The widespread presence of antibiotic residues in food constitutes a serious and escalating threat to public health. The overuse of antibiotics in animal husbandry and agriculture can lead to bioaccumulation in meat, dairy products, and crops, potentially contributing to the development of antimicrobial resistance in humans. Therefore, developing accurate, efficient, and on-site methods for detecting trace levels of such contaminants is of paramount importance. Surface-enhanced Raman spectroscopy (SERS) has emerged as a powerful analytical tool for this purpose, offering exceptional advantages such as ultra-high sensitivity, molecular fingerprint specificity, and capacity for rapid, label-free analysis. This review systematically summarizes the key achievements of SERS technology in the detection of various antibiotic residues across diverse food matrices. It specifically compiles and discusses the achieved limits of detection and recovery rates reported in recent studies, critically evaluating the performance of different SERS substrates and assay formats. The objective is to provide a comprehensive reference for researchers and practitioners, highlighting both the current capabilities and future potential of SERS in ensuring food safety and safeguarding consumer health.