OBJECTIVES: Antimicrobial drug utilization review (DUR) is one of the essential tools to optimize the therapy and minimize the risks that are associated with irrational use of this therapeutic group including the Antimicrobial drug resistance. The aim of the study is to explore how Saudi hospitals setup DUR program for Antimicrobial drugs use METHODS: A cross-sectional survey targeted mangers at hospital pharmacies in both governmental and private hospitals in Riyadh City in 2014. The survey gathered information about the Pharmacy & Therapeutics Committee (P&TC) activities and adopted therapeutic guidelines by the hospitals. Descriptive statistics and nonparametric techniques were utilized for the analysis. RESULTS: Of the 30 hospital pharmacy managers, 23 (76.6%) responded, and only 21(70%) hospital pharmacies met the inclusion criteria, of which 15 governmental and 6 private hospitals. 20(95.2%) hospitals have P&TC, of these 20 hospitals, 16(80%) have subcommittee dedicated for DUR of Antimicrobial medications. 9 (45%) of these subcommittees meet five times or more annually to discuss Antimicrobial DU related issues.17(85%) of the hospitals have Antimicrobial use guidelines. The main P&T committee at 11 (55%) hospitals that have both dedicated subcommittees and Antimicrobial use guidelines conduct at least 12 meetings annually. The governmental hospitals are more likely to dedicate subcommittee to review Antimicrobial use and have higher frequency of meetings than the private hospitals. CONCLUSIONS: The adoption and implementation of Antimicrobial use guidelines is still not optimal in the Saudi hospitals which might have negative impact not only on the patient outcomes but also in public health as a result of irrational use of Antimicrobial drugs which eventually will develop Antimicrobial resistance. The effectiveness of the Antimicrobial DUR program has not been tested in this study, therefore, further studies should be conducted to ensure the effectiveness of the DUR programs in Saudi hospitals