DSpace at VNU: Investigation of antibiotics in health care wastewater in Ho Chi Minh City, Vietnam

Environ Monit Assess (2016) 188:686
DOI 10.1007/s10661-016-5704-6

Investigation of antibiotics in health care wastewater in Ho Chi
Minh City, Vietnam
Thi-Dieu-Hien Vo & Xuan-Thanh Bui & Ngoc-Dan-Thanh Cao & Vinh-Phuc Luu &
Thanh-Tin Nguyen & Bao-Trong Dang & Minh-Quan Thai & Dinh-Duc Nguyen &
Thanh-Son Nguyen & Quoc-Tuc Dinh & Thanh-Son Dao

Received: 5 May 2016 / Accepted: 16 November 2016
# Springer International Publishing Switzerland 2016

Abstract Hospital wastewater contains huge amounts
of hazardous pollutants which are being discharged
daily to environment with or without treatment.
Antibiotics were among the important group of pharmaceuticals considered as a potential source of health risk
for human and other living creatures. Although the
investigations about the existence of antibiotics in hospital wastewater have gained concern for researchers in
many countries, there is only one research conducted in
Hanoi-Vietnam. Hence, in this study, investigations
T.Environmental Engineering and Management Research Group,
Ton Duc Thang University, Ho Chi Minh City, Vietnam
T.e-mail:
T.Faculty of Environment and Labour Safety, Ton Duc Thang
University, Ho Chi Minh City, Vietnam
X.T.Faculty of Environment and Natural Resources, University of

Technology, Vietnam National University, Ho Chi Minh, Vietnam
e-mail:
X.Faculty of Food and Environment, Dong Nai Technology
University, Dong Nai, Vietnam
N.M.Institute of Research and Development, Duy Tan University, Da
Nang, Vietnam

have been done to fulfill the requirement of real situation
in Vietnam by accomplishing survey for 39 health care
facilities in Ho Chi Minh City. As results, seven popular
antibiotics were detected to exist in all samples such as
sulfamethoxazole (2.5 ± 1.9 μg/L), norfloxacin
(9.6 ± 9.8 μg/L), ciprofloxacin (5.3 ± 4.8 μg/L),
of loxa cin (1 0.9 ± 8 .1 μ g/L), e rythromycin
(1.2 ± 1.2 μg/L), tetracycline (0.1 ± 0.0 μg/L), and
trimethoprim (1.0 ± 0.9 μg/L). On the other hand,
survey also showed that only 64% of health care facilities using conventional activate sludge (AS) processes
in wastewater treatment plants (WWTPs). As a consequence, basic environmental factors (BOD5, COD, TSS,
NH4+-N, or total coliforms) were not effectively removed from the hospital wastewater due to problems
relating to initial design or operational conditions.
Therefore, 18% effluent samples of the surveyed
WWTPs have exceeded the national standard limits
(QCVN 28:2010, level B).
Keywords Antibiotics . Hospital . Wastewater . Ho Chi
Minh City

Introduction

Hospitals in Vietnam are classified in three main types
depending on some specific criterias such as 39 central
hospitals, 394 provincial hospitals, and 640 district hospitals (Thu et al. 2012). Ho Chi Minh City (HCMC) has
about 108 hospitals including 21 central hospitals, 31


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hospitals under the Department of Health, 23 district
hospitals, and 33 private hospitals which are in use at
the time. In addition, the city has about 285 other types of
health care facilities such as medical centers, polyclinics,
and specialized clinics. Hospital wastewater has been
known as highly hazardous waste as its characteristics
are toxic and infectious (Verlicchi et al. 2010; Tin et al.
2016). HCMC Department of Natural Resources and
Environment (DONRE) estimated that about 23,000 m3
of wastewater generated from hospitals is directly
discharged to environment daily (Saigon Times 2010).
That wastewater consists of 80% of domestic wastewater
and 20% of the hazardous wastes containing contaminants from patients, blood products, diagnostic samples,
chemicals arising during surgery, blood dialysis, blood
samples, sample preservatives, disinfection, etc.
Moreover, it also contains an emerging source of multiresistant bacteria (Huang et al. 2012) and antibiotics
(Santos et al. 2013). Although the residue individual
antibiotics in the environment are usually at low concentrations as 0.4 ng/L to 35.5 μg/L, they are still considered
to be important emerging pollutants which can cause high
risk on human health (Hernando et al. 2006). This type of

