Background : Sichuan is a province located in southwestern China, which have a higher incidence of tuberculosis (TB).This study aimed to analyze the epidemiological, clinical characteristics, and drug resistance in culture-confirmed children with Tuberculosis meningitis (TBM) in Southwest of China. Materials and Methods: We performed a retrospective study of children with cerebrospinal fluid (CSF) culture-confirmed TBM who were <14 years of age between January 2013 and December 2018 at Public Health Clinical Center of Chengdu (PHCCC). Mycobacterium tuberculosis (MTB) drug sensitivity testing (DST) was performed using the MicroDST TM method. The age, gender, family history of tuberculosis, status of Bacillus Calmette–Guérin (BCG) vaccination, residential areas information, clinical, laboratory and radiological features were recorded. Data were analyzed using SPSS Statistics Client 25.0, and the change in drug resistance rate was analyzed using the Cruskal-Wallis test. Results: From 319 TBM initially recruited patients,42 cases were Mycobacterialculture-positive, with the positive rate of 13.2 per 100 patients. Theirmedian age was nine years, sex distribution was equal. Among 42 patients who were enrolled in the study, 1/42 (2.38%) died. Children with TBM in the southwest of China were mainly concentrated in the minority areas of western Sichuan. In fact, 34/42 (81.0%) patients with TBM belonged to ethnic minorities, and only 2/42 (4.76%) had BCG vaccination histories.All the 42 patients had varying degrees of chest X-rays changes and 18/42 (42.9%) merger of extracranial TB. Fever and headache were the most common presenting symptom. Thirty-five (83.3%) patients suffered from neck stiffness and 30/42 (71.4%) had high CSF pressure. DST results showed that the resistance rate was high; resistance to any anti-tuberculosis drug (ATD) was 13 (31.0%), and to multidrug-resistant tuberculosis (MDR-TB) and XDR it was 2 (4.8%) and 1 (2.4%), respectively. Conclusions : TBM in children in Southwest China was mainly concentrated in the minority areas of western Sichuan. The most common symptoms were fever, headache and neck stiffness and all patients had positive chest X-ray findings. High rates of drug resistance were founded. In addition, more than 95% of patients did not receive BCG vaccination at birth.