Starch/polyvinyl alcohol (PVA)-based antimicrobial packaging films exhibit good antimicrobial and biodegradable properties, and have become a current research hotspot in the field of active packaging. However, their application in food and medicine is limited by inadequate mechanical performance, poor water resistance, migration of antimicrobial agents, and poor environmental adaptability. This study reviews the advances on the effects of starch type and PVA modification on the comprehensive performance of antimicrobial packaging films; discusses the controlled release mechanisms and methods for antimicrobial active ingredients in antimicrobial packaging films; and describes the application of starch/PVA-based antimicrobial packaging films in the storage and preservation of fruits, vegetables, and meat products. Given the broad development prospects of smart active packaging materials, future research on multifunctional composite antimicrobial packaging materials will help improve the indicative, stable, and slow-release control properties of antimicrobial packaging films. This will facilitate the sustainable development of the packaging industry and provide new strategies for the application of green packaging materials in the food and pharmaceutical fields.