wastewater can destroy environmental sustainability and
create serious ecological destruction if pollutants are not
treated properly before entering into the environment via
effluent or sludge (Lin et al. 2010).
More than ten antibiotic classes are in use consisting of
ionophore, aminoglycoside, polypeptide, β-lactam, quinolones, tetracycline, macrolide, streptogramin, sulfonamide,
etc. Among those antibiotic classes, six classes are often
utilized by both human and animals such as aminoglycoside, β-lactam, macrolide, quinolone, sulfonamide, and
tetracycline (Huang et al. 2001). In particular, sulfamethoxazole (3.5 μg/L), norfloxacin (5.9–8.4 μg/L), and ciprofloxacin (25.8–32.0 μg/L) existed in the Hanoi hospital
wastewaters with high concentrations (Duong et al. 2008;
Kovalova et al. 2012). In another study, sulfamethoxazole
and ciprofloxacin might not be removed via biodegradation in the environment after 28 and 40 days (Al Ahmad
et al. 1999).
Several investigations have determined the occurrence
and fate of pharmaceuticals in hospital wastewaters in the
world (Lindberg et al. 2004; Brown et al. 2006; Watkinson
et al. 2009; Chang et al. 2010; Sim et al. 2011; Kovalova
et al. 2012; Eslami et al. 2015). Until now, in Vietnam, the
study of Duong et al. (2008) is certainly the first research
on the occurrence of five antibiotics in the wastewater of
six hospitals in Hanoi. The research focused on

Environ Monit Assess (2016) 188:686

fluoroquinolone groups such as ciprofloxacin, norfloxacin,
ofloxacin, levofloxacin, and lomefloxacin. The results indicated that only ciprofloxacin (1.1–4.4 μg/L) and
norfloxacin (0.9–17.0 μg/L) were detected in the wastewater samples. Therefore, it is essential to understand the
level of contaminated antibiotics in hospital wastewaters in
HCMC. This study aims to investigate the occurrence of
seven popular antibiotics (including sulfamethoxazole,

norfloxacin, ciprofloxacin, ofloxacin, erythromycin,
tetracyclin, and trimethoprim) in raw wastewater collected
from 39 health care facilities in HCMC-Vietnam. Along
with main aim of this survey about antibiotics detection,
the physicochemical parameters were analyzed to evaluate
the general performance of treatment system.

Materials and method
Sampling sites
There were 39 health care facilities (including 12 central
hospitals, 3 district hospitals, and 24 clinics) in HCMC
targeted to conduct survey (Fig. 1). These medical facilities were mostly general hospitals. Samples collected
in input and output were analyzed physicochemical
properties. Without treatment system observed in sampling area, untreated samples were collected directly at
point of discharge sewer. Additionally, antibiotics measurement was considered to use raw wastewater to analyze due to impediment relating to confidential information and unknown reason caused by plant’s operators.
Sample pretreatment and antibiotics analysis
This study focused on seven common antibiotics such as
sulfamethoxazole (SUL), norfloxacin (NOR), ciprofloxacin (CIP), ofloxacin (OFL), erythromycin (ERY), tetracycline (TET), and trimethoprim (TRI) (Table 1). The selected antibiotics were based on the following criteria such as
the common presentation and use of antibiotics in the
environment (Nikolaou and Fatta 2007; GARP- Vietnam
National Working Group 2010; Hoa et al. 2011), achieved
results in the previous studies (Duong et al. 2008; Chang
et al. 2010; Kovalova et al. 2012), and the measuring
ability of the laboratory analysis (Dinh et al. 2011).
The samples were contained in 1-L glass bottle and
stored in an ice box during transportation. All collected
samples were analyzed total suspended solids (TSS),
chemical oxygen demand (COD), biochemical oxygen

