El uso irracional de los medicamentos

Luis Guillermo Jiménez

Texto completo:

PDF

Resumen

Introducción: La globalización ha favorecido la comercialización de medicamentos, lo que impone desafíos para las personas y los sistemas de salud en cuanto a la utilización adecuada, racional y equitativa de esos recursos sanitarios.

Objetivo: Describir algunos temas relacionados con el uso irracional de los medicamentos que favorezcan la reflexión.

Métodos: Se realizó una investigación cualitativa y descriptiva mediante la selección de publicaciones científicas con ayuda de las palabras clave en sitios de la Internet. Se realizó un análisis crítico de los artículos y se estructuró el desarrollo de este trabajo en cinco secciones.

Resultados: El acceso inadecuado a los medicamentos ha facilitado la infrautilización y el uso irracional, en un rango porcentual amplio que varía de un lugar a otro y que junto a la falta de adherencia terapéutica por parte de las personas y el rol pasivo de los profesionales de salud por falta de acciones asertivas, se favorece la incentivación de la contaminación del ambiente y esto puede  afectar la salud de los seres vivos.

Conclusiones: El uso irracional de los recursos sanitarios atenta contra la salud de los organismos vivos y esto requiere de acciones adecuadas.

Palabras clave

infrautilización; desechos; vencidos; medicamentos; uso irracional; salud.

Referencias

Pevnick J, Shane R, Schnipper J. The problem with medication reconciliation. BMJ Qual Saf [Internet]. 2016 [citado 27 Dic 2019]; 25(9): 726-730. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4956589/

Taylor C, Jan S. Economic evaluation of medicines. Australian prescriber [Internet]. 2017 [citado 27 Dic 2019]; 40(2): 76-78. Disponible en: https://europepmc.org/article/PMC/5407996

Moon S. Powerful ideas for global access to medicines. New England Journal of Medicine [Internet]. 2017 [citado 27 Dic 2019]; 376 (6): 505-07. Disponible en: doi:10.1056/nejmp1613861

Barton I, Avanceña A, Gounden N, Anupindi R. Unintended consequences and hidden obstacles in medicine access in Sub-Saharan Africa. Frontiers in Public Health [Internet]. 2019 [citado 27 Dic 2019]; 7: 342. Disponible en: https://www.frontiersin.org/articles/10.3389/fpubh.2019.00342/full?report=reader

Toh M, Chew L. Turning waste medicines to cost savings: a pilot study on the feasibility of medication recycling as a solution to drug wastage. Palliative medicine [Internet]. 2017 [citado 27 Dic 2019]; 31(1): 35-41. Disponible en: https://journals.sagepub.com/doi/abs/10.1177/0269216316639798?journalCode=pmja

Morgan TM. The Economic Impact of Wasted Prescription Medication in an Outpatient Population of Older Adults. Journal of Family Practice [Internet]. 2001 [citado 27 Dic 2019]; 60(9): 779-81. Disponible en: https://go.galegroup.com/ps/anonymous?id=GALE%7CA78917185&sid=googleScholar&v=2.1&it=r&linkaccess=abs&issn=00943509&p=AONE&sw=w

West L, Diack L, Cordina M, Stewart D. A systematic review of the literature on medication wastage: an exploration of causative factors and effect of interventions. International journal of clinical pharmacy [Internet]. 2014 [citado 27 Dic 2019]; 36(5): 873-881. Disponible en: https://annals.org/aim/article-abstract/689659/highly-automated-hospital-medication-system-five-years-experience-evaluation

Perry L, Shinn B, Stanovich J. Quantification of an ongoing

community-based medication take-back program. Journal of the American Pharmacists Association [Internet]. 2014 [citado 27 Dic 2019]; 54(3): 275-279. Disponible en: https://www.sciencedirect.com/science/article/abs/pii/S1544319115301850

Bekker C, Gardarsdottir H, Egberts A, Bouvy M, van den Bemt B. Pharmacists’ activities to reduce medication waste: an international survey. Pharmacy [Internet]. 2018 [citado 27 Dic 2019]; 6(3): 94. Disponible en: https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-019-4065-6

Almanie S, Holdford D. Economic impact of waste in Prescribing, Dispensing, and Medication consumption in the United States. Value in Health [Internet]. 2015 [citado 27 Dic 2019]; 18(3): A81-A82. Disponible en: https://www.valueinhealthjournal.com/article/S1098-3015(15)00533-1/pdf

Luga A, McGuire M. Adherence and health care costs. Risk management and healthcare policy [Internet]. 2014 [citado 27 Dic 2019]; 7: 35. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3934668/

Vella V, West L. Analysis of Disposed Unused Medications at a Village Community Pharmacy. Pharmacy [Internet]. 2019 [citado 27 Dic 2019]; 7(2): 45. Disponible en: www.mdpi.com/journal/pharmacy.

