Food processing, a longstanding practice, employs a range of technologies to regulate microbial populations and ensure consistent quality and safety of products, instilling consumer trust in the food industry. As contemporary demands and safety standards evolve, a pressing need arises for less processed, nutrient-rich food items that adhere to more stringent microbiological criteria, promoting innovative and sustainable processing methods. Among these, hydrodynamic cavitation is presented as a promising technology due to its energy efficiency, low thermal impact, and ability to significantly reduce microbial loads without compromising nutritional value. Recent studies have explored hydrodynamic cavitation application in liquid food sterilization, beverage preservation, and water decontamination, demonstrating notable reductions in both spoilage and microorganisms. However, the exact mechanisms underlying this microbial inactivation ability of hydrodynamic cavitation remain partially understood, posing a challenge to process optimization and broader industrial adoption. This review critically examines the current understanding of hydrodynamic cavitation antimicrobial action, explores key design and operational parameters, and identifies knowledge gaps. Future research directions are proposed to enhance treatment efficacy and to support the integration of hydrodynamic cavitation into scalable, sustainable food processing workflows.