<p>Global scientific literature has extensively documented the overuse of antibiotics, the proliferation of antibiotic-resistant bacteria, and the toxic effects on aquatic fauna from hospital wastewater exposure, highlighting the need for effective antibiotics treatment methodologies. Anaerobic biodegradation has been recognized as an effective method for removing antibiotics and other pharmaceuticals from hospital wastewater, demonstrating the ability to degrade various antibiotic classes. This review critically examines the environmental fate of the antibiotics classes fluoroquinolones, sulfonamides, and diaminopyrimidines in hospital wastewater, emphasizing anaerobic biodegradation as an effective technology and the significance of the microbial community in this process. Furthermore, it examines ecotoxicological impacts across diverse species. The inappropriate disposal of inadequately treated hospital effluent into the environment disseminates antibiotics into freshwater, resulting in sublethal effects on aquatic fauna. The current research gap underscores the promise of anaerobic technologies, coupled with the toxicity assessment of treated effluents containing antibiotic mixtures, to improve comprehension of the environmental fate and effects of these antibiotic classes on aquatic vertebrate and invertebrate species.</p> Graphical abstract <p></p>