Background Antibiotics are the most commonly used drug group in hospitalized patients and primary health clinics as they are all over the world. Inappropriate or unnecessary use of antibiotics leads to adverse effects related with antibiotics, occurrence of resistant microorganisms, and increased therapeutic cost. With the Budgeting Application Instruction, which entered into force in 2003 for controlling antibiotic use, approval of an infectious disease specialist (IDS) was required for use of some differences in antibiotic knowledge and attitudes between parents of Medicaid-insured. It is unknown whether understanding has improved and whether previously identified differences persist.Efforts to reduce antibiotic misuse and overuse are necessary to curb additional increases in antibiotic resistance in developed and developing countries also in KSA saw increases in antibiotic use for children during the last 2 decades, no educational campaigns for patients and professionals, and introduction of new vaccines.