Recent Trends in Removal Pharmaceuticals and Personal Care Products by Electrochemical Oxidation and Combined Systems

: Due to various potential toxicological threats to living organisms even at low concentrations, pharmaceuticals and personal care products in natural water are seen as an emerging environmental issue. The low efficiency of removal of pharmaceuticals and personal care products by conventional wastewater treatment plants calls for more efficient technology. Research on advanced oxidation processes has recently become a hot topic as it has been shown that these technologies can effectively oxidize most organic contaminants to inorganic carbon through mineralization. Among the advanced oxidation processes, the electrochemical advanced oxidation processes and, in general, electrochemical oxidation or anodic oxidation have shown good prospects at the lab-scale for the elimination of contamination caused by the presence of residual pharmaceuticals and personal care products in aqueous systems. This paper reviewed the effectiveness of electrochemical oxidation in removing pharmaceuticals and personal care products from liquid solutions, alone or in combination with other treatment processes, in the last 10 years. Reactor designs and configurations, electrode materials, operational factors (initial concentration, supporting electrolytes, current density, temperature, pH, stirring rate, electrode spacing, and fluid velocity) were also investigated.


Introduction
The concern for pharmaceuticals and personal care products (PPCPs) as toxic substances in the environment and the essential to assess their environmental risks have significantly increased recently. PPCPs are defined as a group of compounds that is including pharmaceutical drugs, cosmetic ingredients, food supplements, and ingredients in other consumer products (e.g., shampoos, lotions) [1]. Pharmaceuticals are used to prevent or treat diseases on humans and animals, whereas personal care products (PCPs) are used mostly to improve the quality of daily life [2]. They are considered as emerging pollutants (new products or chemicals without regulatory status) and whose effects on the environment and human health are unidentified [3]. Due to the widespread occurrence in water bodies, regardless of the low concentrations (normally ranging from ng/L to μg/L), residues of PPCP can harm human and animal health when it enters and accumulates in the food chain, causing unknown long-term effects [2,4]. Table 1. Structures, chemical abstracts service registry number (CAS), and classification for the target pharmaceuticals and personal care products (PPCPs) selected for this study.   Figure 1 shows the analytical method that is essential to investigate the occurrence of PPCPs in the environment, whichs consists of several main steps. This includes selecting appropriate analytical instruments (Table 3), which depend on the characteristics of PPCPs; extracting and purifying the samples by using techniques such as solid-phase extraction (SPE), liquid-liquid extraction (LLE), liquid-liquid micro-extraction (LLME), and solid-phase micro-extraction (SPME) that was introduced in various studies [43,44]; and optimizing of measurement parameters.

Electrochemical Reactor Designs and Configurations
There are two types of electrodes: two-dimensional and three-dimensional. Compared to twodimensional, three-dimensional electrodes ensures a high electrode surface-to-cell volume ratio value. Due to the ease of scale up to a larger electrode size, more electrode pairs, or an increased number of cell stacks, cell designs using the parallel plate geometry in a filter press arrangement are widely used [45].
In the configuration of the reactor, the cell arrangement (divided and undivided cells) must be considered. The anolyte and catholyte are separated into divided cells by a porous diaphragm or ionconducting membrane. Choosing the separating diaphragm or membrane is as critical for divided cells as choosing the correct electrode materials for proper electrolyte system functioning. Generally, the use of divided cells should be avoided wherever possible regarding the cost of separators, the complexity of reducing the electrode gap and the problems of the mechanic, and corrosion [46]. Undivided cells working in batch mode are often under magnetic stirring for mixing at a thermostatically controlled temperature ( Figure 2). The number of electrodes can increase the active area per volume unit. Figure 2. Diagram of the electrochemical reactor, using a glass beaker. The solution was stirred continuously throughout the process with a magnetic bar on a magnetic stirrer. The graphite anode was used as a working anode and a distance of 2 mm. Reprinted from Periyasamy and Muthuchamy [47], copyright © (2018) with permission from Elsevier.
Most of the studies were conducted in undivided electrochemical reactors, usually using solution volumes ranging from 100 to 500 mL, although 1 L or larger volumes were sometimes used [48][49][50]. Divided cells use a separator between anolyte and catholyte, which makes the treatment process more costly and challenging due to the penalty overvoltage of the separator. The investigation of norfloxacin degradation in an electrochemical reactor with the presence and absence of an ion-exchange membrane proved the use of the membrane is highly advantageous as it enhances the anodic reaction kinetics and improves the current efficiency. This leads to an improvement in the degradation of norfloxacin, mineralization, and the consequent mineralization current efficiency [51].
Moreover, Chen et al. [52] used successfully divided and thermostated cells and a Nafion 212 ionexchange membrane separator to perform electrodegradation of DEET with total removal.
Since the metal deposition occurs on the surface of the cathode to boost the space-time yield, it is required to increase the surface area. Therefore, the fluidized bed electrode was developed, with granular graphite and glass beads for filling the gap between the main electrodes and used as the third electrode [32].
Filter-press cells have been used by coupling to a pump and a reservoir ( Figure 3). One module including an anode, a cathode, and a membrane (if necessary) makes it relatively easy to operate and maintain the reactor.

