Antibiotic resistance genes (ARGs) have complex transmission pathways and are prone to form multi-drug-resistant bacteria, threatening the ecological environment and human health. This paper elucidates the distribution and dissemination of ARGs across seven major river basins in China through a comprehensive analysis of relevant literature from the past decade. It presents a comprehensive catalog of pertinent risk assessment methodologies and potential management strategies aimed at mitigating the threat posed by antibiotic resistance due to ARGs. The analysis results showed that the pollution abundance of ARGs showed a decreasing trend from east to west, with the estuarine environment and economically developed areas standing out, with sulfonamides and tetracyclines, among others, as the main types of pollution. Human activities are closely related to the occurrence and spread of ARGs. Mobile genetic factors and microbial communities act as the main drivers to promote the proliferation of ARGs among different microorganisms through horizontal transfer and other pathways. The exhibition of ARGs assessment methods was comparatively analyzed, while Chinese river basins are at medium-high risk and need to be managed rationally. This review can provide a reference for the distribution, spread and management of ARGs in Chinese river basin.