Preferential oxidation of CO (CO-PROX) has tremendous significance in purifying hydrogen for fuel cells to avoid catalyst poisoning by CO molecules. Traditional powder catalysts face numerous challenges, including high pressure drop, aggregation tendency, hotspot formation, poor mass and heat transfer efficiency, and inadequate thermal stability. Accordingly, ceramic monolithic catalysts, known as their excellent thermal stability, high surface area, and superior mass and heat transfer characteristics, are gaining increasing research attention. This review examines recent studies on ceramic monolithic catalysts in CO-PROX, placing emphasis on the regulation of active sites (e.g., precious metals like Pt and Au, and non-precious metals like CuO and CeO2), monolith structures, and coating strategies. In addition, the structure–catalytic performance relationships, as well as the potential and limitations of different ceramic monolithic catalysts in practical application, are discussed. Finally, the challenges of monolithic catalysts and future research prospects in CO-PROX reactions are highlighted.