The occurrence of sulfonamide and macrolide antimicrobials,as well as trimethoprim, was investigated in conventionalactivated sludge treatment. Average daily loads in untreatedwastewater correlated well with those estimated fromannual consumption data and pharmacokinetic behavior.Considerable variations were found during a day, and seasonaldifferences seem to occur for the macrolides, probablycaused by a higher consumption of these substances inwinter. The most predominant macrolide and sulfonamideantimicrobials were clarithromycin and sulfamethoxazole,respectively. In the case of sulfamethoxazole, the main humanmetabolite,
N4-acetylsulfamethoxazole, was included asan analyte, accounting for up to 86% of the total load inuntreated wastewater. The results obtained illustrate theimportance of considering retransformable substances, forexample human metabolites, when investigating thebehavior and fate of pharmaceuticals. Average concentrationsof sulfapyridine, sulfamethoxazole, trimethoprim, azithromycin, and clarithromycin in activated sludge ranged between28 and 68
g/kg of dry weight. Overall the sorption toactivated sludge was shown to be low for the investigatedantimicrobials, with estimated sorption constants foractivated sludge below 500 L/kg. Elimination in activatedsludge treatment was found to be incomplete for allinvestigated compounds. In final effluents, the medianconcentrations for sulfamethoxazole and clarithromycinwere 290 and 240 ng/L, respectively.