Electrode Materials
It has also been shown that the anodes with high over-potential O2 yield better electrochemical oxidation results [53][54][55][56]. Consequently, the electrode material (M) has a significant impact on the performance of PPCPs in oxidative degradation. Accordingly, an interesting issue is a systematic research on the comparative performance of electrode materials.
Sopaj et al. [57] tested on different electrode materials such as carbon felt, carbon fiber, carbon graphite, Platinum (Pt), lead dioxide, dimensionally stable anode (DSA) [58], (Ti/RuO2-IrO2), and boron-doped diamond (BDD) for removing of amoxicillin in aqueous media. BDD anode was more effective in oxidizing and mineralizing amoxicillin in water than the DSA. Moreover, it can be obtained very high electrolysis efficiency for the BDD electrode during the initial stage, even for high current densities.
Barışçı et al. [59] showed the performance of electrodes was significantly different for the anticancer drug carboplatin degradation with various mixed metal oxide (MMO) electrodes and BDD electrode ( Figure 4). CV voltammograms unveiled that BDD, Ti/IrO2-RuO2, Ti/RuO2, and Ti/IrO2-Ta2O5 anodes had the highest levels of oxygen evolution and the poorest anodes were SnO2/Pt, Ti/Pt and Ti/Ta2O5-SnO2-IrO2. Besides, higher oxygen evolution overpotential explained the formation of OH* on the surface of anode instead of molecular oxygen, which improved the efficiency.

Lead and Lead Dioxide
Because of the stability, low cost, and high oxygen evolution potential, lead and lead dioxide have been used as anode materials [60] (Table 4). Recent studies have paid considerable efforts to improve the performance, including the addition of a new intermediate layer between the substrate and the oxidation layer, doping metal, or non-metallic ions and the adoption of new preparation methods [61,62]. Dai et al. [55] found the catalytic effect of La-Gd-PbO2 showed the highest performance followed by that of La-PbO2, Gd-PbO2, PbO2, respectively, in levodopa degradation. Moreover, compared to the pure PbO2 electrode, the PbO2 electrode with 1% Mo had a higher oxygen evolution potential and higher current of reduction and oxidation peaks, which led to increasing in electrochemical activity and decreasing of energy consumption [63].
Porous Ti plays an essential role in improving lead dioxide electrode performance compared to the traditional planar Ti substrate. Zhao et al. [64] found that compared to the traditional PbO2 electrode, Ti/SnO2-Sb2O3/PbO2 had higher stability, safety, and removal performance of musk ketone. Xie et al. [65] developed a TiO2-based SnO2-Sb/polytetrafluoroethylene resin-PbO2 electrode based on TiO2 nanotubes and demonstrated the growing of TiO2 nanotubes on Ti material led to an increase in current efficiency. Before electrons flow, the electrode needs a large overpotential that minimizes the oxygen evolution, decreases the production of hydrogen peroxide and ozone, and favors the creation of *OH, with the electron efficiency of 88.45%. The degradation of ibuprofen demonstrated the degradation rate constant over Ti/SnO2-Sb/Ce-PbO2 was two times of the value over Ti/Ce-PbO2 [66].

