Coenzyme Q10 (CoQ10) is an essential component of the respiratory chain which produces ATP. It is formed from the conjugation of a benzoquinone ring with a hydrophobic isoprenoid chain. Efforts on the production of CoQ10 by microorganisms focus on the development of potent strains by conventional mutagenesis and metabolic engineering especially in Escherichia coli, analysis and modification of the key metabolic pathways and optimization of fermentation strategies. CoQ10 has excellent antioxidant properties and is beneficial in the treatment of several human diseases. The present review covers the current strategies used to improve and/or engineer CoQ10 production in microbes, the yields obtained in light of the current knowledge on the biosynthesis of this molecule. It also highlights the medical effects of CoQ10.