OBJECTIVE: This prospective, observational study evaluates the medication utilization patterns and cost of treatment of patients treated for myocardial infarction (MI) at a government institution in Kerala, India. METHODS: Patients with a diagnosis of MI and received streptokinase (SK) therapy are enrolled into the study. The following data is collected: demographics, clinical outcomes, laboratory results, ECG resolution, drug utilization parameters, and cost data from a patient perspective. The cost of drug therapy for each patient is calculated utilizing the Current Index of Medical Specialties 2004. Logistic regression univariate analysis is conducted to determine the association between outcome and treatment factors with p<0.05. RESULTS: One hundred fifty patients are enrolled. The mean age is 59.1 years and 77% of the patients are male. The average pain to treatment period for SK therapy is 4.69 hours, while the average door to treatment period is 79.9 minutes. A total of 34.7% of the patients experience a post SK ECG resolution above 70% and in hospital mortality is 12.67%. Logistic regression results indicate that greater than 70% resolution on ECG is associated with shorter treatment window period, non anterior infarct, dyslipidemia, lower CPK-1 level, and lower rate of mortality. Increased mortality is associated with heart block, hypotension, low ECG resolution, arrhythmias, low ejection fraction, CHF, and less use of beta blockers, nitrates, ace inhibitors, and atorvastatin. The average cost of care to the patient is Rs 5600.15 (SD Rs 13762.87). The average cost to the hospital for free medicines is Rs 2629.06 (SD Rs 1515.22). Patients who had at least 70% ECG resolution have an average cost of Rs 4090.28, while patients who had less have an average cost of Rs 5539.98. CONCLUSION: Management of myocardial infarction utilizing SK appears to improve clinical outcomes and be cost-effective in a government setting in Kerala, India.