The challenge of emerging contaminants (ECs) in global surface water bodies and particularly in low- and middle-income countries such as India, Pakistan, Bangladesh, and Sri Lanka, is evident from the literature. The complexity arises from the high costs involved in EC analysis and the extensive list of ECs, which complicates the selection of essential compounds for scientific and regulatory investigations. Consequently, monitoring programs often include ECs that may have minimal significance within a region and do not pose known or suspected ecological or human health risks. This study aims to address this issue by employing a multi-risk assessment approach to identify priority ECs in the surface waters of the aforementioned countries. Through an analysis of occurrence levels and frequency data gathered from published literature, an optimized risk quotient (RQ) was derived. The findings reveal a priority list of 38 compounds that exhibit potential environmental risks and merit consideration in future water quality monitoring programs. Furthermore, the majority of antibiotics in India (12 out of 17) and Pakistan (7 out of 17) exhibit a risk quotient for antimicrobial resistance selection (RQ) greater than 1, highlighting the need for devising effective strategies to mitigate the escalation of antibiotic resistance in the environment.
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