Antibiotic residues have been commonly detected worldwide in freshwater, estuarine, and marine ecosystems. The review summarizes the up-to-date information about the toxic effects of over 60 antibiotics on nontarget autotrophic microorganisms with a particular focus on marine microalgae. A comprehensive overview of the available reports led to the identification of significant knowledge gaps. The data on just one species of freshwater green algae (Raphidocelis subcapitata) constitute 60% of the total information on the toxicity of antibiotics, while data on marine species account for less than 14% of the reports. Moreover, there is a clear knowledge gap regarding the chronic effects of antibiotic exposure (only 9% of studies represent exposition time values longer than 7 days). The review summarizes the information on different physiological endpoints, including processes involved in photosynthesis, photoprotective and antioxidant mechanisms. Currently, the hazard assessment is mostly based on the results of the evaluation of individual chemicals and acute toxicity tests of freshwater organisms. Future research trends should involve chronic effect studies incorporating sensitive endpoints with the application of environmentally relevant concentrations, as well as studies on the mixture effects and combined environmental factors influencing toxicity.