Although the ecological risks of antibiotics have been extensively researched globally, fewer studies have been conducted in sensitive and fragile plateau wetland ecosystems. To evaluate the ecological risk of antibiotics in plateau urban wetlands, 18 water samples, 10 plant samples, and 8 sediment samples were collected in March 2022 in the Xining urban wetlands on the Qinghai-Tibet Plateau. The liquid chromatography-electrospray ionization tandem mass spectrometry method was utilized to measure the concentrations of 15 antibiotics in three categories in three types of environmental media. Risk quotients were adopted to assess the ecological risk of antibiotics, and the principal component analysis–multiple linear regression model was used to analyze the source of antibiotics. The results showed that (1) the maximum concentrations of antibiotics in water samples, plants, and sediments reached 1220.86 ng/L, 78.30 ng/g, and 5.64 ng/g, respectively; (2) Tylosin (TYL), norfloxacin (NFX), ofloxacin (OFX), and ciprofloxacin (CFX) in water were at medium and high-risk levels, and OFX had the highest risk value, of 108.04; and (3) the results of source apportionment indicate that 58.94% of the antibiotics came from the Huangshui river and wastewater treatment plant (WWTP) near the wetlands. The current study may provide a reference for the risks and management of antibiotics in plateau urban wetlands.