Pharmaceutical pollutants have emerged as pervasive environmental contaminants, entering ecosystems via wastewater effluents, agricultural runoff and improper disposal. These pollutants typically belong to classes such as antiepileptics, antibiotics, analgesics, non-steroidal anti-inflammatory drugs, hormones and antiseptics. Their recalcitrance arises from their stable chemical structures, which resist degradation and pose significant challenges for conventional wastewater treatment processes, leading to their persistence in the environment and potentially harmful effects on ecosystems and human health. This study investigates microbial engineering strategies for the efficient degradation of pharmaceutical pollutants. Recent advancements in CRISPR systems, ALE, metabolic engineering, bioaugmentation and bioreactor designs have significantly improved pollutant breakdown. Additionally, novel approaches to address emerging contaminants and the application of advanced biotechnologies like synthetic biology and metagenomics are crucial for developing more effective and sustainable bioremediation strategies. These insights offer a roadmap for developing more effective and sustainable solutions for the bioremediation of pharmaceutical pollutants.