OBJECTIVE： To provide reference for promoting the rational use of essential drugs in primary medical institutions. METHODS： Twenty-three rural primary medical institutions （8 township health centers， 15 village clinics） were randomly selected from 2 poverty-stricken counties in Chongzuo city of Guangxi Zhuang Autonomous Region. The utilization of essential drugs was investigated and analyzed statistically through exporting hospital information system data and on-site interviews. RESULTS： The utilization rate of essential drugs in sample township health centers was 72.4％， and the amount of essential drugs accounted for 78.3％. The utilization rate of variety from National List of Essential Drug was 36.9％， which in the Autonomous Regions Essential Drug List Supplement was 47.2％ （utilization rate of chemical drugs was 53.9％， and that of Chinese patent drugs was 39.7％）. The utilization rate of essential drugs in sample village clinics was 64.4％； utilization rate of variety from National List of Essential Drug was 18.3％， which in the Autonomous Regions Essential Drug List Supplement was 10.5％. The amount of 5 major categories accounted for 47.9％ of total amount of chemical agents， among which that of antimicrobial agents took up the highest proportion， being 35.9％. Among top 10 drugs in the list of amount， there were 8 national essential drugs and 4 antimicrobial agents. There were 2.90 kinds of drugs in each outpatient prescription averagely in sample township health centers； the average proportion of antibiotic prescription was 43.0％； the cost of each prescription was 33.12 yuan in average. CONCLUSIONS： The utilization rate of essential drugs in primary medical institutions is lower than the requirements of policy. There are great difference in utilization rate between chemical agents and Chinese patent drugs of township hospital in Autonomous Regions Essential Drug List Supplement. The cost proportion of antimicrobial agents is high. The rationality of prescription drug use still needs to be improved. It is suggested to guarantee essential drugs supply， adjust Autonomous Regions Essential Drug List Supplement in time， control the price of main categories and strengthen antimicrobial agent use monitoring so as to further promote rational drug use.