DSA
In recent decades, MMO electrodes, known as DSA, have been made commercially available (Table 5). These consist of the corrosion-resistant base material, such as titanium or tantalum, coated with a metal oxide layer. DSA is catalytic oxide electrodes that, due to their low Cl2 overpotential, can effectively produce active chlorine species [67].
Studies verify the performance of three-dimensional (3D) was much better, more cost-effective, and saved more energy than traditional two-dimensional (2D). The highest efficiency was recorded in the 3D process for removing carbamazepine compared to a 2D electrochemical process [68]. Furthermore, using a 3D electrode reactor to treat estriol, in batch mode, exhibited reaction rate per unit area was significantly higher and lower energy consumption than conventional 2D electrode reactor with indirect oxidation as the main contributor to the degradation in the batch 3D electrode reactor at all electrode distances [69]. Over 80% of the removal efficiency was attributed to indirect oxidation at an electrode distance of 2 cm ( Figure 5). By adding powder activated carbon (PAC) or metal particles, the conductivity, mass transfer, or adsorption may also be increased in the 3D process [73]. The possibility of catalytic reaction and more reactive sites for adsorption are advantages of the 3D process that lead to better removal performance [74].
The SnO2 electrode has been widely used in wastewater treatment because of its high oxidation activity, it lower toxicity than PbO2, and it being more cost-effective than BDD. Sadly, it also contains limitations due to high energy consumption and instability. Adding TiO2 could reduce the electrode's internal passivation and charge transfer resistance, improving its stability and efficiency in oxidation when Cu limits the growth of crack morphology and offer more effective active sites. They accelerated electronic transfer and decreased SnO2 surface potential, improved the OEP, and increased the response current peak, which increased the electrode's oxidative degradation capacity [75]. Ti/SnO2-Cu showed better stability and higher corrosion resistance than the conventional Ti/SnO2-Sb electrode [76]. RuO2/IrO2-coated titanium anode with improved electrocatalytic behavior and stability are readily available in practical mesh geometries and have extended the lifetime and lower costs compared to BDD electrodes. Various DSA such as Ti/RuO2, Ti/Pt, Ti/IrO2-RuO2, Ti/IrO2-Ta2O5, Ti/Ta2O5-SnO2-IrO2, and Pt/SnO2 used for removing X-ray contrast iohexol demonstrated that Ti/RuO2 provided the highest degradation efficiency [77]. Barışçı et al. [59] found that Ti/RuO2 could reach complete degradation of carboplatin anti-cancer drug in just 5 min and obtained zero toxicity at the end of the process. However, the use of IrO2, RuO2 on large scale is restricted by low abundance, high cost, and difficulty in their separation. Ir/IrO2 nanoparticles could be immobilized on Fe3O4 core/ SiO2 shell via surface-modified NH2 functional groups resulted in high catalytic activity, high stability, and efficient recyclability.

Boron-Doped Diamond
The BDD anode showed high performance on various kinds of PPCPs, as seen in Table 6. The low-pressure conversion of carbon to diamond crystals has allowed a thin layer of diamond film to develop on suitable substrates like silicon, niobium, tungsten, molybdenum, and titanium [78]. He et al. [79] examined aspirin degradation with PbO2, BDD, and porous Ti/BDD as the anode. On BDD electrodes, the electrochemical process involves direct and indirect electrochemical oxidation, whereas, on the PbO2 electrode, only indirect oxidation. The kinetic results can be explained by the mechanism of aspirin degradation, which may take place in two distinct forms: direct oxidation at the electrode surface and indirect oxidation mediated by *OH. In indirect oxidation, the initial step involves the formation of *OH from water molecule discharge. The oxidation is indirectly mediated by *OH contributing to the mineralization of organic pollutants. Aspirin mineralization is mainly performed by reaction with *OH. Porous Ti/BDD is the highest excellent potential for aspirin relative to flat BDD and PbO2 electrode when niobium-supported BDD thin film (Nb/BDD) anode could be applied in a wide range of pH, reducing chemicals for pH adjustment [48].
In various systems, BDD allowed for higher removal rates of PPCPs than other anodes as higher quantities of *OH produced. Sirés et al. [80] indicated that the performance was demonstrated to be much more productive using a large surface area BDD anode than a Pt one, explained by a large number of active hydroxyl radicals BDD (*OH) and minimizing their parasitic reactions. Compared to the Pt and glassy carbon anodes, the BDD anode showed better efficiency for isothiazolin-3-one degradation [81]. BDD physisorbed *OH was observed to cause the combustion of ketoprofen into CO2 and H2O. The poor mineralization was attributed to the formation of chlorinated organic compounds that are refractory at both BDD and Pt anodes [82]. Omeprazole was primarily oxidized by *OH formed from water oxidation at the surface of the Pt or BDD [54]. It also can be seen that the BDD anode was superior to the Pt and PbO2 electrodes for DEET abatement. At the same j value and temperature, the DEET abatement degradation in the order BDD, PbO2, and Pt [52]. It also can be seen the higher oxidation power of BDD became evident in removing estrone than β-PbO2 anode [83].
BDD electrode in a single compartment filter-press flow cell represented the conversion of cephalexin and its hydroxylated intermediates to CO2 depended solely on their diffusion to the BDD surface. Due to the different types and quantities of electrogenerated oxidants, the oxidation rate of cephalexin using distinct salts as supporting electrolytes showed distinct rates; however, none of them were able to mineralize cephalexin and its intermediates, which only occurred through a diffusion mechanism on the surface of the BDD [84]. Due to the high concentration of *OH generated on the BDD surface, with the release of NH4 + and NO3 − ions, nearly 50% of mineralization of paracetamol and diclofenac is always achieved [50].

