OBJECTIVES:  To explore the selected Antimicrobial medication consumption in inpatient units at North West Region Hospitals, Ministry of Health, Saudi Arabia METHODS: It is 12-month antimicrobial drug use by inpatients at North West region hospitals. It included inpatient department for adults, pediatrics, and neonates. The medications selected by Central Antibiotics committee at MOH as part of the National Antimicrobial stewardship program. The consumption-driven from pharmacy database and calculated base on of stranded unit of antimicrobial per each hospital. The antimicrobial consisted of antibacterial drugs, antifungal, and antiviral medications. The cost of antimicrobial consumption calculated by used Ministry of Health National Cost database. All cost used as US currency. RESULTS: The total number of Antimicrobial standard units was (25,845) and average (5,169) per hospital. The highest drug consumption was Ceftriaxone 1 gm injection (8,572) followed by Ceftazidime 1 gm mg injection (2,147) and Imipenem 500 mg injection (1,347). The total cost of Antimicrobial consumption was ( 6,829,003.42 USD) and (1,365,800.68 USD) per each hospital. The highest cost medication consumption from Adults inpatient departments (6,803,229.92 USD) followed by pediatrics inpatient (16,087.6 USD) and Neonatal inpatient departments (9,685.9 USD). The highest medication cost was very broad spectrum antibiotics like Meropenem, Imipenem, and Ceftriaxone. It consumed more than 50% of the cost burden CONCLUSIONS: There was very high consumption of antimicrobial drugs inpatient department with huge cost burden. Urgent application of antimicrobial stewardship program especially adults inpatients departments is a mandate and urgent.