Prescription analysis studies play a crucial role in monitoring prescription patterns and establishing guidelines for effective drug delivery and health care management. Given the physiological differences between the pediatric and adult populations, it is essential to analyze the prescription records specifically for pediatric patients, considering their unique diseases, drugs, and dosages. The objectives of this study were to analyze the prescribing patterns of drugs, rationality, outcomes, and antimicrobial use and drugs from National List of Essential Medicines (NLEM) in pediatric intensive care unit (PICU) patients. A retrospective study design was employed, and data were collected from medical records, including demographic information, diagnoses, drug details, and treatment outcomes of PICU patients. The collected data were then analyzed according to the World Health Organization (WHO) indicators for rational drug use, WHO Access, Watch, and Reserve (AWaRe) guidelines for antimicrobial use, and the proportion of essential drugs prescribed. Descriptive statistics was used to express the data in this study. A total of 184 patient records were analyzed, with 57.6% were males. On average, 4.5 drugs were prescribed per prescription, with injections and syrups comprising nearly 28% each. Approximately 71.5% of prescriptions contained generic drug names. Furthermore, 49% of the prescribed drugs were listed in the NLEM. Antibiotics were present in 50% of the prescriptions, with 50% of them falling under the WHO AWaRe Watch category and 31% in Access category. Majority of the drugs being prescribed in the PICU were with generic names, and less than half the prescriptions contained antibiotics. Watch class of antibiotics was most commonly prescribed.