Tuberculosis remains a major public health concern in the Philippines, one of the countries with the highest global disease burden. Although pulmonary tuberculosis is more common, spinal tuberculosis (Pott’s disease) in children poses significant diagnostic and therapeutic challenges due to risks of progressive deformity and neurological compromise. Local data describing the microbiological characteristics and drug resistance patterns of pediatric spinal tuberculosis remain limited. This study aimed to describe the demographic characteristics, bacteriological profile, and antibiotic susceptibility patterns of pediatric patients diagnosed with Pott’s disease at a tertiary referral center in the Philippines and to identify factors associated with drug resistance. A prospective observational study was conducted over one year involving pediatric patients diagnosed with spinal tuberculosis based on clinical, radiologic, and/or microbiological criteria. Data collected included demographic characteristics, clinical presentation, imaging findings, and laboratory results. Microbiological evaluation consisted of Ziehl–Neelsen staining, GeneXpert MTB/RIF assay, mycobacterial culture using Löwenstein–Jensen medium, and drug susceptibility testing. Descriptive statistics were used to summarize demographic and bacteriological findings, while inferential analyses explored associations between demographic or clinical variables and drug resistance. The study identified prevailing microbiological patterns among pediatric spinal tuberculosis cases and documented instances of drug-resistant disease. Rifampicin resistance detected through GeneXpert demonstrated concordance with culture-based drug susceptibility testing. Selected demographic and clinical factors were found to be associated with resistant infection. These findings provide local evidence on antimicrobial resistance patterns in pediatric Pott’s disease and underscore the importance of early microbiological confirmation and susceptibility testing. Strengthening surveillance and adopting individualized treatment strategies may improve clinical outcomes, prevent progression of spinal deformity, and reduce long-term disability among affected children.