This review highlights the pervasive presence of tetracyclines, a class of antibiotics, and their metabolites in wastewater systems, arising from various way medical, veterinary, and agricultural usage. It delves into the analytical methods for detection, concentrations within treatment plants, fate, and transport mechanisms, including transformation processes and bioaccumulation. The core focus is on the profound environmental impacts, notably the development of antibiotic resistance, consequences for aquatic ecosystems, and potential risks to human health. Regulatory frameworks, mitigation strategies, and future research directions are discussed, emphasizing the urgent need for interdisciplinary efforts and global cooperation to address this critical issue and its far-reaching consequences for public health and the environment.