Environ Monit Assess (2016) 188:686

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Fig. 1 Map of surveyed health
care facilities in Ho Chi Minh
City - Vietnam (yellow crosses:
central hospitals, white crosses:
district hospitals and red crosses:
clinics)

demand (BOD5), ammonia nitrogen (NH4+-N), nitrate
nitrogen (NO3−-N), phosphorus (PO43−-P), and total
coliforms within 24 h herein to the standard method
(APHA 1998).
For antibiotics testing, every sample was adjusted to pH
7 after transporting to the laboratory. Then, 100-mL sample
was filtered through 0.45-μm glass fiber filter (Whatman)
to remove its suspended solids (Seifrtova et al. 2008).
Filtered samples were adjusted to pH 4 and stored at 4°C
before extraction. The off-line solid phase extraction (SPE)
method and LC-MS/MS optimization applied in this study
were based on the protocols of (Dinh et al. 2011). The
OASIS HLB cartridges were conditioned with 3 mL of
MeOH (99.5%) and 3 mL of distilled water. Samples (pH
4) were injected into the cartridges at a flow rate of 2–3 mL/
min. Then, 3 mL of distilled water/MeOH solution (v/v, 95/
5) was used to rinse these cartridges. The cartridges were
dried under vacuum condition during 10 min. Five milliliters of MeOH was injected into the cartridges for elution
process. The extracts were evaporated under a nitrogen

stream at 40°C. Finally, the extracts were filtered through
0.45-μm glass fiber filters and stored at 4°C for analyzing
with LC-MS/MS system. The LC-MS/MS system
(Agilent1200 series) equipped with an Agilent Zorbax
Eclipse Plus C18 column (with diameter, length, and pore
size of 2.1 mm, 150 mm, and 3.5 μm, respectively). A
sample injection volume was 10 μL. Mobile phase solvents
were ultrapure water (Solvent A) and acetonitrile (solvent

B), both solvents acidified with 0.01% formic acid
(HCOOH) in an initial ratio (A/B) of 90:10. Separation
was achieved at 35°C using a flow rate of 0.5 mL/min with
the following (A/B) gradient: 90:10 to 75:25 in 2 min,
65:35 at 4 min, 25:75 at 7 min, and 0:100 at 7.1 min for
3 min. Then, the system was equilibrated for 2.4 min prior
to the next injection (total run time of 12.5 min). The LC
system was coupled to a triple quadruple mass spectrometer
(Agilent 6410) with the electrospray ionization (ESI)
source, and it was operated in positive mode. Argon
(99.9%) was used as collision gas, while nitrogen was used
as the nebulizing gas (11.0 L/h, nebulizer pressure 35 psi)
and was produced via a nitrogen generator (Parker).
Calibration always yielded standard curves with coefficients of determination (R2) greater than 0.99 within experimental concentrations used. The quantification limit which
estimated as ten times the signal of the highest peak generated by the background noise was in the 0.5–10 ng/L range.

Results and discussions
Wastewater treatment situation at the surveyed health
care facilities
The survey results showed that 15/15 hospitals and 11/
24 clinics are fully equipped with wastewater treatment

units. Treatment capacity was ranging from 70 to


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Table 1 Target antibiotics information, EC50 values and concentrations in raw health care wastewaters
Antibiotics MW (g/mol) Log Kow EC50 values (mg/L)

Concentration of antibiotics in raw hospital
wastewater
(μg/L)

Ref.

SUL

253.28

0.89

1.5 (72 h, algae) (Eguchi et al. 2004)

3.5 ± 4.6
0.6 ± 0.1
0.1–0.3
0.4–2.1

0.4–12.8

Kovalova et al. 2012
Chang et al. 2010
Watkinson et al. 2009
Brown et al. 2006
Lindberg et al. 2004

NOR

319.33

0.46

82.0 ± 10.2 (24 h, mouse) (Radko et al. 2013)
16.6 (72 h, algae) (Eguchi et al. 2004)

8.4 ± 2.5
5.9 ± 3.4
0.7 ± 0.1
0.1–0.2

Duong et al. 2008
Kovalova et al. 2012
Chang et al. 2010
Watkinson et al. 2009

CIP

331.35

0.28

0.017 (24 h, bacteria) (Robinson et al. 2005)
25.8 ± 8.1
42.1 ± 9.9 (24 h, human cell) (Radko et al. 2013) 32.0 ± 14.1
0.1 ± 0.0
2.5–15.0
0.9–2.0
3.6–101.0

Duong et al. 2008
Kovalova et al. 2012
Chang et al. 2010
Watkinson et al. 2009
Brown et al. 2006
Lindberg et al. 2004

OFL

361.37

−0.39

0.021 (24 h, bacteria) (Robinson et al. 2005)

2.9 ± 0.3
4.9–35.5
0.2–7.6

Chang et al. 2010
Brown et al. 2006
Lindberg et al. 2004

ERY

733.94

3.06

0.04 (72 h, algae) (Eguchi et al. 2004)

