Malaria is an epidemic with 1.3% reduction in annual per capital economic growth rate. This study was to assess physicians’ antimalarial utilization in children below five years and conformity to guidelines. This is a retrospective and cross-sectional random sampling of prescriptions of antimalarials in under five between January 2012 and December 2014 in the secondary facility and January 2012 to December 2017 in two health facilities. Data was recorded using WHO indicator forms and analyzed using SPSS. Exactly, 800 prescriptions giving a total of 1,243 and 1313 drugs were prescribed in the Secondary Facility (CH), Warri and Primary Health Care (PHC), Oria respectively with an average of drugs prescribed per encounter (DPPE), CH (3.1 ± 0.01) and PHC, (3.3 ± 0.1). Antimalarials, were the most prescribed. Generic prescription was more in PHC (59%) than in CH (58%). Syrups were most prescribed 70.96% in CH, Warri and 53% in PHC, Oria. However, 27(50.9%) of physicians based prescription on experience, 13(24.5%) and 4(7.5%) followed WHO and National Antimalarial Treatment Policy (NATP) guidelines respectively while (17.1%) on the efficacy of the antimalarial. The antimalarial utilization practices conform to the WHO guidelines although there are lapses. Prescription was predominantly based on experience.