Other Electrodes
The Pt electrode showed better performance in sulfamethoxazole and diclofenac degradation wit electrolyte supports under the same conditions as the carbon electrode [89]. Compared to RuO2/Ti, IrO2/Ti, and RuIrO2/Ti electrodes, Pt/Ti demonstrated that the removal efficiency of berberine was considerably higher [90].
Carbon nanotubes are recognized in wastewater as an advanced anode material for recalcitrant antibiotics for electrocatalysis oxidation. Cyclic voltammetry analysis of La2O3-CuO2/carbon nanotube (CNT) showed a stronger catalytic activity of the modified electrode and stable working life with an efficiency of 90% to 1 mg/L ceftazidime within 30 min, which is much higher than that of pristine CNTs and DSA [91]. The addition of TiO2 could promote the electron transfer and reusability of the CeO2-ZrO2/TiO2/CNT electrode [92]. In three electrodes promoted by multiwall carbon nanotubes (MWCNTs) (MWCNT, MWCNT-COOH, and MWCNT-NH2), concerning the electrode surface chemistry, MWCNT-NH2, with the highest isoelectric point (4.70), is the most promising material due to improved reactant interactions [93].

Initial PPCPs Concentration
The initial drug concentration significantly influenced the rate of electrochemical decomposition and the process efficiency for both drugs, ifosfamide, and cyclophosphamide [94]. The higher degradation rate of ibuprofen achieved at relative lower initial concentrations at the initial ibuprofen concentrations ranges from 1.0 to 20.0 mg/L [66]. The concentration of parabens in the aqueous matrix was the element that, regardless of the aqueous matrix under investigation, exerts a more extraordinary effect on the target variable. An increase in the initial parabens concentration resulted in a decrease in the efficiency of removal [95] and the mineralization rate decreases when salicylic acid concentration rose from 200 mg/L. During bulk electrolyzes at a low j value and high salicylic acid concentration, salicylic acid was oxidized to aromatic compounds due to a low local concentration on the anode surface of electrogenerated *OH relative to salicylic acid. As bulk electrolyzes at a high j value and low salicylic acid concentration, the product was directly combusted to CO2 due to a high local concentration on the anode surface of electrogenerated *OH relative to salicylic acid [96].
Interestingly, it could be seen that the efficiency improved with the increased concentration of paracetamol and diclofenac due to the gradual increase in the concentration of *OH to oxidize contaminants before participating in non-oxidizing reactions [50]. The removal of caffeine had two stages, depending on its concentration. At low concentrations, the efficiency significantly increased with j value, suggesting a crucial role of mediated oxidation processes [97].

