An Overview of the Presence of Cephalosporin Antibiotics in Aquatic Environments

Background: Cephalosporins, widely used β-lactam antibiotics, are becoming significant environmental pollutants, primarily due to their high use and persistence. They are released into the environment mainly through wastewater treatment plants, agricultural runoff, and hospital discharge, with particularly high concentrations recorded in effluents. Conventional wastewater treatment methods have inadequate removal efficiency, while advanced treatments, such as ozonation, activated carbon adsorption, and advanced oxidation processes, although more efficient, may produce toxic by-products. Recent studies emphasize the importance of improved detection and monitoring techniques and advocate for stricter effluent regulations. Despite growing research attention, important knowledge gaps remain, including limited long-term field monitoring, insufficient data on environmentally realistic exposure scenarios, and incomplete assessment of transformation-product toxicity. Methods: The search strategy used the SCOPUS and PUBMED databases with the keywords “cephalosporin” AND “aquatic environment”, resulting in 341 records. After applying predefined inclusion and exclusion criteria, 110 peer-reviewed English-language studies meeting predefined thematic inclusion criteria and relevant to the occurrence, environmental fate, ecotoxicological effects, antimicrobial resistance, and removal of cephalosporins in aquatic environments were included in the narrative synthesis. Results: The literature on cephalosporins in aquatic environments has expanded significantly from 1978 to 2025, prompted by concerns about pharmaceutical contamination and antibiotic resistance. Studies from 2016 to 2025 used advanced and multidisciplinary monitoring techniques, revealed key pollution sources such as wastewater treatment plants and hospitals, and correlated antibiotic residues with resistance genes, highlighting the need for continued monitoring and mitigation efforts. Ecotoxicological and fate studies further indicate that transformation processes may generate products with altered or increased toxicity, complicating environmental risk assessment. Conclusions: The literature shows increasing attention to cephalosporins in aquatic environments, reporting associations with antimicrobial resistance and adverse effects on aquatic organisms, including potential toxicity from transformation products. This review highlights the need for integrated monitoring, standardized toxicity assessment, and improved treatment strategies within a One Health framework.