Introduction: Multidrug-resistant (MDR) meningitis is a severe, life-threatening infection of the meninges surrounding the brain and spinal cord. Management is challenging due to limited antimicrobial penetration across the blood–brain barrier and rising antimicrobial resistance. Early identification of the causative organism and targeted therapy are essential to improve outcomes. Casereport: A 1-year-old boy , the third child of healthy non-consanguineous parents, presented with a nine-day history of fever, cough, and coryza. There were no seizures, altered consciousness, or focal neurological deficits. Development was ageappropriate, although growth parameters were below the expected range. The child had a history of colostomy for congenital imperforate anus. On examination, neck stiffness was present, while other systemic findings were unremarkable. During hospitaliza tion, he eveloped high-grade fever spikes. Laboratory investigations revealed elevated inflammatory markers with neutrophilic leukocytosis. Chest radiography and abdominal ultrasonography were normal. Lumbar puncture demonstrated cerebrospinal fluid findings consistent with bacterial meningitis. Empirical intravenous Ceftriaxone was initiated without clinical improvement. Neuroimaging was normal. Following microbiology consultation, treatment was escalated to Meropenam and Vancomycin; however, the child remained febrile. The cerebrospinal fluid culture report identified Escherichia coli resistant to all antibiotics. After discussion with the microbiology team, intravenous Colistin was administered for 14 days, resulting in complete clinical resolution. Discussion: This case highlights the rarity and severity of MDR bacterial meningitis in children. It underscores the importance of timely cerebrospinal fluid culture, antimicrobial sensitivity testing, and judicious antibiotic use to guide targeted therapy and prevent resistance.