Sulfamethoxazole (SMX) is one of the most frequently detected antibiotics in aquatic environments and is difficult to remove by conventional biological treatment because of its persistence, potential toxicity to microbial communities, and associated risk of antibiotic resistance selection. Aerobic granular sludge membrane bioreactors (AGMBRs), which combine the compact and stratified structure of aerobic granular sludge with membrane-based solid–liquid separation, have emerged as a promising platform for SMX-contaminated wastewater treatment because they provide high biomass retention, decoupled sludge retention time (SRT) and hydraulic retention time (HRT), and stable effluent quality. This review systematically summarizes recent advances in AGMBRs for SMX removal, with emphasis on how operating parameters (e.g., dissolved oxygen, hydraulic retention time, organic loading rate, C/N ratio, and sludge retention time) and membrane-related factors (e.g., membrane flux, aeration-induced shear, membrane type, and pore size) affect treatment performance and process stability. The main SMX attenuation pathways in AGMBRs are discussed from three perspectives: sorption and partitioning within granules and extracellular polymeric substances (EPSs), microbial biodegradation and co-metabolism, and membrane retention that prolongs effective contact time and shapes microbial ecology. Particular attention is given to the dual role of EPS and soluble microbial products (SMPs), which contribute to granule stability and SMX tolerance but also accelerate membrane fouling through cake-layer formation, pore blocking, and transmembrane pressure increase. Current challenges include incomplete understanding of transformation products, ARG- and MGE-related risks, long-term fouling–biodegradation interactions, and the lack of pilot-scale validation. Future research should therefore focus on mechanism clarification, integrated control of removal and fouling, energy-efficient operation, and scale-up of AGMBRs for practical antibiotic wastewater treatment.
zhang et al. (2026) studied this question.