Pharmaceutical contaminants, such as Cefuroxime sodium, pose a significant threat to aquatic ecosystems due to their persistence and bioactivity. This study reports the synthesis of sustainable mesoporous silica adsorbents, RH-MCM-41 and RH-SBA-15, from rice husk, an abundant agricultural waste, for efficient removal of cefuroxime from water. The adsorbents exhibited point of zero charge (pHPZC) values of 5.2 and 4.5, respectively, influencing surface interactions with anionic cefuroxime. Batch adsorption experiments revealed high removal efficiencies, while desorption studies demonstrated that acidic eluents, particularly nitric and phosphoric acid, regenerated over 90% of adsorbed antibiotic. Reusability tests confirmed structural stability and sustained adsorption over multiple cycles. Compared with conventional adsorbents, rice husk-derived mesoporous silica combines high adsorption performance, low-cost synthesis, and environmental sustainability, offering a practical solution for pharmaceutical wastewater treatment. These findings highlight the potential of valorised agricultural waste as a cost-effective, eco-friendly, and reusable material for mitigating emerging contaminants in water systems.