<p>Antibiotic pollution poses a significant threat to aquatic ecosystems and human health. However, comprehensive nationwide assessments remain scarce. Using the PRISMA method, this study conducts a meta-analysis of 139 studies (2000–2024) to evaluate the spatiotemporal distribution, sources, and risks of antibiotics in China's surface waters. Results reveal 117 antibiotics detected, with concentrations ranging from 0.773 to 119,284&#xa0;ng·L⁻¹, showing a distinct "east-high, west-low" pattern. Tetracyclines (Oxytetracycline, Chlorotetracycline, Tetracycline) were identified as the dominant pollutants, particularly Oxytetracycline, whose average concentration in the Wangyang River Basin reached 97,433.8&#xa0;ng·L⁻¹, far exceeding other regions. Key pollution sources include livestock farming, aquaculture, and pharmaceutical waste. Risk quotient method revealed that Sulfamethoxazole, Sulfadiazine and Roxithromycin pose high risks to algae, with Sulfamethoxazole's high-risk areas accounting for 88.75% of monitored waters. Human health risk analysis showed that Ciprofloxacin and Sulfamethoxazole exhibit significant non-carcinogenic (up to 8.03) and carcinogenic risks (up to 0.009) to children, respectively, with high-risk areas concentrated in the Bohai Bay and Pearl River Basin. This meta-analysis emphasizes the need for enhanced monitoring, improved wastewater treatment, and targeted policies for high-risk antibiotics, providing a scientific basis for managing antibiotic pollution in China.</p>