Objective To comprehensively evaluate the rational drug use in class Ⅲ public hospitals in Guangxi by using entropy⁃weighted TOPSIS method and RSR method, providing a scientific basis for optimizing the rational drug use management of hospitals. Methods Based on data of rational drug use indicators of class Ⅲ public hospitals performance appraisal monitoring data in Health Commission of Guangxi Zhuang Autonomous Region from 2019 to 2022, rational drug use of 63 class Ⅲ public hospitals in Guangxi between 2019 and 2022 was analyzed. Entropy weight method was adopted to determine the weights of each index, and the closeness of the rational drug use indices of hospitals was calculated by TOPSIS method, and rank⁃sum ratio (RSR) method was used to classify and rank. Results From 2019 to 2022, the proportion of prescriptions reviewed by Guangxi's class Ⅲ public hospitals in the total number of prescriptions, the proportion of medical orders of discharged patients reviewed, the proportion of essential drug prescriptions of outpatients, and the proportion of drugs approved by state⁃organized centralized procurement of drugs revealed an overall upward trend. The intensity of antimicrobial use, the utilization rate of essential drugs among inpatients, the proportion of the number of varieties of essential drugs purchased, and the proportion of funds allocated and used for national essential drugs were on the decline. In terms of the weight of each indicator, from 2019 to 2022, the proportion of reviewed prescriptions in the total number of prescriptions, the proportion of medical orders of discharged patients reviewed, and the proportion of the number of varieties of essential drugs purchased weighed heavily. From 2019 to 2022, institutions 15, 8, 22, and 40 ranked the top in terms of hospital closeness. RSR method divided the hospitals into four levels, including 5 hospitals of excellent level, 27 hospitals of favorable level, 27 hospitals of pass level, and 4 hospitals of poor level. Conclusion The rational use of drugs in class Ⅲ public hospitals in Guangxi has been improved to a certain extent, but there is still a distance from the national standard. The indicators of essential drugs have not risen or decreased, which should be given special attention. The performance of rational drug use in specialized hospitals is superior to that of general hospitals. The rational drug use varies greatly in different hospitals, and some hospitals need to focus on improvement. 

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