A cross-sectional survey was conducted to determine prevalence and assess risk factors for carriage of antibiotic resistant strains of Streptococcus pneumoniae in healthy school children in Hong Kong. Throat swabs were collected from 1455 subjects and written questionnaires providing demographic data and medical history were completed by parents. The overall carriage rate of Streptococcus pneumoniae was 3·5%, of which 49% were penicillin resistant. High levels of resistance to tetracycline (73%), erythromycin (52%), trimethoprim (66%) and ciprofloxacin (57%) were observed. Carriage was associated with presence of a younger sibling (OR = 1·79) and use of antibiotics (OR = 2·31). High use of day care and small size of housing units did not result in a high rate of carriage. The low rate of carriage may be linked to high use of antibiotics, geographical factors or ethnicity. High rates of antibiotic resistance reflect heavy use of antibiotics by general practitioners.