ObjectiveTo assess the patterns of antibiotic consumption and expenditure in Vietnam.DesignThis was a cross-sectional study.SettingThis study used data of antibiotic procurement that was publicly announced from 2018 to 2022 as a proxy for antibiotic consumption.ParticipantsThis study included winning bids from 390 procurement units in 63 provinces in Vietnam for 5 years with a total expenditure of US$ 12.8 billions that represented for approximately 20–30% of the national funds spend on medicines.InterventionsAntibiotics were classified by WHO AWaRe (Access, Watch and Reserve) classification.Outcome measuresThe primary outcomes were the proportions of antibiotic consumptions in number of defined daily doses (DDD) and expenditures.ResultsThere was a total of 2.54 million DDDs of systemic antibiotics, which accounted for 24.7% (US $3.16 billions) of total expenditure for medicines purchased by these public health facilities. The overall proportion of Access group antibiotics ranges from 40.9% to 53.8% of the total antibiotic consumption over 5 years.ConclusionThis analysis identifies an unmet target of at least 60% of the total antibiotic consumption being Access group antibiotics and an unreasonable share of expenditure for non-essential antibiotics in public hospitals in Vietnam.