Protecting the Last Line of Defense: Analytical Approaches for Sample Preparation and Determination of the Reserve Group of Antibiotics in the Environment

Drug resistance in microorganisms is a serious threat to life and health due to the limited number of antibiotics that show efficacy in treating infections and the difficulty in discovering new compounds with antibacterial activity. To address this issue, the World Health Organization created the AWaRe classification, a tool to support global and national antimicrobial stewardship programs. The AWaRe list categorizes antimicrobials into three groups–Access, Watch, and Reserve–according to their intended use. The Reserve group comprises “last resort” medicines used solely for treating infections caused by bacterial strains that are resistant to other treatments. It is therefore necessary to protect them, not only by using them as prudently as possible in humans and animals, but also by monitoring their subsequent fate. Unmetabolized antibiotics enter the environment through hospital and municipal wastewater or from manure, subsequently contaminating bodies of water and soils, thus contributing to the emergence and spread of antibiotic resistance. This article presents a review of determination methods for the Reserve group of antimicrobials in water, wastewater, and manure. Procedures for extracting and determining these substances in environmental samples are described, showing the limited research available, which is typically on a local level.