Bacterial meningitis, marked by inflammation of the meninges, poses a critical medical emergency with rapid progression and life-threatening consequences. This study aimed to assess bacterial isolates and their antimicrobial resistance patterns in cerebrospinal fluid (CSF) among under-five children in a tertiary care hospital in Madhya Pradesh. Over one year, 77 CSF samples were collected and analyzed. Most cases presented with fever, seizure, altered sensorium, and refusal to feed. The identified bacterial isolates included S. pneumoniae, Pseudomonas, K. pneumoniae, Enterococcus, and E. coli. Mortality was notably high in lab-confirmed S. pneumoniae infections, emphasizing the urgency of effective management. Antimicrobial susceptibility revealed sensitivity to various antibiotics, although penicillin resistance was a concern. The study underscores the importance of swift diagnosis, immediate antibiotic therapy, and public awareness to mitigate the global burden of bacterial meningitis, especially among vulnerable populations like children.