Background: Community-acquired pneumonia (CAP) remains a major cause of morbidity and mortality among children under five years of age, particularly in low- and middle-income countries. Escalating antibiotic resistance has increasingly complicated empirical management of pediatric CAP. Objectives: To determine the prevalence, bacterial etiology, and antibiotic resistance patterns of CAP in hospitalized children aged below five years over a nine-month study period. Methods: A hospital-based prospective observational study was conducted from March 2021 to December 2021 at Malla Reddy Medical College for Women, Hyderabad, and Narayana Medical College, Nellore. Seventy-nine children under five years diagnosed with CAP using WHO criteria were enrolled. Blood cultures, nasopharyngeal swabs, and sputum specimens were collected and subjected to culture and sensitivity testing following standard bacteriological protocols. Results: Of 79 enrolled children, bacterial isolates were obtained from 76 cases (96.2%). Streptococcus pneumoniae (30.4%) was the most common pathogen, followed by Haemophilus influenzae (21.5%) and Staphylococcus aureus (16.5%). High resistance rates were observed for penicillin/ampicillin (61.1%), cotrimoxazole (62.6%), and erythromycin (49.7%). Ceftriaxone and levofloxacin demonstrated superior sensitivity at 85.8% and 93.9% respectively. Mortality was 6.3% (n=5) with a mean hospital stay of 5.7 ± 2.6 days. Conclusion: S. pneumoniae and H. influenzae remain the leading bacterial pathogens of pediatric CAP in this region, exhibiting alarmingly high resistance to first-line antibiotics including penicillin and cotrimoxazole. Local antibiogram data must guide empirical antibiotic therapy protocols, with third-generation cephalosporins being the preferred initial treatment choice.