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The aquatic environment and drinking water production are under increasing pressure from the presence of pharmaceuticals and their transformation products in surface waters. Demographic developments and climate change result in increasing environmental concentrations, deeming abatement measures necessary. Here, we report on an extensive case study around the river Meuse and its tributaries in the south of The Netherlands. For the first time, concentrations in the tributaries were measured and their apportionment to a drinking water intake downstream were calculated and measured. Large variations, depending on the river discharge were observed. At low discharge, total concentrations up to 40 g/L were detected, with individual pharmaceuticals exceeding thresholds of toxicological concern and ecological water-quality standards. Several abatement options, like reorganization of wastewater treatment plants (WWTPs), and additional treatment of wastewater or drinking water were evaluated. Abatement at all WWTPs would result in a good chemical and ecological status in the rivers as required by the European Union (EU) Water Framework Directive. Considering long implementation periods and high investment costs, we recommend prioritizing additional treatment at the WWTPs with a high contribution to the environment. If drinking water quality is at risk, temporary treatment solutions in drinking water production can be considered. Pilot plant research proved that ultraviolet (UV) oxidation is a suitable solution for drinking water and wastewater treatment, the latter preferably in combination with effluent organic matter removal. In this way >95% of removal of pharmaceuticals and their transformation products can be achieved, both in drinking water and in wastewater. Application of UV/H2O2, preceded by humic acid removal by ion exchange, will cost about Euro0.23/m(3) treated water.