Background Urinary tract infections (UTIs) are a common and potentially ‘serious health concern in the pediatric population’. Timely diagnosis and appropriate antibiotic therapy are critical to prevent complications. However, the rising trend of antibiotic resistance among uropathogens poses a significant challenge to effective treatment, particularly in resource-limited settings. To determine the frequency of bacterial isolates responsible for UTIs in children and assess their resistance patterns to commonly used antibiotics. Methods This descriptive cross-sectional study was conducted from ‘January 2022 to January 2023 at the Department of Pediatrics, Khyber Teaching Hospital, Peshawar’. A total of 89 children aged below 12 years with culture-confirmed UTIs were enrolled. Urine samples were collected using standard methods and subjected to culture and sensitivity testing. Bacterial identification and antibiotic susceptibility were performed using conventional techniques and disk diffusion method, respectively, following CLSI guidelines. Statistical analysis was carried out using SPSS version 25, with a p-value less than 0.05 considered significant. Results ‘Escherichia coli was the most frequently isolated pathogen (54%), followed by Klebsiella pneumoniae and Pseudomonas species’. High resistance rates were noted against ampicillin (59%), cefixime (53%), and ceftriaxone (49%). Nitrofurantoin, fosfomycin, and meropenem demonstrated comparatively lower resistance. Multidrug-resistant strains were identified in 10% of cases, while ESBL production was rare. Significant associations were found between age, nutritional status, and prior UTI history with resistance patterns. Conclusion This study highlights a worrying trend of resistance to commonly prescribed antibiotics in pediatric UTIs. Empirical therapy should be guided by local resistance data, and antibiotics such as nitrofurantoin and fosfomycin may be preferred for initial treatment in uncomplicated cases. Strengthening antibiotic stewardship and encouraging routine urine culture testing are essential to improve treatment outcomes.