In Italy, data regarding the aetiological role, antibiotic resistance, and serotype distribution of isolates of Streptococcus pneumoniae are scarce and based on very small population samples. We found that S. pneumoniae caused about 30% of lower respiratory tract infections and 15% of acute otitis media infections in Italian children. The incidence of S. pneumoniae meningitis in subjects aged 0-4y was 1.1 x 100,000. In children <5 y of age with meningitis, the most common S. pneumoniae serotypes were, in rank order, 14, 6, 23, 1 and 4; among 53 nasopharyngeal carriers the most frequent serotypes were 6 and 19. The actual percentage of resistance of S. pneumoniae to penicillin is 10.2%, while for macrolides it reaches 25.5%. More data on the distribution of serotypes in Italian children are urgently needed in order to obtain a better understanding of the impact of the new pneumococcal vaccines.