Antibiotics, widely used pharmaceuticals, enter wastewater treatment systems and ultimately the aquatic environment through the discharge of wastewater from residential areas, hospitals, breeding farms, and pharmaceutical factories, posing potential ecological and health risks. Due to the misuse and discharge of antibiotics, the spread of antibiotic resistance genes (ARGs) in water bodies and significant changes in microbial community structure have direct toxic effects on aquatic ecosystems and human health. This paper summarizes the occurrence of antibiotics in wastewater treatment systems and their ecological and health risks, focusing on the impact of antibiotics on aquatic microorganisms, aquatic plants and animals, and human health. It points out that existing wastewater treatment processes have poor removal capabilities for antibiotics and even become an important pathway for the spread of some antibiotics. In terms of detection technology, the article discusses the application of immunoassays, instrumental analysis, and emerging sensor technologies in detecting antibiotics in sewage, each with its advantages and limitations. Future efforts should combine multiple technologies to improve detection accuracy. Regarding the removal methods of antibiotics, the paper categorizes physical, chemical, and biodegradation methods, introducing various advanced technologies including membrane separation, adsorption, electrochemical oxidation, photocatalytic oxidation, and membrane bioreactors. Although these methods have shown good removal effects in the laboratory, there are still many limitations in large-scale practical applications. This paper innovatively takes urban wastewater treatment systems as the entry point, systematically integrating the sources of antibiotics, environmental risks, detection technologies, and treatment methods, providing targeted and practical theoretical support and technical guidance, especially in the removal of antibiotics in wastewater treatment, on a scientific basis. Future efforts should strengthen the control of antibiotic sources, improve the efficiency of wastewater treatment, optimize detection technologies, and promote the formulation and implementation of relevant laws and standards to more effectively manage and control antibiotic pollution in the aquatic environment.