Background: Respiratory tract infections are the leading cause of morbidity and mortality in children worldwide. Management of respiratory tract infections poses a challenge in de-veloping countries particularly due to limited resources for bacterial identification and therefore administration of antibiotics is empirical. Nasopharyngeal and throat carriage of respiratory tract bacterial pathogens is an important step toward invasive infections and the resistance pattern of nose and throat pathogens can also predict the resistance pattern of invasive infections. Objective: The objective was to describe clinical presentation and bacterial etiological agents causing respiratory tract infections among ambulatory school children in Moshi mu-nicipality, Tanzania Methodology: We conducted a cross sectional community based study from January to March, 2014. A total of 2,016 pupils who were presumed to be healthy were screened, and 170 children, aged 6-14 years from 4 primary schools were enrolled. Clinical assessment was conducted followed by nasopharyngeal and throat swabs collection from children with respiratory tract symptoms. Specimens were processed to isolate pathogenic bacteria fol-lowing standard operating procedures. Isolates were tested for sensitivity against: Ampicil-lin, Chloramphenicol, Gentamicin, Ceftriaxone and Cotrimoxazole. Results: Of 2,016 screened school children, 474 (23.5%) had respiratory tract symptoms, and the ratio was 1 in every 4 children had respiratory tract symptoms. Cough 136 (80.0%) was the most common respiratory symptom followed by running nose 104 (61.2%). Res-piratory tract bacterial pathogens were isolated from 123 (73.7%) of 167 children whose nasopharyngeal and throat swabs were collected. S. aureus was the most prevalent isolate 68 (55.3%) followed by S. pneumoniae 43 (35.0%), and the least prevalent isolate was K. pneumoniae 7 (5.7%). Older age in this group was statistically significant associated with low prevalence of S. pyogenes and K. pneumoniae (p<0.05). Majority of isolated upper res-piratory tract bacteria were resistant to Ampicillin. S. pneumoniae exhibited the highest rate of the resistance whereby 33 (91.7%) isolates from the children were resistant to Ampicil-lin. However, the resistance of isolates to Cotrimoxazole was found to be low. [xii] Conclusion: Prevalence of respiratory tract symptoms was high among ambulatory school children who were presumed to be healthy. Majority of the children presented with cough. The most common upper respiratory tract bacterial isolate was S. aureus. The resistance pattern of respiratory tract bacteria isolates against the recommended first line antibiotics for respiratory tract infections in children was high. Recommendation: To reduce complications associated with respiratory tract infections, there is a need to strengthen school health program, and cotrimoxazole should be used in the treatment of uncomplicated respiratory tract infections.