Background: Helicobacter pylori (H. pylori) is a spiral-shaped Gram-negative bacteria that typically colonizes the stomach in early childhood. It is common worldwide, with higher rates in developing countries. Treatment eradication using first-line treatment regimens is declining, highlighting the importance of regional antibiotic resistance data to guide H. pylori treatment regimens. This study aimed at evaluation of antibiotic resistance patterns in H. pylori strains affecting pediatric patients and the predictors of this resistance. Patients and methods: This study included thirty pediatric patients who underwent endoscopic evaluation of their upper gastrointestinal symptoms at Ain Shams University pediatric hospital's gastroenterology unit. Five gastric biopsies were taken (from the corpus and antrum) for histopathology, rapid urease test and culture and sensitivity Results: According to culture and sensitivity results, resistance to metronidazole was the highest (86.7%), followed by clarithromycin (50%). Levofloxacin and tetracycline had the lowest resistance (6.7% and 13.3%, respectively). Excess fat consumption was associated with resistance to clarithromycin and amoxicillin. While duodenal nodularity and duodenal ulcer were associated with resistance to levofloxacin and tetracycline respectively. Conclusion: current H. pylori eradication regimen in Egypt, should be revised according to the local antibiotic susceptibility data. Further studies are needed to assess predictors for resistance to antibiotics.