Antibiotics are widely used in animal husbandry, and various types of antibiotic resistance genes (ARGs) are frequently detected in livestock waste around the world. Conventional livestock waste treatment processes do not completely remove ARGs, resulting in their release to soil and water environments. Various exposure routes of these ARGs to humans, including inhalation and ingestion of antibiotic-resistant bacteria (ARB) that harbor them, may be contributing to the rise in resistant clinical infections that are increasingly difficult to treat with antibiotics. In this review, we assess the occurrence and variability of ARGs in livestock wastes and their potential propagation pathways to human pathogens. We also review the mechanisms and environmental factors that influence the dissemination of ARGs through these pathways, and evaluate the ARG removal efficiency of common livestock waste management approaches. Challenges and research needs for assessing and mitigating the risk of antibiotic resistance dissemination from livestock waste are also presented.