The removal of antibiotics by bioelectrochemical systems (BES) was introduced. The effects of reaction processes on the performance of microbial electrolytic cell (MEC) and the electricity production of microbial fuel cells (MFCs) were summarized. The treatment efficiency of the BES coupling system was analyzed, and the fate of antibiotic resistance bacteria (ARB) and antibiotic resistance genes (ARGs) was discussed. The analysis shows that in MEC, the magnitude of applied voltage affects the degradation efficiency of antibiotics, and the cathode provides electrons and reduces antibiotics. The effective removal of antibiotics in BES mainly depends on the co-metabolic degradation or direct oxidation in the anode. Antibiotics can act as the only electron donor and the only carbon source for MFC power generation. Some coupling systems are more energy-saving and efficient in the removal of antibiotics without external power supply. During the degradation of antibiotics, low currents can facilitate the propagation of ARGs through vertical gene transfer (VGT) and horizontal gene transfer (HGT), while high currents are expected to eliminate ARB and ARGs.