Al-Shareef F, El-Asrar S, Al-Bakr L, Al-Amro M, Alqahtani F, Aleanizy F, Al-Rashood S. (2016). Investigating the disposal of expired and unused medication in Riyadh, Saudi Arabia: a cross-sectional study. International journal of clinical pharmacy [Internet]. 2016 [citado 27 Dic 2019]; 38(4): 822-828. Disponible en: https://www.researchgate.net/profile/Sara_Alrashood/publication/299359522_Investigating_the_disposal_of_expired_and_unused_medication_in_Riyadh_Saudi_Arabia_a_cross-sectional_study/links/5af7f8ca4585157136e6a4c0/Investigating-the-disposal-of-expired-and-unused-medication-in-Riyadh-Saudi-Arabia-a-cross-sectional-study.pdf

Bekker C, Van Den Bemt B, Egberts A, Bouvy M, Gardarsdottir H. Patient and medication factors associated with preventable medication waste and possibilities for redispensing. International journal of clinical pharmacy [Internet]. 2018 [citado 27 Dic 2019]; 40(3): 704-711. Disponible en: https://link.springer.com/article/10.1007/s11096-018-0642-8

Waldman A, Balskus E. The human microbiota, infectious disease, and global health: challenges and opportunities. ACS infectious diseases [Internet]. 2017 [citado 27 Dic 2019]; 4(1): 14-26. Disponible en: https://pubs.acs.org/doi/abs/10.1021/acsinfecdis.7b00232

UK P. C. Medication review. In Medicines Optimisation: The safe and effective use of medicines to enable the best possible outcomes. National Institute for Health and Care Excellence [Internet]. United Kimdong: NICE; 2015. [citado 27 Dic 2019] Disponible en: https://www.ncbi.nlm.nih.gov/books/NBK355921/

Chambers K, Austin J. Assessing medication redistribution practices between long-term care facilities, free clinics, and charitable pharmacies in Ohio [Internet]. USA: Ohio; 2016. [citado 27 Dic 2019]. Disponible en: http://digitalcommons.cedarville.edu/cgi/viewcontent.cgi?article=1292&context=research_scholarship_symposium

Wilks C, Krisle E, Westrich K, Lunner K, Muhlestein D, Dubois R. Optimization of medication use at accountable care organizations. Journal of managed care & specialty pharmacy [Internet]. 2017 [citado 27 Dic 2019]; 23(10): 1054-1064. Disponible en: https://www.jmcp.org/doi/pdf/10.18553/jmcp.2017.23.10.1054

Handayani T, Priyatno D. Drug Regulation in Self Medication. J Biol Med Res [Internet]. 2018 [citado 27 Dic 2019]; 2(2): 9. Disponible en: https://pdfs.semanticscholar.org/a4cc/b466501569b149998db265af06e76c03ad06.pdf

Vatovec C, Van Wagoner E, Evans C. Investigating sources of pharmaceutical pollution: Survey of over-the-counter and prescription medication purchasing, use, and disposal practices among university students. Journal of environmental management [Internet]. 2017 [citado 27 Dic 2019]; 198: 348-352. Disponible en: https://www.sciencedirect.com/science/article/pii/S0301479717304590

West L, Azzopardi-Muscat N, Grech V, Giordano M, Vella V, Mifsud I, Cordina M. Medication wastage: the current situation. J Malta College of Pharmacy Practice [Internet]. 2015 [citado 27 Dic 2019]; 21, 25-8. Disponible en: http://mcppnet.org/publications/ISSUE21-7.pdf

Wang T, Ku P, Lu H, Hsu K, Trezise D, Hong Y. Investigation and analysis of medication disposal in hospitals and community pharmacies in Taiwan. Sustainability [Internet]. 2020 [citado 01 Ene 2020]; 12(1): 11. Disponible en: www.mdpi.com/journal/pharmacy.

