<p>Antibiotic contamination has emerged as a critical environmental challenge due to its persistence, difficulty in removal, and adverse impacts, including gene dissemination, resistance, and ecosystem disruption. Despite their clinical and agricultural benefits, the release of antibiotics into the environment is poorly regulated, leading to growing ecological and public health concerns. Conventional physicochemical methods, including advanced oxidation processes, activated carbon adsorption, and membrane filtration, are highly effective for antibiotic removal but are constrained by high costs associated with energy use, chemical inputs, and membrane replacement. Additionally, techniques such as Fenton reactions (using iron hydroxides with antibiotic residues), coagulation flocculation (binding metal hydroxides to antibiotics), and electrocoagulation (producing electrode corrosion sludge) generate toxic sludge, complicating its disposal. More sustainable approaches, such as bioremediation, biochar-assisted systems, anaerobic and aerobic digestion, biological aerated filters, and microbial fuel cells, demonstrate cost-effectiveness and minimal sludge production. However, both physico-chemical and biological methods still face limitations, emphasising the need for integrated solutions. Hybrid technologies that combine conventional and biological techniques, such as biochar-based bioreactors coupled with membrane separation or advanced oxidation, offer a promising approach for effective remediation. Emerging strategies also highlight the role of novel adsorbent materials (e.g., activated carbon, sawdust) and the application of machine learning in optimising antibiotic waste treatment. Future strategies require coordinated action across healthcare, agriculture, and the pharmaceutical sector, alongside robust risk assessment frameworks that consider both human and environmental health. This review examines current bioremediation strategies, hybrid technologies, and policy measures, underscoring the importance of integrated and sustainable approaches to address antibiotic contamination and resistance genes.</p> Graphical Abstract <p></p>