Introduction: Anti-epileptic drugs (AEDs) are the primary therapeutic modes for epileptic patients and have been demonstrated to control seizure, which decreases morbidity and mortality associated with epilepsy. There is a paucity of data on treatment outcome among epileptic patients in resource poor settings. The aim of this study was to assess AED utilization pattern and treatment outcome among epileptic patients on follow-up. Materials and Methods: A retrospective cross-sectional study was conducted among epileptic patients on follow-up at Epilepsy clinic of Jimma University specialized hospital. A total of 290 patient record cards which had 3 years of follow-up information was used to evaluate AED utilization pattern and treatment outcome through medical records review. Results: From a total 290 cards of epileptic patients on follow-up, 170 (58.6%) were males. The common type of seizure diagnosed was generalized tonic clonic seizure, 232 (80%). Monotherapy was commonly used in the management of seizure, 54.5%, among which phenobarbitone was the most commonly utilized single anticonvulsant drug. One hundred and sixty-five (56.7%) patients were seizure free during follow-up periods and 125 (43.3%) patients were not, of which 121 (73.3%) of patients had 1 up to 5 seizure attacks per 3 months during the 3 years follow-up period. Conclusion: All studied epileptic patients were put on traditional AEDs; phenobarbitone being the most frequently prescribed single drug. About one in every two epileptic patients evaluated were seizure free during the 3 years follow-up period.