There were still 15 people buried under rubble in San Marcos, Governor Luis Rivera said. The district borders Mexico, where the quake was also felt.
Guatemalan President Otto Perez Molina put the country on the highest alert, placed the military on standby and flying to the worst affected area. Damage was heaviest in San Marcos.
In the towns of San Pedro Sacatepequez, El Recuerdo, San Francisco, El Quetzal and other communities, numerous houses collapsed. In the neighbouring region of Quetzaltenango, adobe houses collapsed, killing four people and burying six others, rescuers working in the area said.
Guatemala's seismological institute Insuvimeh said the earthquake had a magnitude of 7.2. The US Geological Survey said the quake measured 7.5 on the Richter scale. The epicentre was almost 42 kilometres under the Caribbean Sea, 56 kilometres south-west of Retalhuleu, Guatemala, and 61 kilometres south-east of Suchiate in the southern Mexican state of Chiapas, USGS said.//DPA