Nicolescu T. Medication Error Prevention: Where are we now and What are the Strategies for the Future? Anesthesiology and Pain Management [Internet]. 2017 [citado 27 Dic 2019]; 4 (1): 1-5. Disponible en: https://pdfs.semanticscholar.org/a9c0/d18a1052b196e98af9f70292eb8e47189ea8.pdf

Vilela R, Jericó M. Implementing technologies to prevent medication errors at a high-complexity hospital: analysis of cost and results. Einstein (São Paulo) [Internet]. 2019 [citado 28 Dic 2019]; 17(4). Disponible en: http://www.scielo.br/scielo.php?pid=S167945082019000400301&script=sci_arttext

Blozik E, Rapold R, Reich O. Prescription of potentially inappropriate medication in older persons in Switzerland: does the dispensing channel make a difference?. Risk management and healthcare policy [Internet]. 2015 [citado 28 Dic 2019]; 8: 73. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4418391/

Brassil M, Torreggiani W. Recycling in IR, What IR specialists can do to help. Cardiovascular and Interventional Radiology [Internet]. 2019 [citado 28 Dic 2019];42 (6): 789-790. Disponible en: https://link.springer.com/article/10.1007/s00270-019-02206-9

Vlahu E, Hassan H, Win K. Knowledge acquisition of consumer medication adherence. In delivering superior health and wellness management with Iot and analytics (pp. 317-343). Springer, Cham [Internet]. 2020 [citado 28 Dic 2019]. Disponible en: https://link.springer.com/chapter/10.1007/978-3-030-17347-0_15

Barnett N. Medication adherence: where are we now? A UK perspective. European Journal of Hospital Pharmacy: Science and Practice [Internet]. 2014 [citado 28 Dic 2019]; 21(3): 181-184. Disponible en: https://www.researchgate.net/profile/Nina_Barnett/publication/273883281_Medication_adherence_Where_are_we_now_A_UK_perspective/links/56fd211808aea3275abb9b00.pdf

Pringle J, Fawcett J. Facilitating the therapeutic alliance between pharmacists and patients to improve medication adherence. In Prescott D, Maeschalck C, Miller S (Eds.). Feedback informed treatment in clinical practice: Reaching for excellence [Internet]. USA: American Phychological Association; 2017 [citado 28 Dic 2019]. Disponible en: https://psycnet.apa.org/record/2017-23015-016

Vrijens B, Antoniou S, Burnier M, de la Sierra A, Volpe M. Current situation of medication adherence in hypertension. Frontiers in pharmacology [Internet]. 2017 [citado 28 Dic 2019]; 8: 100. Disponible en: https://www.frontiersin.org/articles/10.3389/fphar.2017.00100/full

Inglezakis V, Moustakas K. Household hazardous waste management: A review. Journal of environmental management [Internet]. 2015 [citado 28 Dic 2019]; 150: 310-321.Disponible en: https://www.sciencedirect.com/science/article/pii/S0301479714005623

Lucca J, Alshayban D, Alsulaiman D. Storage and disposal practice of unused medication among the Saudi families: An endorsement for best practice. Imam Journal of Applied Sciences [Internet]. 2019 [citado 28 Dic 2019]; 4(1): 1. Disponible en:

http://www.eijas.org/article.asp?issn=25890603;year=2019;volume=4;issue=1;spage=1;epage=6;aulast=Lucca

West L, Stewart D, Cordina M. Mixed-methods approach to determine adherence, knowledge and behavioral determinants associated with medication wastage. Research in Social and Administrative Pharmacy [Internet]. 2019 [citado 28 Dic 2019]; pii: S1551-7411(18)31009-X. doi: 10.1016/j.sapharm.2019.08.003. Disponible en. https://www.ncbi.nlm.nih.gov/pubmed/31422017

Bataduwaarachchi V, Thevarajah R, Weeraratne C. Medication waste disposal practices among patients attending selected out patient departments in a tertiary care institution: a cross sectional survey. International Journal of Basic & Clinical Pharmacology [Internet]. 2018 [citado 29 Dic 2019]; 7(5): 888. Disponible en: https://pdfs.semanticscholar.org/ec83/e5828d540c42c3b4e5118d5da4dbba60f8c7.pdf

Luo Y, Reimers K. Emergence of an information infrastructure through integrating waste drug recycling, medication management, and household drug management in China [Internet]. USA: In Proceedings of the 52nd Hawaii International Conference on System Sciences; 2019 [citado 29 Dic 2019]. Disponible en: https://scholarspace.manoa.hawaii.edu/bitstream/10125/59837/1/0397.pdf