Supporting Electrolytes
In the presence of NaCl as the supporting electrolyte, the degradation rate of PPCPs was favored. Experiments on RuO2/Ti, IrO2/Ti, RuIrO2/Ti, and Pt Ti electrodes showed a constant reaction rate in NaCl solution three to five times higher than in Na2SO4 and the oxidation rate of berberines increased due to active chlorine formation [90]. Ambuludi et al. [98] indicated that the pseudo-first-order rate constant increased when NaCl replaced Na2SO4 as the electrolyte support and it was almost unaffected by the concentration of ibuprofen. Otherwise, the poor mineralization of ketoprofen was due to the formation of chlorinated organic compounds, which are refractory, at both BDD and Pt anodes in the presence of NaCl as supporting electrolyte while total mineralization using Na2SO4 as an electrolyte was achieved [82]. Indermuhle et al. [97] found using NaCl, compared to Na2SO4, caffeine could reach a faster degradation but more reaction intermediates are formed and the mechanism is consistent with other proposed (Figure 6).    [98] In the presence of Na2SO4, the increasing concentration of Na2SO4 provided a higher rate of degradation of the anti-cancer drug carboplatin but further increased the concentration of Na2SO4, which did not offer a higher rate of degradation due to SO4 2− excess [59]. Moreover, 0.1 M electrolytesupporting Na2SO4 was found to be more active for sulfamethoxazole and diclofenac mineralization, with an efficiency of 15%-30% higher than 0.1 M electrolyte-supporting phosphate buffer on Pt and carbon electrodes [89].
Various inorganic ions have significant effects on removing certain PPCPs that were compared with a higher removal rate in the presence of chloride species than other ions. Acetaminophen, diclofenac, and sulfamethoxazole degradation showed high removal efficiencies, and faster reaction rates may correlate with the presence of chloride species, which may be due to the involvement of hypochlorite ions. Although all of the drugs were degraded by indirect electrochemical oxidation, cyclic voltammograms suggested that chloride species may have coexisted with *OH and have been converted into by-products of degradation [49], whereas ions Cl − and PO4 3− significantly increased the decomposition rate of ifosfamide [94]. Current density (j), pH, and temperature also among parameters that have been optimized and investigated in the EOP. Which factor most crucial for efficiency removal depends on the kinds of PPCPs, the material of electrodes and the nature of electrolytes applied. For naproxen removal, the current influence was the greatest among these variables, and the second was the salt concentration, the third flow rate and the fourth pH [105]. Domínguez et al. [106] also proved that the influence of the current was the greatest, then the concentration of salt and the flow rate, respectively, on carbamazepine degradation.
The j value shows a vital role in the removal efficiency with increasing removal efficiency when j increased in most cases of PPCPs [66,97,104] and other factors are dependent or not significant under certain operating conditions. Isothiazolin-3-ones degradation rate was faster as the j value applied increased but nearly independent of electrolyte pH [81]. Moreover, the complete removal of norfloxacin is dependent on pH. However, the removal increased with the temperature at 10°C, 25°C, and 40°C may result from a gradual increase in the diffusion coefficient and the oxidation of byproducts under temperature conditions [100]. Interestingly, DEET degradation increased with increasing current density but was moderately affected by temperature (25-75 °C) [52]. Similarly, the salicylic acid mineralization rate increased at 25 °C with an increase of applied current, the pH impact was not significant [96]. This also can be seen in the case of ketoprofen [82], ifosfamide, and cyclophosphamide [94]. Interestingly, the carboplatin degradation rates increased significantly in the initial phases of electrolysis as j value increased on the Ti/RuO2 electrode. However, a further increase in j did not affect the rate of degradation [59]. Sun et al. [107] found that pH decreased, the efficiency of chloramphenicol degradation increased, and maximum degradation was achieved at pH 2, Figure  7. Stirring increased the rate of mass transfer and PPCPs formed a contentious relationship on the electrode surface to increase the efficiency of removal. When the stirring speed was too slow, the mass transfer resistance would be the limitation. With the free radical produced from the electrode surface, PPCPs were unable to react quickly. It was also not possible to transfer the hydroxyls produced to the solution in time. On the other hand, the high stirring speed turned leads to short time for PPCPs touching the electrode surface, PPCPs could not be wholly oxidized and soon left the electrode surface. O2 and H2 bubbles produced from H2O electrolysis would be more competitive to access molecule surface with extreme disturbance, resulting in reducing removal efficiency. The kinetic study of naproxen degradation at fix potential indicates that the rate of degradation increases with the stirring speed at 250 and 500 rpm [93]. For diffusion reactions, the stirring rate is an essential factor. The stirring rate showed a definite increase in the removal of ceftazidime and then decreased as the stirring speed between 150 and 200 rad min −1 [76].

