The increasing prevalence of pharmaceutical residues, particularly antibiotics, in water supplies poses a serious risk to both the environment and human health. The limited biodegradability of antibiotics and the inadequacy of conventional wastewater treatment methods to eliminate them contribute to the emergence of antibiotic-resistant bacteria. Adsorption using natural clays, a cost-effective and efficient technique, has emerged as a promising solution for removing these pollutants. Modified clay composites, in particular, have shown significant potential due to advancements in surface modification and hybridization techniques. This review explores the latest developments in the generation of modified clay minerals to eliminate antibiotics from water, emphasizing upcoming trends and approaches to enhance adsorption capacity. Techniques such as intercalation with organocations or metal-pillared clay minerals and acid activation and thermal treatment can improve adsorption properties like surface area, capacity, stability, and mechanical strength. Furthermore, the development of clay and its composites offers advantages in its adsorption capacity, recovery, and physicochemical properties compared to modified and unmodified clay and clay minerals.