Rivers can act as reservoirs of highly resistant strains and help the dissemination of pathogenic strains to animals and humans using water. This study aimed to determine the antimicrobial susceptibility patterns among bacterial isolates from Nairobi River water, Kenya. A total of 18 water samples were collected from three different sampling points along Nairobi River during wet and dry seasons. We employed standard microbiological methods to isolate and identify bacteriafrom these selected sites. Escherichia, Klebsiella, Yersinia, Pseudomonas, Proteus vulgaris, Serratia and Shigella recorded the highest occurrence along the selected sites of Nairobi River. Drug sensitivity using the Disc diffusion method showed that Ceftazidime, Ampicillin, Cefotaxime, Amoxicillin and Cefepime had the highest levels of inactivity ranging from (61.5% to 82%), (56.3% to 76.9%), (43.6% to 62.5%), (59.4% to 61.5%), and (33.3% to 44%) and most susceptible to Levofloxacin (97.4%), Ciprofloxacin (93%) and Amoxy/clav (87.5%). Members of Serratia,Shigella, Escherichia, and Salmonella showed the highest level of extended spectrum beta lactamases (ESBLs) production at 9.8%, 9.8%, 7.8%, and 7.8%. The sites with human industrial and agricultural zone activities had strains that were more resistant than isolates obtained from the other sites of the river with minimum human activities. The study concludes that, Nairobi River bear heavy burdens of potentially virulent resistant bacterial strains that may form major public health hazards to humans and animal's health. Therefore, there is need to educate people on the use of appropriate protective materials and communities along the Nairobi River.