Levels of six antibiotics used in China estimated by means of wastewater-based epidemiology.

Due to lack of proper regulation, information about antibiotics consumption in many countries such as China is difficult to obtain. In this study, a simple method based on wastewater-based epidemiology was adopted to estimate their usage in four megacities of China. Six antibiotics (norfloxacin, ofloxacin, sulfamethoxazole, trimethoprim, erythromycin and roxithromycin), which are the most frequently consumed antibiotics in China, were selected as the targets. Based on our results, Chongqing had the largest total annual consumption of the selected six antibiotics among the four megacities, followed by Guangzhou, then Hong Kong, with Beijing having the least, with values of 4.4 g/y/P, 4.0 g/y/P, 1.6 g/y/P, and 1.3 g/y/P, respectively. Compared with the daily consumption per capita in Italy, the estimated consumption levels of the selected six antibiotics in four cities of China were 12-41 times those of Italy. Our results suggested that the consumption of antibiotics in China was excessive.