In nursing homes (EHPADs) equipped with an in-house pharmacy (PUI), continuous monitoring of antibiotic use could help improve practices by identifying targeted areas for improvement. Our objective was therefore to describe ATB consumption in volunteer EHPAD facilities that participated in the surveillance program of the National Mission for the Surveillance and Prevention of Antibiotic Resistance in Healthcare Facilities (SPARES). In 2020, 2021, and 2022, data were collected on the use of systemic ATBs classified under WHO class J01, as well as rifampicin, oral imidazoles, and fidaxomicin, dispensed by the PUI in nursing home settings. Quantities were expressed in defined daily doses (DDD, 2023 version), relative to activity measured in resident days (RD). In total, 491 nursing homes reported their antibiotic consumption in 2020, 470 in 2021, and 444 in 2022. In 2022, overall consumption was 35.1 DDD/1,000 ODD, higher than in 2021 (31.5) and 2020 (33.4). The lowest consumption was observed in 2021. The most commonly used antibiotics were amoxicillin-clavulanic acid, amoxicillin, and ceftriaxone (35%, 24%, and 7%, respectively, in 2022). Overall, the share of fluoroquinolone consumption, that of third-generation cephalosporins, and the share of injectable antibiotics were lower in 2022 than in previous years. In contrast, the share of critical antibiotics as defined by SPILF (Group II antibiotics that may be prescribed by healthcare professionals practicing outside a healthcare facility: amoxicillin/clavulanic acid, cefadroxil, cephalexin, cefaclor, cefuroxime axetil, cefixime, cefpodoxime proxetil, ceftriaxone, ciprofloxacin, levofloxacin, moxifloxacin, norfloxacin, ofloxacin, azithromycin, fusidic acid, rifampicin) was higher in 2022 than in 2021. This finding, coupled with the increase in consumption in 2022—which nevertheless remained lower than in 2019 (37.0 DDD/1,000 person-days)—calls for strengthening infection prevention measures to reduce the need for antibiotics and promoting the appropriate use of antibiotics when they are necessary. The development of multidisciplinary antibiotic therapy teams, regional antibiotic therapy centers, and the inclusion of the appropriate use of antibiotics in national infection prevention and antibiotic resistance initiatives will enable the implementation of actions tailored to the specific needs of nursing homes. Continued monitoring of consumption will be useful for evaluating the impact of the actions implemented.