Abstract: Objective The clinical characteristics and antibiotic sensitivity of children with Streptococcus pneumoniae (SP) pneumonia were analyzed to provide reference for the diagnosis and treatment of SP pneumonia. Methods The clinical data and antibiotic sensitivity results of children with SP pneumonia hospitalized in the Children's Hospital affiliated to the Capital Institute of Pediatrics from March, 2016 to March, 2018 were collected and analyzed with χ² test. Results A total of 250 cases with SP pneumonia were enrolled, including 99 mild cases and 151 severe cases. Two hundred (80%) cases were under 5 years old. Cough and fever were the main clinical manifestations, and unilateral lung infection were more common. In severe cases, the percentage of neutrophil ratio>60% (76.20%), CRP>50 mg/L (24.00%) and D-dimer ≥ 0.243 mg/L (57.00%) were significantly higher than that in mild cases. In cases with mixed mycoplasma infection, the percentage of cases with pleural effusion, atelectasis and massive lung consolidation were 36.20%, 18.80%, 27.50% respectively, which were significantly higher than that of patients without mixed mycoplasma infection. In cases with mixed parainfluenza infection, the percentage of wheezing cases was 53.30%, which was significantly higher than that of patients without parainfluenza infection.The resistance rate of SP to erythromycin was 99.59%. SP was not resistant to linezolid, ofloxacin, moxifloxacin, teliomycin, vancomycin or levofloxacin. The multidrug resistance rate of SP was 72.00%. The main multidrug resistance models contained two or more kinds of antibiotics among β-lactam antibiotics, macrolides, tetracyclines and sulfonamides. Conclusion Most of the SP pneumonia cases are children under 5 years old. The clinical manifestations of SP pneumonia are nonspecific so etiological examinations is necessary for making a definitive diagnosis. Mixed infection is common in children with SP pneumonia. SP pneumoniae cases present with pleural effusion, atelectasis or massive lung consolidation should consider mixed mycoplasma infection, and those present with wheezing should consider mixed parainfluenza infection. SP pneumoniae with higher neutrophil ratio, CRP or D-dimer might be severe cases. Sp is highly resistant to erythromycin, tetracycline and trimethoprim/sulfamethoxazole. SP multidrug resistance is common. Regular monitoring of SP drug sensitivity should be strengthened.