Klaus Kümmerer

Bio: Klaus Kümmerer is an academic researcher from Lüneburg University. The author has contributed to research in topics: Biodegradation & Medicine. The author has an hindex of 57, co-authored 330 publications receiving 19437 citations. Previous affiliations of Klaus Kümmerer include University Medical Center Freiburg & University of Freiburg.

Pharmaceuticals in the environment : sources, fate, effects and risks

Abstract: General Aspects.- Pharmaceuticals in the Environment - A Brief Summary.- Special Characteristics of Pharmaceuticals Related to Environmental Fate.- Sources, Occurrence and Fate.- Drug Production Facilities - An Overlooked Discharge Source for Pharmaceuticals to the Environment.- Substance Flows Associated with Medical Care - Significance of Different Sources.- Pharmaceutical Residues in Northern European Environments: Consequences and Perspectives.- Antibiotics in the Environment.- Veterinary Antibiotics in Dust: Sources, Environmental Concentrations, and Possible Health Hazards.- Fate of Veterinary Medicines Applied to Soils.- Pharmaceuticals as Environmental Contaminants: Modeling Distribution and Fate.- Environmental Exposure Modeling: Application of PhATE(TM) and Great-ER to Human Pharmaceuticals in the Environment.- Exposure Assessment Methods for Veterinary and Human-Use Medicines in the Environment: PEC vs. MEC Comparisons.- Effects.- Effects of Pharmaceuticals on Aquatic Organisms.- Another Example of Effects of Pharmaceuticals on Aquatic Invertebrates: Fluoxetine and Ciprofloxacin.- Effects of Antibiotics and Virustatics in the Environment.- Realizing the Potential Benefits of Small Animal Models for the Aquatic Hazard Assessment of Human Pharmaceuticals: A Conceptual Approach.- On the Ecotoxicology of Pharmaceutical Mixtures.- Chronic Mixture Toxicity of Pharmaceuticals to Daphnia - The Example of Nonsteroidal Anti-Inflammatory Drugs.- The Ecotoxicological Effects of Pharmaceuticals (Antibiotics and Antiparasiticides) in the Terrestrial Environment - a Review.- Odorants - Potent Substances at Minor Concentrations: The Ecological Role of Infochemicals.- Risk Assessment.- European Developments in the Environmental Risk Assessment of Pharmaceuticals.- The State and the Future Development/Perspective of Environmental Risk Assessment of Medicinal Products for Human Use: Aspects of Its Regulations in Japan.- Deterministic and Probabilistic Environmental Risk Assessment for Diazepam.- Comparison of Prospective and Retrospective Environmental Risk Assessments of Human Pharmaceuticals.- Methodological Aspects Concerning the Environmental Risk Assessment for Medicinal Products Research Challenges.- Risk Management.- Strategies for Reducing the Input of Pharmaceuticals into the Environment.- Cost Action 636 Xenobiotics in the Urban Water Cycle - A Network for Collaboration within Europe.- Removal of Pharmaceutical Residues from Contaminated Raw Water Sources by Membrane Filtration.- Photooxidation as Advanced Oxidation Treatment of Hospital Effluents.- Pharmaceuticals and Environment: Role of Community Pharmacies.- Mitigation of the Pharmaceutical Outlet into the Environment - Experiences from Sweden.- Pharmaceutical Waste.

Resistance in the Environment

Abstract: Antibiotics, disinfectants and bacteria resistant to them have been detected in environmental compartments such as waste water, surface water, ground water, sediments and soils. Antibiotics are released into the environment after their use in medicine, veterinary medicine and their employment as growth promoters in animal husbandry, fish farming and other fields. There is increasing concern about the growing resistance of pathogenic bacteria in the environment, and their ecotoxic effects. Increasingly, antibiotic resistance is seen as an ecological problem. This includes both the ecology of resistance genes and that of the resistant bacteria themselves. Little is known about the effects of subinhibitory concentrations of antibiotics and disinfectants on environmental bacteria, especially with respect to resistance. According to the present state of our knowledge, the impact on the frequency of resistance transfer by antibacterials present in the environment is questionable. The input of resistant bacteria into the environment seems to be an important source of resistance in the environment. The possible impact of resistant bacteria on the environment is not yet known. Further research into these issues is warranted.