Electrode Spacing and Fluid Velocity
The changes in the spacing of the electrodes would affect not only the mass transfer limitations but also the electron transport and electric resistance [108]. The effect of electrode spacing, however, depends on the direct or indirect oxidation. In the latter case, the electrode spacing should be matched with the diffusion length of *OH species. Duan, et al. [76] found that the oxidation of ceftazidime decreased as the spacing of the Ti/SnO2-Cu electrode changed at 1, 2, and 3 cm under the current of 20 mA. As the spacing increased, the electrochemical resistance also increased while the charge in the electrolyte decreased. Xie et al. [65] (Figure 8) tested ofloxacin removal with the changes in electrode spacing. The reaction rate increased with the first-order pseudo constant changed as the distance decreased from 3 cm to 0.5 cm and the mass transfer coefficient increased.
It can be seen that the electrocatalytic oxidation process relied primarily on the high potential for direct oxidation on the electrode surface and the generation of free radicals for indirect oxidation of PPCPs. Consequently, the spacing increases, which leads to a loss in *OH production and oxidation power on anode surfaces. Diffusion efficiency also affects removal efficiency and so at a larger electrode spacing, the electrolysis process needs more time because of longer diffusion distance. Both electrode spacing and fluid velocity are critical since increasing velocities that lead to an increase in the rate of mass transfer while decreasing electrode spacing increases the surface area available for mass transfer [65].

Applications for Real Water and Wastewater Containing PPCPs
EOP is a promising technique with different degradation rates for the removal of PPCPs from water and WWTP effluents under optimal conditions concerning the ecological system [98,107,109,110].
Because of the presence of chloride ions in the effluent, oxidation in secondary treated wastewater was faster than in pure water [111]. Carbamazepine electrodegradation is feasible for WWT in several aqueous matrices [112], after 50 min of electrolysis time, caffeine was removed entirely in DIW and was almost removed in the wastewater sample may be related to the organic matter in wastewater. Having regard to these results, EOP is an effective method for further removal of caffeine from effluent from aerobic or anaerobic reactors that treat municipal wastewater, even though a high concentration of caffeine was used compared to low concentration in natural water. Compared to conventional methods for removing caffeine from urban wastewater, this approach appears to be more feasible for the following reasons: ease of operating, rapid removal of caffeine, and the effective efficiency of treatment [110]. The caffeine elimination obtained in real wastewater was found to be higher than in synthetic wastewater due to the contribution of electrogenerated oxidant species, such as hypochlorite [113], when sulfonamides and DEET removal were most efficient in the presence of municipal wastewater treatment plant (MWWTP) effluents [52,102].

