BackgroundRationale antibiotic use is crucial to address antimicrobial resistance (AMR) threats. No study has been undertaken in the Kurdistan Regional Government (KRG) using validated methodologies to document current antibiotic use and areas for improvement given high AMR rates. Research design and methodsPoint prevalence survey (PPS), using the Global PPS methodology, was conducted among the three major public hospitals in KRG/northern Iraq from September-December 2019. Prevalence and quality of antibiotic use were assessed using agreed indicators. ResultsPrevalence of antibiotic use was high (93.7%;n=192/205); with third generation cephalosporins the most commonly prescribed antibiotics (52.6%;n=140/266). Reasons for treatment was recorded for only 61.7% (n=164/266) of antibiotics and high use (89.9%) of parenteral therapy was observed. All therapy was empirical, no stop/review dates were recorded and no treatment guidelines were available. The majority of the prescribed antibiotics (62%; n=165/266) were from the WHO Watch list. ConclusionPrevalence of antibiotic use was high not only versus other hospitals in the region but globally including Africa, coupled with significant evidence of sub-optimal prescribing. Swift action is needed to improve future prescribing to reduce AMR. One or two areas should initially be targeted for quality improvement including development of local guidelines, documentation of antibiotic indications and/or stop/review dates.