0.2 ± 0.3
0.1 ± 0.0

Kovalova et al. 2012
Chang et al. 2010

TET

444.44

−1.37

4.0 (48 h, bacteria) (Halling-Sørensen 2001)

ND–0.04

Watkinson et al. 2009

TRI

290.32

0.91

80.3 (72 h, algae) (Eguchi et al. 2004)

0.9 ± 0.9
0.3–0.3
2.9–5.0
0.6–7.6

Kovalova et al. 2012
Watkinson et al. 2009
Brown et al. 2006
Lindberg et al. 2004

Kow octanol-water partition coefficient, EC50 50% effective concentration, ND not detected

1000 m3/day for the hospitals and from 0.5 to 7.0 m3/
day for the clinic centers. In hospitals, conventional
activated sludge processes (ASP) (aeration tank, moving
bed bioreactor, etc.) are applied in those wastewater
treatment units. For the clinics, only septic tank (ST) is
used for wastewater treatment. The on-site three-chamber septic tank is the compulsory treatment unit for
individual households in the city. Figure 2 shows that
pollutant removal efficiencies of WWTPs of the city
hospitals (63 ± 28% of BOD5, 49 ± 2% of COD,
44 ± 30% of TSS, 36 ± 18% of NH 4 + -N, and

27 ± 16% of PO43−-P) were lower than those of other
WWTPs applying fluidized bed biofilm aeration
(FBBA), aeration tank, and extended aeration (EA)
reported by Prayitno et al. (2013). The removal of
BOD5, COD, TSS, and nutrients in the reported systems
was from low to average so that they did not effectively
treat wastewater from health care facilities in HCMC.

In addition, the treatment performance of septic tanks
of clinic centers was greater than that of activated sludge
systems in this survey. This is clearly explained that a
low concentration of organic matters and nitrogen
compounds was noticed in the raw wastewater
generated from hand washing, cleaning, and toilet
flushing from preliminary health check in clinic
centers. Similarly, Mesdaghinia et al. (2009) documented that characteristics of health care wastewater were
influenced by the level, type of service and water demand. Wastewater from a health care facility is synthesized from all hospital activities such as medical activities, emergency, laboratory, radiology, surgery, diagnosis, laundry, kitchen, etc. Main activities of the clinics
are often medical examination and prescription for outpatient treatment. Therefore, wastewater arises primarily
from toilets, cloth washing, and instruments cleaning. In
general, the concentration of pollutants in the raw


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Fig. 2 Removal efficiencies in
health care wastewater treatment
plants (ASP activated sludge
processes, ST septic tank—data

from this study, FBBA* fluidized
bed biofilm aeration, AS*
activated sludge, EA* extended
aeration—data reported by
Prayitno et al. (2013))

wastewater of the hospitals was higher than those detected in samples of the clinics.
Figure 3 shows that the concentrations of pollutants
in raw wastewater in HCMC health care facilities were
COD of 133 ± 60 mg/L, BOD5 of 54 ± 32 mg/L, and
TSS of 50 ± 36 mg/L, while the nutrient pollution of the
raw wastewater was slightly low compared to those of
domestic wastewater (NH4+-N of 16 ± 14 mg/L and
PO43−-P of 2 ± 2 mg/L). The total coliforms were
ranging from 7.5 × 103 to 64 × 106 MPN/100 mL.
These concentration values were 1.3–3.7 times lower
than those found in raw wastewater of Thailand and
China (Liu et al. 2010; Prasertkulsak et al. 2016).
Based on the survey results, effluents of 7/39 health care
facilities did not comply with the Vietnam standard
limits (QCVN 28:2010, level B) (MONRE 2010). In
the comparison with national standard (level B), concentrations of some parameters analyzed in the effluent
had exceeded standard limits. Particularly, the average
values of treated effluents from hospitals were generally
higher than those standard limits (for instance, COD of
1.9 times, BOD5 of 2.3 times, TSS of 1.3 times, NH4+-N
of 3.0 times, and total coliforms of 300 times). The
wastewater treatment systems of those hospitals have
not been operated adequately and effectively to meet
required standard limits. In addition, treated wastewater

quality at level B cannot be safe for water body.
Therefore, a future concern has been focused strictly
on improvement of effluent quality to level A.
Overall, the situation of wastewater pollution caused
by health care facilities reached to warning statement
due to various reasons. Firstly, 58% clinics implemented
in this survey did not have WWTPs (only septic tank
installed), so wastewater was discharged directly into
the sewage line. Secondly, although the WWTP of those
facilities was equipped with the biological treatment

