As two major types of pollutants of emerging concerns, microplastics (MPs) and antibiotics (ATs) coexist in aquatic environments, and their interactions are a source of increasing concern. Therefore, this work examines the interaction mechanisms of MPs and ATs, and the effect of MPs on ATs bioavailability and antibiotic resistance genes (ARGs) abundance in aquatic environments. First, the mechanisms for ATs adsorption on MPs are summarized, mainly including hydrophobic, hydrogen-bonding, and electrostatic interactions. But other possible mechanisms, such as halogen bonding, CH/π interaction, cation-π interaction, and negative charge-assisted hydrogen bonds, are newly proposed to explain the observed ATs adsorption. Additionally, environmental factors (such as pH, ionic strength, dissolved organic matters, minerals, and aging conditions) affecting ATs adsorption by MPs are specifically discussed. Moreover, MPs could change the bioaccumulation and toxicity of ATs to aquatic organisms, and the related mechanisms on the joint effect are reviewed and analyzed. Furthermore, MPs can enrich ARGs from the surrounding environment, and the effect of MPs on ARGs abundance is evaluated. Finally, research challenges and perspectives for MPs-ATs interactions and related environmental implications are presented. This review will facilitate a better understanding of the environmental fate and risk of both MPs and ATs.