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Background: The extended spectrum beta-lactamase (ESBL)-producing Escherichia coli strains which have been implicated in septicaemia among hospitalized children is a serious concern due to their high resistance rates to commonly used antimicrobial agents. The objective of this study was to determine the prevalence and antibiotic susceptibility of urinary ESBL-producing E. coli in paediatric patients who had clinical evidence of urinary tract infections (UTI). Methodology: Clean catch specimens of urine collected from 100 eligible paediatric patients with clinical evidence of UTI in St. Patricks' Hospital, Mile Four, Abakaliki, Ebonyi State, were cultured for isolation of E. coli using standard bacteriological techniques. Isolates were confirmed for ESBL production by double disk synergy test (DDST), and antibiotic susceptibility of the ESBL-producing ones was determined by the modified Kirby Bauer disk diffusion method. Results: Twenty one (21%) E. coli were isolated out of which 11 (52 %) were ESBL producers, all of which were totally resistant (100%) to cefotaxime, ticarcillin and sulfamethoxazole-trimethoprim, 85% to aztreonam and 83% to ceftazidime. The multiple antibiotic resistance index (MARI) values ranged from 0.4 to 0.9, which implies high usage of antimicrobials. Conclusion: The high prevalence of multi-drug resistant ESBL-producing E. coli obtained in this study shows that there has been overuse (abuse or misuse) of antibiotics in the study area. There is need for antimicrobial stewardship programme that will ensure prudent use of antimicrobial agents to forestall the emergence and spread of multi-drug resistant bacteria. [ABSTRACT FROM AUTHOR]