units (aeration tank, moving bed bioreactor) or anaerobic process (septic tank), items such as COD, BOD5,
TSS, and total coliforms could not be removed
completely. Lack of sufficient equipment in the initial
design stage and inappropriate operational conditions
(such as insufficient air supply, loss of activated sludge,
too long or too short sludge retention time, improper
dosage of the chemical in disinfection process, etc.)
were the reasons leading to low removal efficiency in
those systems. Thirdly, the operators of wastewater
treatment plants did not access to technical and managerial regularities properly. Indeed, treatment efficiency
of the WWTPs was not inspected and maintained regularly. Finally, managers and operators of WWTPs were
not specialized in the field of waste treatment engineering. Therefore, the quality of wastewater discharged into
water environment at 18% facilities did not satisfy the
requirement of national standard (level B) for health
care wastewater.

Fig. 3 Effluent characteristic of health care facilities in Ho Chi
Minh City, Vietnam (Eff effluent, ASP activated sludge processes,
ST septic tank, no WWTP no wastewater treatment plant)

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Environ Monit Assess (2016) 188:686

Fig. 4 Detection frequency of antibiotics in raw wastewater of
health care facilities in Ho Chi Minh City, Vietnam (SUL sulfamethoxazole, NOR norfloxacin, CIP ciprofloxacin, OFL

ofloxacin, ERY erythromycin, TET tetracyclin, TRI trimethoprim,
n numbers of samples analyzed)

Today’s health care systems must be developed
to meet the increasing demand of patients. That
fact results in high volume of wastewater produced
from those facilities. This could lead to hydraulic
shock load in the WWTPs. On the other hand,
without upgrading of wastewater treatment systems, there will be a significant negative impact
on the environment due to high risk of infection
caused by increase of untreated wastewater.
Sharma et al. (2015) strongly recommended to
apply an efficient and advanced on-site treatment
for health care wastewater instead of dumping the
wastewater into the sewage system. Apart from
typical physio-chemical parameters, health care
wastewater also includes hazardous micro pollutants such as antibiotics.

previous studies in other countries. Detection frequency of these antibiotics reached 100% for all

samples in this study, especially, sulfamethoxazole,
norfloxacin, and ciprofloxacin were found in all
samples. Moreover, detection frequency was 90%
of trimethoprim, 80% of erythromycin, and 20% of
tetracyclin. This research also showed that the
occurrence of seven antibiotics in health care
wastewater in HCMC was 1.0–3.3 times higher
than those in Rio Grande, New Mexico (Brown
et al. 2006), South East Queensland, Australia
(Watkinson et al. 2009), Liestal, Switzerland
(Kovalova et al. 2012), and Chongqing, China
(Chang et al. 2010). According to results of Van
Boeckel et al. (2014), antibiotics consumption of
Vietnam was 0.7–11.3 billion standard units (a
standard unit is a measure of volume based broadly on the smallest identifiable dose given to a
patient, dependent on the pharmaceutical form
such as pill, capsule, or ampoule), being 1–157
times higher than New Mexico, Switzerland, and

Occurrence of antibiotics in health care wastewater
Figure 4 shows concentrations of antibiotics detected in the healthcare wastewater in HCMC and

Fig. 5 Concentrations of antibiotics in the raw wastewaters from
health care facilities in Ho Chi Minh City, Vietnam (SUL sulfamethoxazole, NOR norfloxacin, CIP ciprofloxacin, OFL

ofloxacin, ERY erythromycin, TET tetracyclin, TRI trimethoprim,
n numbers of samples analyzed)


