The continuous release of large quantities of antibiotics into the aquatic environment has led to widespread water pollution in China. Therefore, this study investigated the antibiotic pollution levels and ecological risks of surface water in seven major Chinese watersheds based on research papers from 2013 to 2024. Measured concentrations and ecotoxicity data of sulfonamides (SAs), tetracyclines (TCs), fluoroquinolones (FQs), and macrolides (MLs) in the aquatic environments of China were collected and compiled. The environmental concentration and distribution characteristics of antibiotics in seven major watersheds were statistically analyzed to carry out the evaluation of multiple ecological risks of antibiotics in watersheds across the country, and at the same time, the traceability analysis of antibiotic pollution in different regions was carried out, which will provide a certain theoretical basis for the precise management of antibiotic pollution in the future. The results showed that the distribution and environmental risks of the four antibiotics in different watersheds varied greatly, with the Yangtze River Basin, the Huanghuai Basin, and the Pearl River Basin being affected by anthropogenic activities, economic development, and other factors, with a wider range of antibiotic sampling sites and higher detection concentrations, and with the Northwestern Basin, the Southwestern Basin, and the Songhua and Liaohe River Basins having an overall lower risk of antibiotics. FQs were detected at high concentrations in all the basins, mostly posing high risk to aquatic environments. SAs were the most frequently detected but had the lowest ecological risk. The results of the more refined risk assessment (joint probability curves, JPCs) were ranked in order of risk, with FQs ≥ TCs >
MLs >
SAs. These results can be used as a reference for integrated management and sustainability studies on basins across the country.