Antibiotics, which have been identified as emerged pollutants, are creating an increase in environmental concerns, with sulfonamide antibiotics (SAs) being among the most commonly discovered antibiotics. Due to their widespread usage and inadequate sewage treatment, SAs are frequently released into the aquatic environment. The introduction of SAs into aquatic environments can kill or inhibit the growth or metabolic activity of microorganisms, thereby affecting biological communities and ecological functions and disrupting the equilibrium of aquatic ecosystems. The transmission of SAs to human beings can occur through trophic transfer of food chains, particularly when humans consume aquatic food. This study examines the trophic transfer of SAs along the aquatic food chain, provides a summarize of the spatial distribution of SAs in aquatic environments, and evaluates the environmental risks associated with it. The prevalence of SAs was predominantly noted in the aqueous phase, with relatively lower concentrations detected in sediments, solidifying their status as one of the most widespread antibiotics among aquatic organisms. SAs, characterized by their high biomagnification capacity and strong bioaccumulative properties in invertebrates, emerge as the antibiotic type with the greatest ecological risks. The ecological risk posed by sulfonamide antibiotics to aquatic organisms is more pronounced than the health risk to humans, suggesting that the adverse effects on aquatic life warrant greater attention. Additionally, this study offers practical recommendations to address the limitations of previous research, emphasizing the importance of regulating exposure and establishing a robust health risk prediction system as effective measures for antibiotic control.