Pharmaceuticals, hormones, and other organic wastewater contaminants in U.S. streams, 1999-2000: a national reconnaissance.

Abstract: To provide the first nationwide reconnaissance of the occurrence of pharmaceuticals, hormones, and other organic wastewater contaminants (OWCs) in water resources, the U.S. Geological Survey used five newly developed analytical methods to measure concentrations of 95 OWCs in water samples from a network of 139 streams across 30 states during 1999 and 2000. The selection of sampling sites was biased toward streams susceptible to contamination (i.e. downstream of intense urbanization and livestock production). OWCs were prevalent during this study, being found in 80% of the streams sampled. The compounds detected represent a wide range of residential, industrial, and agricultural origins and uses with 82 of the 95 OWCs being found during this study. The most frequently detected compounds were coprostanol (fecal steroid), cholesterol (plant and animal steroid), N,N-diethyltoluamide (insect repellant), caffeine (stimulant), triclosan (antimicrobial disinfectant), tri(2-chloroethyl)phosphate (fire retardant), and 4-nonylphenol (nonionic detergent metabolite). Measured concentrations for this study were generally low and rarely exceeded drinking-water guidelines, drinking-water health advisories, or aquatic-life criteria. Many compounds, however, do not have such guidelines established. The detection of multiple OWCs was common for this study, with a median of seven and as many as 38 OWCs being found in a given water sample. Little is known about the potential interactive effects (such as synergistic or antagonistic toxicity) that may occur from complex mixtures of OWCs in the environment. In addition, results of this study demonstrate the importance of obtaining data on metabolites to fully understand not only the fate and transport of OWCs in the hydrologic system but also their ultimate overall effect on human health and the environment.

Pharmaceuticals and personal care products in the environment: agents of subtle change?

Abstract: During the last three decades, the impact of chemical pollution has focused almost exclusively on the conventional "priority" pollutants, especially those acutely toxic/carcinogenic pesticides and industrial intermediates displaying persistence in the environment. This spectrum of chemicals, however, is only one piece of the larger puzzle in "holistic" risk assessment. Another diverse group of bioactive chemicals receiving comparatively little attention as potential environmental pollutants includes the pharmaceuticals and active ingredients in personal care products (in this review collectively termed PPCPs), both human and veterinary, including not just prescription drugs and biologics, but also diagnostic agents, "nutraceuticals," fragrances, sun-screen agents, and numerous others. These compounds and their bioactive metabolites can be continually introduced to the aquatic environment as complex mixtures via a number of routes but primarily by both untreated and treated sewage. Aquatic pollution is particularly troublesome because aquatic organisms are captive to continual life-cycle, multigenerational exposure. The possibility for continual but undetectable or unnoticed effects on aquatic organisms is particularly worrisome because effects could accumulate so slowly that major change goes undetected until the cumulative level of these effects finally cascades to irreversible change--change that would otherwise be attributed to natural adaptation or ecologic succession. As opposed to the conventional, persistent priority pollutants, PPCPs need not be persistent if they are continually introduced to surface waters, even at low parts-per-trillion/parts-per-billion concentrations (ng-microg/L). Even though some PPCPs are extremely persistent and introduced to the environment in very high quantities and perhaps have already gained ubiquity worldwide, others could act as if they were persistent, simply because their continual infusion into the aquatic environment serves to sustain perpetual life-cycle exposures for aquatic organisms. This review attempts to synthesize the literature on environmental origin, distribution/occurrence, and effects and to catalyze a more focused discussion in the environmental science community.

Clinical Practice Guidelines by the Infectious Diseases Society of America for the Treatment of Methicillin-Resistant Staphylococcus aureus Infections in Adults and Children

Abstract: Evidence-based guidelines for the management of patients with methicillin-resistant Staphylococcus aureus (MRSA) infections were prepared by an Expert Panel of the Infectious Diseases Society of America (IDSA). The guidelines are intended for use by health care providers who care for adult and pediatric patients with MRSA infections. The guidelines discuss the management of a variety of clinical syndromes associated with MRSA disease, including skin and soft tissue infections (SSTI), bacteremia and endocarditis, pneumonia, bone and joint infections, and central nervous system (CNS) infections. Recommendations are provided regarding vancomycin dosing and monitoring, management of infections due to MRSA strains with reduced susceptibility to vancomycin, and vancomycin treatment failures.