There is a dearth of information on the occurrence and risks of antibiotics in the urban rivers from plateau areas. This study investigated 83 antibiotics in water and sediments of an urban river and effluents of sewage treatment plants (E-STPs) in Xining, Qinghai (northeastern Tibetan Plateau). Fifty-three antibiotics were detected, and the concentrations of individual antibiotics varied in the range of undetected (ND)-552 ng/L in water, ND-164 ng/g in sediments, and ND-3821 ng/L in E-STPs. Seasonal differences of antibiotic concentrations were significant for water samples (p < 0.05) but insignificant for sediments (p > 0.05). In urban area, E-STP is the main source of antibiotics in the river, while runoff from manured cropland contributes partially to antibiotics in the river in the suburban area. The antibiotic compositions in water were different from those in sediments, but were similar to those in E-STPs. Notably, because of strong solar radiation and long sunshine hours in the plateau area, low levels of quinolones, which are sensitive to photolysis, were observed in river water. Moreover, norfloxacin and enrofloxacin, observed in urban river from other regions of China, were not detected in the Huangshui River water. The occurrence of ofloxacin, erythromycin, roxithromycin, clarithromycin, and trimethoprim in E-STPs may induce a possible risk to antibiotic resistance evolution. Trimethoprim, anhydroerythromycin, sulfamethoxazole, sulfapyridine, and clindamycin in river water could pose low to medium risks to aquatic organisms. Further investigation on the occurrence and distribution of antibiotic resistance genes in the Huangshui River is urgently needed.