Objectives The aim of this study was to determine the asymptomatic pharyngeal carriage rate of S. pyogenes, antimicrobial pattern and related risk factors among school children in Hawassa, Southern Ethiopia. Results Out of 287school children’s screened, 35(12.2%) were colonized with S. pyogenes. The carriage rate was significantly associated with factors such as sex (Female p=0.013) occupational status of mother (p=0.002), lower income source (500-900ETB, 1000-1500ETB) (p=0.001, and p=0.042), history of hospitalization (p=0.00) and residence of the children (p=0.002). High level resistant to tetracycline and low level to Vancomycine were observed, while penicillin, Amoxicillin, Erythromycin, Chloramphenicol, and Ceftriaxone were found to be effective.