Introduction:Based on the fact that many children present with more than one clinical problem with major overlap in the presenting signs and symptoms, Integrated Management of Childhood Illness guidelines (IMCI) were developed by the World Health Organization (WHO) and incorporated into the national health programs of many developing countries. IMCI system is a cost-effective strategy that improves the quality of care through the use of evidence based management protocols for the most common causes of childhood death and illness. Alexandria was one of the first Egyptian governorates which applied the IMCI guidelines in Egypt.Aim: This study tried to explore the degree of primary health care physicians’ compliance with IMCI guidelines and their attitude towards its application in Alexandria. Settings and design: Cross sectional study was conducted in representative sample from the primary health care facilities in Alexandria from which physicians using IMCI guidelines and mothers received care in IMCI clinics were included in the study.Results:The highest compliance reported was that of writing disease classification (100%), as regards infants below 2 months the highest physicians’ compliance was proper assessment of jaundice (100%) and possible bacterial infection (95%) and despite being critical only 85.7% of physicians were complied with weight assessment and its plotting in the growth curve. For children below 5 years physicians were generally well complied with the guidelines especially for assessment of dangerous signs and possible bacterial infection. Conclusion: Despite being applied for years, IMCI guidelines still show certain areas of poor compliance, an issue that need further investigation in order to maximize physicians’ compliance and achieve the best of their performance.