In recent years, antibiotic resistance in groundwater has become a significant environmental and public health concern, with limited research on the issue. This review aims to synthesize existing research on the occurrence, distribution, and factors influencing the presence of antibiotics and antibiotic-resistant bacteria (ARB) in groundwater. Identifying and understanding the sources and pathways for antibiotics and ARB is critical in groundwater, as it is a vital source of drinking water for 2.2 billion people worldwide and is recurrently linked to significant outbreaks of infection. This review includes studies from the years 2004 to 2025 and it revealed that groundwater samples contained isolates that were resistant to antibiotics. Most of the studies on occurrence of antibiotics resistance in groundwater was carried out in China. Our meta-analysis revealed that sulfonamides, tetracyclines, and fluoroquinolones, are frequently detected in groundwater sources although the occurrence is less compared other water matrices. The highest mean value of CIP in groundwater was reported to be 28.13 mg/L . Reactivity, Hydrogeological and Physicochemical factors are vital factors involved in the transport and fate of ARB in groundwater, whereas environmental factors, such as groundwater flow, aquifer characteristics, and proximity to pollution sources, contribute to the variability of ARB contamination levels. This review highlights the urgent need for enhanced monitoring, improved wastewater management, and effective strategies to mitigate the infiltration of antibiotics and ARB into groundwater to protect both environmental and public health.