Objective To explore the prescribing patterns of outpatients receiving antibiotics for upper respiratory tract infections (URTIs) in rural Western China and to identify the correlation in terms of doctors and patients characteristics. Methods Totally 7678 prescriptions for URTIs were collected from 680 primary health village clinics of 40 counties across 10 provinces of Western China. Two outcome variables were used in the analysis: the occurrence of prescribing at least one antibiotic drug for an URTI and the occurrence of prescribing two or more antibiotics for an URTI. GEE logistic regression models were used to examine the socioeconomic and demographic determinants of the above two outcome variables. Results The percentage of prescribing at least one antibiotic for URTIs was 48.6% while the percentage of prescribing antibiotic combination (two or more antibiotics) was 4.6%. The two measurements of antibiotic utilization differed remarkably among the 10 provinces. Patients diagnosed with tonsillitis and faucitis had higher odds (OR=8.86 for tonsillitis and OR=4.64 for faucitis) of antibiotic prescription than patients with other diagnosis of URTIs. Patients with tonsillitis and faucitis also had higher odds (OR=3.82 for tonsillitis and OR=2.71 for faucitis) of multiple antibiotic prescription than those with other diagnosis of URTIs. The number of drugs per prescription and injection in prescriptions were also significant predictors of antibiotic and multiple antibiotic utilization for URTIs. Conclusion It is concluded that the percentage of antibiotic prescription for URTIs is higher in rural Western China than in most of other countries with available data and that prescriptions of antibiotics for URTIs are associated with residence regions of patients, URTI diagnosis and background information on drug prescription.