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In one of the first attempts to examine pharmaceutical pollution in rivers around the world, a new study found numerous medicines at potentially toxic levels in more than one-quarter of the waterways, indicating the contaminants pose a global threat to environmental and human health.

Moreover, the most contaminated sites were located in low-to-middle-income countries. In particular, the most troubling pollution was seen in areas with pharmaceutical manufacturing, poor wastewater, and inadequate infrastructure for waste management, according to the study published in the Proceedings of the National Academy of Science.

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The findings, which examined the presence of dozens of active pharmaceutical ingredients in 258 rivers in 104 countries, suggest worsening pollution traced to the production of a wide array of medicines, some of which are sold over the counter, depending on the country. Overall, the researchers found the largest concentrations were for painkillers, antibiotics, and drugs used to treat convulsions.

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