The removal routes of pharmaceuticals especially biodegradation routes in the activated sludge process are still unclear. Some studies indicated pharmaceuticals were mainly removed via nitrification process (autotrophic biodegradation), while others suggested pharmaceuticals were mainly removed via COD degradation process (heterotrophic biodegradation). These unclear problems limited the improvements of pharmaceuticals removal. In this study, in order to elucidate three biodegradation routes (nitrification, COD degradation, or both nitrification and COD degradation), autotrophic and heterotrophic reactors were individually developed to separate nitrification and COD degradation form the activated sludge process (mix-trophic process including nitrification and COD degradation). Furthermore, the pharmaceuticals removal routes of adsorption, hydrolysis, and oxidation were also studied. Among six degradable pharmaceuticals, heterotrophic biodegradation and adsorption were the major removal routes. Two sulfonamides of five antibiotics were predominantly removed by COD degradation process, while nitrification and adsorption had no contributions. Adsorption, hydrolysis, nitrification, and COD degradation were the main elimination routes of cefalexin. COD degradation and adsorption were the dominant removal routes of norfloxacin. Tetracycline was mainly removed by the adsorption route, and hydrolysis and oxidation also played a role. For two drugs, ibuprofen was removed mainly via nitrification and COD degradation, and no adsorption occurred. Diclofenac could not be removed at all and was persistent in the aerobic conditions. Kinetic studies showed that biodegradation of the two sulfonamides, cefalexin, norfloxacin, and ibuprofen followed first-order kinetics rather than zero-order or second-order kinetics. (C) 2018 Elsevier B.V. All rights reserved.