This study investigated the occurrence and removal of 12 antibiotics (ciprofloxacin, enrofloxacin, levofloxacin, norfloxacin, nalidixic acid, azithromycin, clarithromycin, roxithromycin, lincomycin, novobiocin, sulfamethoxazole, trimethoprim) at four sewage treatment plants (STPs): two STPs in Kyoto, Japan and two STPs in Beijing, China. The STPs differed in design and operation conditions, utilized a variety of secondary treatment processes. The antibiotics were frequently detected in influents and effluents, and ranged from ng/L up to lower μg/L. In influent, clarithromycin (1.1–1.6 μg/L) and levofloxacin (3.6–6.8 μg/L) were detected in the highest concentration in Japanese and Chinese STPs, respectively. The overall elimination of the antibiotics were differed between STPs and ranged from negative to >90%. These data demonstrate that there are detectable levels of antibiotics are discharging from STPs, and only some of these antibiotics are being removed in a significant proportion by STPs. It was also observed that biological nutrient removal based sewage treatment processes (anaerobic–anoxic–oxic: A2O; and anoxic–oxic: AO) have relatively higher antibiotics removal efficiencies than oxidation ditch (OD) processes.