Many advanced technologies have shown encouraging results in removing antibiotics from domestic wastewater. However, as activated sludge treatment is the most common sewage treatment system employed worldwide, improving its effect on antibiotic removal would be more desirable. Understanding the removal mechanisms, kinetics and factors that affect antibiotic removal in the activated sludge process is important as it would allow us to improve the treatment performance. Although these have been discussed in various literature covering different types of antibiotics and wastewater, a specific review on antibiotics and domestic wastewater is clearly missing. This review paper collates, discusses and analyses the removal of antibiotics from sewage in the activated sludge process along with the removal mechanisms and kinetics. The antibiotics are categorised into six classes: β-lactam, dihydrofolate reductase inhibitor, fluoroquinolone, macrolide, sulfonamides and tetracycline. Furthermore, the factors affecting the system performance with regard to antibiotic removal are examined.