Combined Systems
While EOP has been widely demonstrated for their ability to remove trace and persistent PPCPs in water and wastewater, complex water matrices could be found that inhibit their efficient operation. As a result, they may potentially reduce or fully retard the efficiency, requiring longer hydraulic retention time or higher volume capacity for compensation. System hybridization or combination of EOP with other water technologies is possible to overcome the operational problems associated with the complex water matrices.
Zaghdoudi et al. [114] investigated the possibility of coupling an electroreduction pretreatment before a biological process for dimetridazole removal. Direct electrolysis was initially conducted at the low potential to reduce amino derivatives formation and then azo dimer formation with a total degradation of dimetridazole achieved and the ratio of biochemical oxygen demand (BOD5)/chemical oxygen demand (COD) increased. As mineralization yields of all electrolyzed solutions increased significantly, the enhancement of biodegradability was demonstrated during biological treatment. Nevertheless, the real mineralization yields should most likely be significantly higher if the contribution of titanocene, which is possibly biorecalcitrant, is not taken into account in the amount of TOC. Belkheiri et al. [115] examined the biodegradability improvement of tetracycline-containing solutions after an electrochemical pretreatment, as a large amount of the applied drugs are not metabolized and, therefore, can be found in wastewater. BOD5 measurements verified biodegradability increased with the oxidation potential as the ratio of BOD5/COD increased. Despite its chemical transformation, none of the reduced tetracycline solutions are biodegradable. Yahiaoui et al. [116] found after 5 h of electrochemical pre-treatment of tetracycline, the BOD5/COD ratio increased considerably and confirmed during biological treatment, with 76% of dissolved organic carbon (DOC) removed.
Pharmaceutical degradation in conventional WWTPs is a problem because industrial sewage and hospital effluents contain low-concentration pharmaceuticals. Rodríguez-Nava et al. [117] found high efficiencies in removal without affecting activated sludge performance of integrating EOP with a biological system for simultaneous removal from wastewater of recalcitrant drugs (bezafibrate, gemfibrozil, indomethacin, and sulfamethoxazole). Drugs contained in wastewater without electrochemical pretreatment was persistent in the biological process and encouraged bulking formation. García-Gómez et al. [118] proved membrane bioreactor (MBR) high capacity to remove COD and low capacity for degradation (20%) of carbamazepine after 120 days, which presumably suggests that given the weak degradation and carbamazepine was not toxic to microorganisms. The EOP, on the other hand, was able to degrade carbamazepine completely.
In an exciting study for investigating pre-and post-treatment in one system to remove synthetic hospital wastewater fortified with four drug pollutants including carbamazepine, ibuprofen, estradiol, and venlafaxine by the combination of MBR and EOP, MBR alone treatment of wastewater showed a high percentage of ibuprofen and estradiol removal (about 90%), while carbamazepine and venlafaxine performed a low elimination (at around 10%). EOP as post-treatment, this allowed high removal (about 97%) of the four pharmaceutical pollutants and far more successful compared to EOP as pre-treatment [119]. The integration of electrochemical processes into MBR systems can utilize the mechanism of biodegradation, sorption, hydrolysis, and filtration on conventional MBR and electrocoagulation, electroosmosis, and electrophoresis on electrochemical processes that improve both the performance and the control of membrane fouling for eliminating recalcitrant micropollutants [120,121].

Conclusions
EOP is a promising technique with different degradation rates for the removal of PPCPs from water and wastewater, from synthetic or real, concerning the ecological system. There are numerous studies that have recently focused on the finding of electrode materials and optimal conditions, including initial PPCPs concentration, supporting electrolytes, j value, pH, temperature, stirring rate, and electrode spacing that are effective for removing a certain or groups of PPCPs with considering reduce operating cost. In terms of operational parameters, it was shown that the current influence was the greatest among these variables in some mentioned studies. Although the electrochemical process has recorded several influential factors, only some of them show a significant impact on real systems.
Studies showed that the EOP system depends heavily on the type of anode. BDD anode shows high performance on various kinds of PPCPs. The BDD anodes have been reported to produce higher organic oxidation rates and higher current efficiencies than other metal oxides commonly used. The development of BDD anodes and the enormous advantages of this electrode compared to others make this material was investigated on most of the works published in the literature. The performance of 3D electrolysis is much better, more cost-effective, and saves more energy consumption than traditional 2D electrolysis. The results validate 3D electrolysis in pretreatment or advanced treatment applications as a promising alternative method to remove PPCPs from secondary effluents.
Real field samples may contain other species of radical electrolytes that may participate in the electrochemical process and therefore act as interferences within the EOP system. It is therefore recommended that the electrochemical degradation process be the last step in the domestic water treatment since the technique also largely depends on the electrolytes in the water.
Toxicity evaluation is an essential environmental pollution control factor since the degradation by-products from the initial structure can be more toxic. It can be seen that in some kinds of PPCPs, intermediates are more toxic than the molecule of the parent, while others are less harmful. By evaluating toxicity, it helps significantly in optimizing treatment conditions to achieve the elimination of adverse effects of by-products.
EOP has widely demonstrated their ability to remove trace and persistent PPCPs in water and wastewater. Further, complex water matrices could be found that inhibit their efficient operation. System hybridization or combination of EOP with other water technologies is possible to overcome the operational problems associated with the complex water matrices.

Conflicts of Interest:
The authors declare no conflicts of interest.