ABSTRACT
Ivermectin is an antiparasitic used in human medicine and veterinary medicine. Moreover, its use intensified in Brazil during the pandemic as an early treatment for COVID-19. Bearing in mind that drugs enter the environment via different pathways, ecotoxicological studies are essential to understanding the effects of these compounds on biota. The aim of this study was to perform a bibliometric analysis of the ecotoxicological effects of ivermectin. Searches were conducted using different English, Portuguese and Spanish descriptors in different databases within the 2010-2021 time window. The papers found were subjected to inclusion and exclusion criteria and subsequently studied. Fourteen publications, with records going all the way back to 2012, were assessed. According to their type, most papers were classified as original studies and revealed that the predominant test organisms were flies. In terms of subject areas, the studies fell within the fields of Environmental Science, Toxicology, Molecular Biochemistry, Pharmacology and Pharmacy and Multidisciplinary Chemistry. In all of the papers studied, there was a case of association of researchers from different countries as well as a predominance of English manuscripts. Word cloud analysis based on the keywords highlighted a concern with the impacts of this antiparasitic on the biota present in manure. As a result of the survey conducted, environmental monitoring of this substance and the performance of experiments that contemplate the current situation of occurrence of this drug in different environmental matrices are recommended.
ABSTRACT
The city of Vitoria-Gasteiz was one of the probable first entrances of the SARS-CoV2 in Spain, one of the worst affected countries in the world during the first COVID 19 wave. Driven by the urgency of the situation, multiple drugs with antiviral activity were used off label. Sadly, most of these treatments were of little or no benefit and thus, the number of patients suffering from COVID-19 attended in intensive care units (ICUs) multiplied. After being administered to patients, a variable proportion of these drugs reach the environment where they may have detrimental effects, although this aspect is usually ignored by healthcare professionals. In this study we measured the patterns of hospital drug use in the city of Vitoria-Gasteiz (Spain) during the first COVID-19 wave pandemic, focusing on those with antiviral activity and those used in the ICUs. Subsequently, we measured concentrations of selected drugs in the city's wastewater treatment plant influent and effluent and estimated the potential risk for the environment. The hospital use of certain antivirals and drugs used for sedo-analgesia were dramatically increased during the first wave (cisatracurium was multiplied by 25 and lopinavir/ritonavir by 20). A mean of 1.632 daily defined doses of hydroxychloroquine were used during the period of February-May 2020. In this study we report the first positive detection of hydroxychloroquine ever in the environment. We also show the second positive report of lopinavir. Low risk was estimated for hydroxychloroquine, lopinavir and ritonavir (Risk quotients (RQ) <1), and medium risk for azithromycin (RQ 0f 0.146).
Subject(s)
COVID-19 , Antiviral Agents , COVID-19/epidemiology , Drug Combinations , Humans , Pandemics , RNA, Viral , SARS-CoV-2 , Spain/epidemiologyABSTRACT
Despite uncertainty about its clinical benefit, ivermectin has been used for COVID 19, even in prophylaxis. The European Medicines Agency (EMA) has advised against its use for the prevention or treatment of COVID-19 outside randomised clinical trials. Although the potential negative environmental effects of ivermectin have been widely recognised when used in veterinary medicine, scarce attention has been devoted to the potential ecotoxicological impact of human use. We believe is time to include One Health's philosophy in our daily practice. In the specific case of ivermectin & COVID 19, environmental aspects should also be on the table.