Yemm R, Jones C, Mitoko T. Displaying medication costs on dispensing labels as a strategy to reduce wastage: views of the Welsh general public. Integrated pharmacy research & practice [Internet]. 2017 [citado 29 Dic 2019]; 6: 173. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5774318/

Bashaar M, Thawani V, Hassali M, Saleem F. Disposal practices of unused and expired pharmaceuticals among general public in Kabul. BMC public health [Internet]. 2017 [citado 29 Dic 2019]; 17(1): 45. Disponible en: https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-016-3975-z

Dalton K, Byrne S. Role of the pharmacist in reducing healthcare costs: current insights. Integrated pharmacy research & practice [Internet]. 2017 [citado 29 Dic 2019]; 6, 37. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5774321/

Adsley R. Medication review services in community pharmacy. Practice Nursing [Internet]. 2019 [citado 29 Dic 2019]; (3): 146-148. Disponible en: https://www.magonlinelibrary.com/doi/abs/10.12968/pnur.2019.30.3.146

Atalia K, Buha D, Bhavsar K, Shah N. A review on composting of municipal solid waste. Journal of Environmental Science, Toxicology and Food Technology [Internet]. 2015 [citado 29 Dic 2019]; 9(5): 20-29. Disponible en: https://pdfs.semanticscholar.org/69d3/625bf8871f0cd7b7f6c4de8650bcab8a9b2a.pdf

Rajan R, Robin D, Vandanarani M. Biomedical waste management in Ayurveda hospitals–current practices & future prospectives. Journal of Ayurveda and integrative medicine [Internet]. 2018 [citado 29 Dic 2019]; 10 (3): 214-21. Disponible en: https://www.sciencedirect.com/science/article/pii/S0975947617302127

Turkdogan F, Sonisik T, Dalgic G. Determining pharmaceutical waste generation capacity in Istanbul and the habits relating to pharmaceutical waste disposal. Fresenius Enviromental Bulletin [Internet]. 2019 [citado 29 Dic 2019]; 32: 931. Disponible en. https://www.researchgate.net/profile/Baha_Bilgilioglu/publication/331310536_OBJECT_BASED_CLASSIFICATION_OF_UNMANNED_AERIAL_VEHICLE_UAV_IMAGERY_FOR_FOREST_FIRES_MONITORING/links/5c72a004299bf1268d214040/OBJECT-BASED-CLASSIFICATION-OF-UNMANNED-AERIAL-VEHICLE-UAV-IMAGERY-FOR-FOREST-FIRES-MONITORING.pdf#page=419

Smejkalová J. Wastage of medicines and its financial impact on the healthcare system in the Czech Republic. Ceska a Slovenska farmacie: casopis Ceske farmaceuticke spolecnosti a Slovenske farmaceuticke spolecnosti [Internet]. 2019 [citado 29 Dic 2019]; 67 (5-6): 192-199.Disponible en: https://europepmc.org/article/med/30871324

Garey KW; Johle ML; Behrman K; Neuhauser MM. Economic Consequences of Unused Medications in Houston, Texas. Ann Pharmacother [Internet]. 2004 [citado 29 Dic 2019]; 38:1165-8. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/15138296

Crumplin G. Waste medicines v unwanted medicines - incineration or altruism? The Pharmaceutical Journal [Internet]. 2000 [citado 28 Dic 2019]; 264 (7089): 467. Disponible en: http://www.pjonline.com

Dobson G, Tilson V. Case medication waste reduction in an In-Hospital Pharmacy, Part B. INFORMS Transactions on Education [Internet]. 2016 [citado 29 Dic 2019]; 16(2): 73-76. Disponible en: https://pubsonline.informs.org/doi/pdf/10.1287/ited.2015.0147csB

Emblin K, Nash I, Jefferies S. Pharmacy at home: service for frail older patients demonstrates medicines risk reduction and admission avoidance. Prevention [Internet]. 2019 [citado 30 Dic 2019]; 10: 00. Disponible en: https://www.pharmaceuticaljournal.com/research/research-article/pharmacy-at-home-service-forfrailolderpatients-demonstrates-medicines-risk-reduction-and-admissionavoidance/20201303.article?firstPass=false

