Overuse of antibiotics contributes to the development of antimicrobial resistance. This study aims to assess the condition of antibiotic use at health facilities at county, township and village levels in rural Guangxi, China. The authors conducted a cross-sectional study of outpatient antibiotic prescriptions in 2014 for children aged 2–14 years with upper respiratory infections (URI). The study concludes that inappropriate use of antibiotics was high for outpatient childhood URI in the four counties of Guangxi, China, with the highest rate found in township hospitals. A significantly high proportion of prescriptions containing antibiotics were broad-spectrum, by intravenous infusion or with multiple antibiotics, especially at county hospitals. Urgent attention is needed to address this challenge.