OBJECTIVES: To explore the Antimicrobial medication use in Ambulatory care clinics and Emergency Units at North West Region Hospitals, Ministry of Health, Saudi Arabia METHODS: It is 12-month antimicrobial drug consumption by ambulatory care clinics and Emergency department at North West region hospitals. It included all adults, pediatrics, and neonatal population. The medications selected by Central Antibiotics committee at MOH as part of the National Antimicrobial stewardship program. The consumption-is driven from pharmacy database and calculated base on of stranded unit of antimicrobial per each hospital. The cost of antibiotics consumption calculated by used Ministry of Health National Cost database. All cost used as US currency. RESULTS: The total number of Antimicrobial standard units at Ambulatory care clinics and Emergency were (25,116) and (8,687) with average (5,023.2) and (1,737.4) per hospital respectively. The highest drug consumption at Ambulatory care was Azithromycin tablet (10,932), followed by Azithromycin syrup (7,760), and Moxifloxacin tablet, while at Emergency department Azithromycin syrup (4,357) followed by Ceftriaxone injection (805) and Gentamicin 80 mg injection. The total cost of Antimicrobial consumption at Ambulatory care and Emergency were ( 37,620.13 USD) and (24,822.61) USD) respectively. The highest medication cost at ambulatory care was Levofloxacin injection, Linezolid tablet, and Azithromycin syrup while the Emergency they were Meropenem, Azithromycin syrup, and Moxifloxacin injection. CONCLUSIONS: An Ambulatory care clinics and Emergency department had a high consumption of antimicrobial drugs with burden cost. Antimicrobial stewardship program at Ambulatory care clinics and Emergency are necessary to prevent bugs related resistance, improve patient outcome and avoid especially adults Department is a mandate and necessary.