Narwat A, Sindhu A. Practice towards disposal of medicines (unused/expired drugs) among the patients visiting tertiary care teaching hospital in Haryana, India. International Journal of Research in Medical Sciences [Interent]. 2019 [citado 30 Dic 2019]; 7(8): 3050. Disponible en: https://pdfs.semanticscholar.org/eecc/9bf56177d3b0ffbc05a69739610668bd7e30.pdf

Davis S, Hurtado J, Nguyen R, Huynh T, Lindon I, Hudnall C, Bork S. Innovations in medication preparation safety and wastage reduction: use of a workflow management system in a pediatric hospital. Hospital pharmacy [Internet]. 2017 [citado 30 Dic 2019]; 52 (1): 54-59. Disponible en: https://journals.sagepub.com/doi/abs/10.1310/hpj5201-54?journalCode=hpxa

Segura P, Takada H, Correa J, El Saadi K, Koike T, Onwona-Agyeman S, dos Santos A. Global occurrence of anti-infectives in contaminated surface waters: Impact of income inequality between countries. Environment International [Internet]. 2015 [citado 30 Dic 2019]; 80: 89-97. Disponible en: https://s3.amazonaws.com/academia.edu.documens/45476567/Global_occurrence_of_anti-infectives_in_20160509-1860116cwend.pdf?responsecontent...

Liao C, Ho C. Risk management for outsourcing biomedical waste disposal–Using the failure mode and effects analysis. Waste management [Internet]. 2014 [citado 30 Dic 2019]; 34(7): 1324-1329. Disponible en: https://www.sciencedirect.com/science/article/pii/S0956053X14000981

de Oliveira P, Cunha I, Pedreira M, Marck P. Environmental sustainability in medication processes performed in hospital nursing care. Acta Paulista de Enfermagem [Internet]. 2016 [citado 30 Dic 2019]; 29(3): 316-324. Disponible en: https://www.redalyc.org/pdf/3070/307047624011.pdf

Stewart D, Whittlesea C, Dhital R, Newbould L, McCambridge J.

Community pharmacist led medication reviews in the UK: A scoping review of the medicines use review and the new medicine service literatures. Research in Social and Administrative Pharmacy [Internet]. 2019 [citado 30 Dic 2019]; pii: S1551-7411(18)30860-X. doi: 10.1016/j.sapharm.2019.04.010. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/31085141

Sivasankaran, P, Elmutaz, B, Ganesan N, Durai R. Storage and safe disposal of unwanted/unused and expired medicines: A Descriptive cross-sectional survey among Indian rural population. Journal of Young Pharmacists [Internet]. 2019 [citado 30 Dic 2019]; 11(1): 97. Disponible en: https://www.jyoungpharm.org/sites/default/files/JYoungPharm-11-1-97.pdf

Naveen A, Suguna A, Basineni M. A study on unused and expired drug disposal practices: knowledge and behavioural patterns among the rural population . International Journal of Scientific Research [Internet]. 2019 [citado 30 Dic 2019]; 8(6). Disponible en: http://www.worldwidejournals.net/index.php/IJSR/article/viewFile/139/136

Anderson C, Zhan K, Boyd M, Mann C. The role of pharmacists in general practice: a realist review. Research in Social and Administrative Pharmacy [Internet]. 2019 [citado 30 Dic 2019]; 15(4): 338-345. Disponible en: http://eprints.nottingham.ac.uk/52311/1/The%20role%20of%20pharmacists%20in%20general%20practicea%20realist%20review%20%20_.pdf

Goldstein D, Hirsch A. A policy that encourages wastage of expensive medications—the JW modifier. JAMA oncology [Internet]. 2018 [citado 30 Dic 2019]; 4(2): 155-156. Disponible en: https://jamanetwork.com/journals/jamaoncology/article-abstract/2665176

Hatswell A, Porter J. Reducing drug wastage in pharmaceuticals dosed by weight or body surface areas by optimising vial sizes. Applied Health Economics and Health Policy [Internet]. 2019 [citado 30 Dic 2019]; 17(3): 391-397. Disponible en: https://discovery.ucl.ac.uk/id/eprint/10067293/1/Hatswell_2018-10-24_Reducing%20drug%20wastage_v5.pdf

Ebrahim, A. J., Teni, F. S., & Yimenu, D. K. (2019). Unused and Expired Medications: Are They a Threat? A Facility-Based Cross-Sectional Study. Journal of primary care & community health [Internet]. 2019 [citado 30 Dic 2019]; 10. Disponible en: https://journals.sagepub.com/doi/pdf/10.1177/2150132719847857

