OBJECTIVES: Research data on antibiotic usage pattern and cost comparison  are scant in our country. Therefore we planned to identify oral antibiotic (OA) consumption and cost comparison for 2010 in tertiary care hospital in Sri Lanka. METHODS:  Aggregate data for 2010 was collected from records of pharmacy and unit price was obtained from medical supplies division. Initial and final stocks of the OA, quantity received, quantities issued, quantity consumed and hospital data from VEN analysis were obtained. We identified the top ten for total cost (TTTC) and top ten for consumption (TTCS) OA. RESULTS: Ninethy-three percent of total cost for TTTC was utilized for the top seven highly consumed OA with low unit price. Seven percent of TTTC had been utilized for the drugs which were not in TTCS. In contrast three drugs  in TTCS had not been included in TTTC but in the list of top 20.  Low quota ( 2.5%) of the TTTC had been utilized for non essential drug in VEN which was not even in TTCS of OA. CONCLUSIONS: Ninety-three percent of the cost has been effectively utilized highly consumed low cost OA in this hospital for 2010. Seven percent of money in TTTC was spent for expensive OA.  We suggest the authority to reconsider the change the drug ordering pattern with minimum cost and to suitable alternative low cost generics instead of expensive product