A systematic review of sources, occurrence, behavior and risks of global marine antibiotics

Abstract The widespread use of antibiotics has resulted in their significant release into the environment, with the ocean becoming a major sink for antibiotics and antibiotic resistance genes (ARGs). This review synthesizes global data on marine antibiotic contamination, covering sources, occurrence, behavior, and associated ecological and human health risks. Sulfonamides, fluoroquinolones, macrolides, and tetracyclines dominate, with sulfamethoxazole most frequently detected (71.1% in seawater, 30.4% in sediment, 47.6% in biota). Peak levels reached 332,440 ng L −1 in seawater, 1515 ng g −1 in sediment, and 3341 ng g −1 in organisms, the highest in coastal China. Antibiotics with low direct toxicity may still drive ARG development. Coexisting contaminants (e.g., heavy metals, microplastics) may enhance impacts. Seafood-related health risks, especially in adolescents, merit attention. Monte Carlo analysis confirms ecological, antimicrobial resistance, and health risks remain significant under realistic exposure scenarios. These findings support global efforts in marine antibiotic pollution control and risk governance.