The objective of this review is to highlight the need for further investigation of microbial toxicity caused by desorption of surfactant from Surfactant Modified Zeolite (SMZ). SMZ is a low cost, versatile permeable reactive media which has the potential to treat multiple classes of contaminants. With this combination of characteristics, SMZ has significant potential to enhance water and wastewater treatment processes. Surfactant desorption has been identified as a potential issue for the ongoing usability of SMZ. Few studies have investigated the toxicity of surfactants used in zeolite modification towards microorganisms and fewer have drawn linkages between surfactant desorption and surfactant toxicity. This review provides an overview of natural zeolite chemistry, characteristics and practical applications. The chemistry of commonly used surfactants is outlined, along with the kinetics that drive their adsorption to the zeolite surface. Methodologies to characterise this surfactant loading are also described. Applications of SMZ in water remediation are highlighted, giving focus to applications which deal with biological pollutants and where microorganisms play a role in the remediation process. Studies that have identified surfactant desorption from SMZ are outlined. Finally, the toxicity of a commonly used cationic surfactant towards microorganisms is discussed. This review highlights the potential for surfactant to desorb from the zeolite surface and the need for further research into the toxicity of this desorbed surfactant towards microorganisms, including pathogens and environmental microbes.