Fleming L, Redshaw C, Depledge M, Stahl-Timmins W. Time to act: pharmacists must be prepared for environmental changes. Prevention [Internet]. 2019 [citado 30 Dic 2019]; 10: 00. Disponible en: https://www.pharmaceutical-journal.com/opinion/time-to-act-pharmacists-must-be-preparedforenvironmentalchanges/11138390.fullarticle?firstpass=false

Ahmed A, Shafique I. Perception of household in regards to water pollution: an empirical evidence from Pakistan. Environmental Science and Pollution Research [Internet]. 2019 [citado 31 Dic 2019]; 26(9): 8543-8551. Disponible en: https://link.springer.com/article/10.1007/s11356-019-04273-4

Pérez N, López R, Pérez S, Barrado E. Analytical methodologies for the determination of pharmaceuticals and personal care products (PPCPs) in sewage sludge: A critical review. Analytica chimica acta [Internet]. 2019 [citado 31 Dic 2019]; 20 (1083): 19-40. doi: 10.1016/j.aca.2019.06.044. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/31493808

Meyer M, Powers S, Hampton S. An Evidence Synthesis of Pharmaceuticals and Personal Care Products (PPCPs) in the Environment: Imbalances among Compounds, Sewage Treatment Techniques, and Ecosystem Types. Environmental science & technology [Internet]. 2019 [citado 31 Dic 2019]; 53(22): 12961-12973. Disponible en: https://pubs.acs.org/doi/full/10.1021/acs.est.9b02966

Balakrishna K, Rath A, Praveenkumarreddy Y, Guruge K, Subedi B. A review of the occurrence of pharmaceuticals and personal care products in Indian water bodies. Ecotoxicology and environmental safety [Internet]. 2017 [citado 31 Dic 2019]; 137: 113-120. Disponible en: http://digitalcommons.murraystate.edu/cgi/viewcontent.cgi?article=1014&context=faculty

Quesada H, Baptista A, Cusioli L, Seibert D, de Oliveira Bezerra C, Bergamasco R. Surface water pollution by pharmaceuticals and an alternative of removal by low-cost adsorbents: A review. Chemosphere [Internet]. 2019 [citado 31 Dic 2019];222:766-780. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/30738319

Fekadu S, Alemayehu E, Dewil R, Van der Bruggen B. Pharmaceuticals in freshwater aquatic environments: A comparison of the African and European challenge. Science of the Total Environment [Internet]. 2019 [citado 31 Dic 2019]; 654: 324-337. Disponible en: https://www.researchgate.net/profile/Samuel_F_Hayleeyesus2/publication/328839202_Pharmaceuticals_in_freshwater_aquatic_environments_A_comparison_of_the_African_and_European_challenge/links/5c29f9f1a6fdccfc70734099/Pharmaceuticals-in-freshwater-aquatic-environments-A-comparison-of-the-African-and-European-challenge.pdf

Kleywegt S, Payne M, Ng F, Fletcher T. Environmental loadings of Active Pharmaceutical Ingredients from manufacturing facilities in Canada. Science of the Total Environment [Internet]. 2019 [citado 31 Dic 2019]; 646: 257-264. Disponible en: https://www.sciencedirect.com/science/article/pii/S0048969718327402

Patel M, Kumar R, Kishor K, Mlsna T, Pittman C, Mohan D. Pharmaceuticals of emerging concern in aquatic systems: chemistry, occurrence, effects, and removal methods. Chemical reviews [Internet]. 2019 [citado 31 Dic 2019]; 119(6): 3510-3673. Disponible en: https://pubs.acs.org/doi/full/10.1021/acs.chemrev.8b00299

Mackuľak T, Černanský S, Fehér M, Birošová L, Gál M. Pharmaceuticals, drugs and resistant microorganisms-environmental impact on population health. Current Opinion in Environmental Science & Health [Internet]. 2019 [citado 31 Dic 2019]; 9: 40-8. Disponible en: https://www.sciencedirect.com/science/article/pii/S2468584419300029

Enlaces refback

  • No hay ningún enlace refback.




Copyright (c) 2020 http://creativecommons.org/licenses/by-nc/4.0

Licencia de Creative Commons
Este obra está bajo una licencia de Creative Commons Reconocimiento-NoComercial 4.0 Internacional.