The environmental challenges posed by plastic pollution have prompted the exploration of eco-friendly alternatives to disposable plastic packaging and utensils. Paper-based materials, derived from renewable resources such as wood pulp, non-wood pulp (bamboo pulp, straw pulp, reed pulp, etc.), and recycled paper fibers, are distinguished by their recyclability and biodegradability, making them promising substitutes in the field of plastic food packaging. Despite their merits, challenges like porosity, hydrophilicity, limited barrier properties, and a lack of functionality have restricted their packaging potential. To address these constraints, researchers have introduced antimicrobial agents, hydrophobic substances, and other functional components to improve both physical and functional properties. This enhancement has resulted in notable improvements in food preservation outcomes in real-world scenarios. This paper offers a comprehensive review of recent progress in hydrophobic antimicrobial paper-based materials. In addition to outlining the characteristics and functions of commonly used antimicrobial substances in food packaging, it consolidates the current research landscape and preparation techniques for hydrophobic paper. Furthermore, the paper explores the practical applications of hydrophobic antimicrobial paper-based materials in agricultural produce, meat, and seafood, as well as ready-to-eat food packaging. Finally, challenges in production, application, and recycling processes are outlined to ensure safety and efficacy, and prospects for the future development of antimicrobial hydrophobic paper-based materials are discussed. Overall, the emergence of hydrophobic antimicrobial paper-based materials stands out as a robust alternative to plastic food packaging, offering a compelling solution with superior food preservation capabilities. In the future, paper-based materials with antimicrobial and hydrophobic functionalities are expected to further enhance food safety as promising packaging materials.