidence Synthesis of Pharmaceuticals and Personal Care Products (PPCPs) in the Environment: Imbalances among Compounds, Sewage Treatment Techniques, and Ecosystem Types.

Pharmaceuticals and personal care products (PPCPs) garner increasing attention globally for both their usefulness as indicators of human waste and their potency as emerging organic toxicants. Three decades of rapid increase in PPCP study combined with an increasing number of PPCPs on the global market have created an opportunity (1) to review trends in diversity of compounds, sewage treatment techniques (STTs), and ecosystems investigated as well as (2) to identify knowledge gaps in the literature. We conducted a quantitative evidence synthesis of 6517 abstracts from primary articles in the environmental PPCP literature by examining relative abundance of specific PPCP classes, STTs, and ecosystem types. Our results demonstrate that non-prescription drugs and antibiotics dominated PPCP abstracts, appearing in 51% and 39% of reviewed abstracts, respectively, in comparison to hormones (18%), prescription drugs (18%), fragrances (0.3%), and antioxidants (0.0%), which can all elicit physiological and ecological responses even at low concentrations. References to centralized STTs (e.g., activated sludge, 37%) were more frequent than decentralized STTs (e.g., septic, 2%), despite decentralized STTs being common and frequently high impact sources of sewage pollution worldwide. Freshwater lotic systems (63%) were more prevalent than freshwater lentic (24%) and terrestrial (20%) systems. This discrepancy is notable because the longer residence times of lentic and terrestrial systems may enable PPCPs to concentrate and thus increase risk of biological consequences. These results highlight distinct opportunities to address knowledge gaps in the environmental PPCP literature, including underrepresented compounds (e.g., fragrances), sewage treatment techniques (e.g., septic systems), and ecosystem types (e.g., lakes).