Introduction: Antimicrobial utilization studies involve the study of prescription and utilization of drugs in society with analysis of the medical, social, and economic consequences. Aims: To determine the current practice of antimicrobial usage, rationality, and economic burden of cost of antimicrobials in ICU of Government Medical College, Amritsar. Settings and Design: The present prospective, observational study was carried out in the ICU of a tertiary care Hospital attached to the Government Medical College, Amritsar from March 2021 to March 2022. Material and Methods: All the new consecutive patients irrespective of the clinical condition and sex, shifted to ICU are included. Statistical analysis used: SPSS software. Results: Most frequently prescribed antimicrobial groups were beta lactam antibiotics (58.24%) followed by nitroimidazole (19.08%) Only 3.11% prescriptions followed laboratory evidence and rest of the patients were administered empirical therapy. Metronidazole formed the bulk of prescription and was the most economical for the patients (Rs. 11.25 per patient per day) Piperacillin- tazobactam combination was maximally prescribed. Conclusions: It is concluded that most of the prescriptions followed ICMR guidelines. Culture sensitivity is rarely done and most patient continue on empirical therapy. Formulating institutional antimicrobial prescription guidelines is the need of the hour.