Background <p>Drug-resistant tuberculosis (DR-TB) is associated with low treatment success rates and increased mortality. Household contacts (HHCs) face an elevated risk of infection and disease progression due to prolonged exposure. Consequently, systematic screening and tuberculosis preventive treatment (TPT) are critical to interrupt transmission within households. However, screening practices and TPT regimens vary substantially across countries and settings worldwide, and the available evidence remains fragmented. This study aims to synthesize evidence on screening strategies and TPT regimens for HHCs of patients with DR-TB, identify implementation barriers and research gaps, and inform future contact management approaches.</p> Methods <p>We systematically searched nine databases including PubMed, Embase, and Web of Science. Each database was searched from inception to November 13, 2025. Eligible studies included observational studies (including cohort and cross-sectional studies), implementation studies, and randomized controlled trials reporting on screening approaches or TPT strategies among HHCs of patients with DR-TB. Data extraction was conducted in accordance with the Joanna Briggs Institute (JBI) methodological framework for scoping reviews, and reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews (PRISMA-ScR) guidelines. Two reviewers independently extracted data using a standardized form, including study characteristics, screening strategies, diagnostic methods, TPT regimens, safety and adherence outcomes, and implementation-related factors. The findings were summarized descriptively and presented as a structured narrative synthesis organized by thematic domains.</p> Results <p>A total of 26 studies were included. Most studies (20/26) employed a sequential cascade screening strategy combining symptom assessment, imaging evaluation (when clinically indicated), and molecular or microbiological confirmation, often supplemented by tuberculin skin test (TST) or interferon-gamma release assays (IGRAs) for latent tuberculosis infection (LTBI) detection. Most studies were conducted in high TB burden low- and middle-income countries, particularly in Pakistan, South Africa, and China, with several multicenter studies spanning countries in Africa, Asia, and Latin America. Pediatric studies frequently incorporated gastric aspiration as an adjunct diagnostic method. TPT was implemented in 14 studies, with initiation rates ranging from 2% to 98.8%. Levofloxacin-based regimens were the predominant preventive treatment strategy. Compared with combination regimens, levofloxacin monotherapy generally achieved higher treatment completion rates (68.4%–100% vs. 56%–70.3%). Children experienced fewer adverse events than adults (10% vs. 37%). Frequently reported implementation barriers included resource limitations, transportation difficulties, stigma, and poor treatment adherence.</p> Conclusion <p>Screening and TPT for HHCs of patients with DR-TB were commonly implemented using sequential cascade screening approaches and levofloxacin-based preventive treatment regimens across diverse settings. Included studies generally reported acceptable treatment completion and safety outcomes, particularly for levofloxacin-based monotherapy, although implementation outcomes varied substantially across regions and populations. Resource limitations, stigma, transportation difficulties, and poor adherence were frequently reported as barriers to implementation. Given the substantial heterogeneity in study design, screening strategies, and implementation contexts, findings should be interpreted cautiously. Further research is needed to improve evidence on standardized screening approaches, regimen effectiveness, and implementation feasibility across different settings, particularly among high-risk populations such as young children and people living with human immunodeficiency virus (HIV).</p> Clinical trial number <p>Not applicable.</p>