Multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis (TB) continue to pose a serious challenge to healthcare systems across the world, significantly affecting efforts aimed at global TB control and elimination. Resistance to first-line anti-tubercular drugs, particularly isoniazid and rifampicin, along with additional resistance to fluoroquinolones and other second-line agents in XDR-TB, has made treatment increasingly difficult, lengthy, expensive, and often associated with substantial adverse effects. Management of these resistant forms of TB now relies heavily on individualized treatment strategies guided by drug susceptibility testing and the wider adoption of WHO-recommended all-oral regimens. The introduction of newer and repurposed drugs such as bedaquiline, delamanid, pretomanid, linezolid, and clofazimine has considerably improved therapeutic outcomes and has contributed to the development of shorter, more tolerable regimens, especially in high-burden settings like India. In addition to pharmacological therapy, successful management depends on timely diagnosis, careful treatment monitoring, management of adverse drug reactions, nutritional and psychological support, and a multidisciplinary patient-centered approach. Advances in rapid molecular diagnostics, digital adherence technologies, host-directed therapies, and novel drug combinations are further reshaping the landscape of MDR/XDR-TB care and offer renewed hope for improving treatment success and strengthening future global TB control strategies.