Environ Monit Assess (2016) 188:686

China in 2010. This can explain the high detection
frequency of antibiotics in hospital wastewater in
HCMC-Vietnam.
Figure 5 shows that the concentrations of sulfamethoxazole, norfloxacin, ciprofloxacin, ofloxacin, erythromycin, tetracyclin, and trimethoprim were 2.5 ± 1.9,
9.6 ± 9.8, 5.3 ± 4.8, 10.9 ± 8.1, 1.2 ± 1.2, 0.1 ± 0.0,
and 1.0 ± 0.9 μg/L, respectively. Three remarkable
antibiotics with high concentrations were norfloxacin,
ciprofloxacin, and ofloxacin. These results also found
that ciprofloxacin concentrations in hospital wastewaters in HCMC-Vietnam were lower than in HanoiVietnam (25.8 ± 8.1 μg/L) (Duong et al. 2008),
Liestal-Switzerland (32.0 ± 14.1 μg/L) (Kovalova
et al. 2012), South East Queensland-Australia
(15 μg/L) (Watkinson et al. 2009), and KalmarSweden (3.6–101.0 μg/L) (Lindberg et al. 2004).
Conversely, norfloxacin concentrations in this study
were higher than in Hanoi-Vietnam (8.4 ± 2.5 μg/L)
(Duong et al. 2008), Liestal-Switzerland
(5.9 ± 3.4 μg/L) (Kovalova et al. 2012), ChongqingChina (0.7 ± 0.1 μg/L) (Chang et al. 2010), and South
East Queensland-Australia (0.2 μg/L) (Watkinson et al.
2009). The occurrence of ofloxacin in this study was
higher than in Chongqing-China (2.9 ± 0.3 μg/L)
(Chang et al. 2010) and Kalmar-Sweden (0.2–
7.6 μg/L) (Lindberg et al. 2004) (Table 1).
Dealing with technical guidance of EU Directive 93/
67/EEC (CEC 1996), the effective concentrations
(EC50) were used to establish different risk classes.
EC50 value was classified such as below 1 mg/L of
Bvery toxic to aquatic organisms^; 1–10 mg/L of
Btoxic^ and 10–100 mg/L of Bharmful to aquatic
organisms.^ The value of EC50 greater than 100 mg/L
was not classified. Previous studies showed that almost

EC50 values of studied antibiotics were less than
100 mg/L (Table 1). Hence, if these antibiotics in health
care wastewater are not removed effectively, they will
be potentially harmful to aquatic organisms.
The occurrence of antibiotics in the environment
was due to antibiotic drug usage to protect human
and animal health. As reported by Thu et al.
(2012), in 36 hospitals in Vietnam, 5104/7571
(67.4%) of surveyed patients used antibiotics for
their treatment. Hoa et al. (2011) announced that
in the Northern Vietnam, 566/821 (69%) of surveyed children clinical records used antibiotics.
Van Boeckel et al. (2014) demonstrated that the
consumption of antibiotic drugs increased by 36%

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all over the world from 2000 to 2010. Dramatic rise
observed in antibiotics use has led to increasing
their potential occurrence in the environment for
many years. Currently, Vietnam has not compiled
any standard or regulation for antibiotics residue in
health care wastewater yet. Topal and Topal (2015)
stated that conventional activated sludge process
was not efficient for tetracyclin removal. WHO
(2012) also mentions that pharmaceuticals were
able to be removed about 21–50% by the conventional biological treatment processes such as activated sludge and biofiltration depending on such
factors as sludge retention time, temperature, and
hydraulic retention time. If pollutant removal of
treatment plants is incomplete, antibiotics will be
discharged into water body. Potential impacts of

antibiotics are genotoxic effects, destruction of aqua
ecology, increase of antibiotic resistance, and even
increase of human heath risks in the long run.

Conclusions
In summary, this study introduces an overview of wastewater treatment situation in the health care facilities in
HCMC-Vietnam and especially the occurrence of antibiotics in their wastewaters.
&

&
&

&

Sulfamethoxazole, norfloxacin, ciprofloxacin,
ofloxacin, trimethoprim, erythromycin, and
tetracyclin were introduced in the high concentration (up to 23.7 μg/L) in raw wastewater which was
higher than 4–53 times compared to those of hospitals wastewater at other Asian countries as China
and Australia.
Thirty-six percent of the surveyed health care facilities were not fully equipped with decentralized
wastewater treatment units.
Eighteen percent of discharged effluent does not
comply with national standard limits
(QCVN28:2010/BTNMT, level B) due to insufficient initial design and inappropriate operational
conditions as well.
Current applied treatment technologies do not perform well in removal of trace organic compounds as
well as the antibiotics. Thus, advanced wastewater
treatment technologies should be considered to introduce in removing antibiotics from hospital wastewaters in the future.

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Acknowledgements The authors would like to thank for the
research grant from National Foundation for Science and Technology Development (NAFOSTED) No. 105.99-2015.16, Ministry of Science and Technology – Vietnam. This study has been
conducted under the framework of CARE-RESCIF initiative. In
addition, the laboratory support of Mr. Tin and Mr. Thao are highly
appreciated.

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