Biofermenting residue (BR) arising from the production of antibiotics was cogasified in an industrial scale MCSG coal-water slurry gasifier. It released large amounts of volatiles during pyrolysis at low temperature (below 650 degrees C), as follows from thermogravimetric analysis in an inert gas stream. The main evolved volatiles are light gaseous compounds, such as H2O, CO, CO2, and H-2 (monitored by MS analysis), and heavy organics with high oxygen content (monitored by FTIR analysis). During industrial scale experimental tests, BR cogasification had little influence on syngas composition, when compared with straight coal-water slurry gasification. The emissions to air from BR cogasification basically meet the emission limits in China. The solid residues produced meet the Chinese requirements of agricultural sludge. Cogasification in a MCSG coal-water slurry gasifier may be a viable alternative solution for BR treatment. However, further research is needed to apply this in other types of gasifiers or to expand the range of waste/biomass cotreatment.