Antibiotics were the world’s great therapeutic hope after the Second World War, but today, unmonitored use has become one of the greatest risks for humanity. Without overestimation, one of the last scientific books on antibiotics was entitled: Antibiotics, the perfect storm. Before to environmental contamination by antibiotics, the pathogens got resistant to them. Because of the radical changes that antibiotics have brought about, they can generate new resistant bacteria in the environment that were previously harmless. These microorganisms will be exposed to concentrations of antibiotics never reached or will be exposed to unknown molecules that, for many of them, in certain environments, have never been exposed before. Initially, many of these antibiotics did not penetrate soils with high agricultural production, but in the following decades, they were even interspersed into crops. Nowadays, hundreds of tons of antibiotics are dumped into rivers and the sea. Many hospitals have water treatment facilities to prevent significant contamination, but not all companies, farms, and hospitals in developed, emerging, or poor countries apply wastewater treatment. Antibiotics are incorporated into wild microorganisms and plants, triggering a broad “unnatural” resistance, which will rapidly incorporate this information into the genome of other pathogenic microorganisms by horizontal transfer. On the other hand, antibiotics could be incorporated into drinking water and water intended for human or agricultural consumption that travels without being detected or monitored. This review covers the most important aspects of environmental pollution by antibiotics.

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