Antibiotic compounds, like sulfamethoxazole (SMX), have become a concern in the aquatic environment due to the potential development of antibacterial resistances. Due to extensive consumption, excretion and disposal, SMX has been frequently detected in wastewaters and surface waters. This has led to numerous studies investigating the nature of SMX, with many researchers focusing on the biodegradation and persistence of SMX during wastewater treatment and in the environment. This review provides a summary of recent developments, outlines the discrepancies in observations and results, and demonstrates the need for further research to determine optimal biological removal strategies for SMX and other antibiotics.