Pharmaceutical contamination is widespread in the world's rivers, with the highest cumulative concentrations found in low-to-middle-income countries. This pollution poses a threat to both environmental and human health, potentially exceeding safe levels for aquatic organisms and contributing to antimicrobial resistance.

None identified.

This study provides a valuable global snapshot of pharmaceutical pollution in rivers, using a standardized methodology that allows for meaningful comparisons across different regions. The scale of the study is impressive, covering a wide range of countries and socioeconomic conditions. While some limitations exist regarding the sampling methodology and the correlational nature of some analyses, the overall findings are significant and contribute substantially to our understanding of this global environmental challenge. The authors have clearly addressed potential biases, enhancing the credibility of the research.