The present study investigated the utilization of blood clam shells as a potential substitute for conventional media, as well as the influence of the acclimation time on the efficacy of an intermittent slow sand filter (ISSF) in the treatment of real domestic wastewater. ISSF was operated with 16 h on and 8 h off, focusing on the parameters of turbidity, ammonia, and phosphate. Two media combinations (only blood clam shells [CC] and sand + blood clam shells [SC]) were operated under two different acclimatization periods (14 and 28 d). Results showed that SC medium exhibited significantly higher removal of turbidity (p < 0.05) as compared to CC medium (45.99 ± 26.84 % vs. 3.79 ± 9.35 %), while CC exhibited slightly higher (p > 0.05) removal of ammonia (23.12 ± 20.2 % vs. 16.77 ± 16.8 %) and phosphate (18.03 ± 11.96 % vs 13.48 ± 12 %). Comparing the acclimatization periods, the 28 d of acclimatization period showed higher overall performances than the 14 d. Further optimizations need to be conducted to obtain an effluent value below the national permissible limit, since the ammonia and phosphate parameters are still slightly higher. SEM analysis confirmed the formation of biofilm on both mediums after 28 d of acclimatization; with further analysis of schmutzdecke formation need to be carried out to enrich the results.