The greener prescription: Life cycle environmental impact of oral and IV penicillin treatments

Antibiotics are vital in treating bacterial infections and often administered intravenously (IV) to patients admitted to hospitals. Oral alternatives are generally as effective when used clinically appropriately, but the environmental impact of different dosage forms remain understudied. As healthcare’s environmental impact continue to increase, understanding the impact of treatment choices is essential for promoting sustainable healthcare. We conducted an attributional Life Cycle Assessment (LCA) estimating the environmental impact of penicillin treatment for pneumonia, comparing the impact via IV and oral routes, using both Midpoint and Endpoint indicators using ReCiPe 2016. The analysis included manufacturing, packaging, administration, and disposal phases. Oral treatment had 4–14% of the environmental impact of IV treatment across the impact categories. For IV treatment, the majority of emissions stemmed from IV equipment. Sensitivity analyses showed manufacturing emissions were primarily energy-driven. The environmental impact of oral treatment was influenced by the electricity mix in the country of manufacturing, while the impact of IV treatment could be reduced by up to 38% by implementing equipment recycling. Applying toxicity characterization factors for penicillin excreted to the environment, showed potential underestimation of the Freshwater/Marine Ecotoxicity Potential with an increase of over 8700% and 676%, respectively. Our results indicate prescribing oral formulations when clinically appropriate offers an opportunity to decrease the environmental impact. Reductions could be obtained by sourcing products from regions with low-emission electricity mix and improving waste management of IV equipment by recycling. The continued progress in pharmaceutical LCAs relies on better data availability and harmonized methods. • Comparative life cycle assessment of oral and intravenous penicillin treatments. • System boundary defined as cradle-to-grave. • Functional unit defined as 1 million International Units of penicillin. • Noticeably lower environmental impact for oral penicillin treatment. • Recommendations for future research and future treatment choice for clinical practice.