Fate, occurrence and potential adverse effects of antimicrobials used for treatment of tuberculosis in the aquatic environment in South Africa

The consumption of tonnes of anti-tubercular and other anti-microbial compounds for the control of the tuberculosis epidemic and other opportunistic diseases associated with human immunodeficiency virus presents tuberculosis-endemic countries such as South Africa, with a problem regarding the occurrence and fate of these compounds in the aquatic environment. The majority of these compounds are not readily degradable and could persist in the aquatic environment with potential detrimental effect on the aquatic microbiota ecosystem, development and dissemination of anti-microbial resistance as well as chronic toxicity in humans due to long-term exposure. This review summarises and discusses the occurrence, fate and potential adverse effects of the commonly administered anti-tubercular compounds in the aquatic environment in tuberculosis-endemic countries and South Africa in particular. It further attempts to identify information gaps in the literature regarding anti-tubercular compounds in the environment that needs further investigation so that their risk can be comprehensively assessed and impact mitigated.