Zwitterionic polycarboxybetaine (pCB)-based materials have drawn special attention due to their outstanding properties of resisting proteins adsorption, biofilm formation and cell attachment on a variety of substrates and surfaces, reducing the uptake of pCB-coated nanosized materials, as well as providing the capability of further functionalization. Zwitterionic pCBs have been proven to be excellent choices for many applications, not only limited to the field of antifouling. This review will summarize the recent progress on the development of pCB materials and the understanding of the structure–function–property relationships of carboxybetaine materials.