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<h3>Background and Importance</h3> Endoscopic retrograde cholangiopancreatography (ERCP) is a key diagnostic and therapeutic technique in biliary and pancreatic pathologies, whose most prevalent complication is cholangitis, with high morbidity and mortality. Proper antibiotic prophylaxis reduces the risk of infection. <h3>Aim and Objectives</h3> To analyse the criteria for prescribing antibiotic prophylaxis in patients undergoing ERCP and the degree of compliance with clinical recommendations. <h3>Material and Methods</h3> Retrospective observational study conducted in a secondary-level hospital (January/2024-July/2025), including 67 hospitalised patients. The clinical variables (age, sex, reason for admission, ALT/AST values), type and duration of the antibiotic were collected from the Mambrino electronic medical records. Transaminase values were classified as normal, mild(<5USN), moderate(5-15USN) and severe(>15USN). The statistical analysis was carried out using the SPSS program, including descriptive statistics for qualitative and quantitative variables, chi-square test for associations between antibiotic and clinical variables (choledocholithiasis, cholangitis and ALT/AST transaminase levels), logistic regression models to identify predictors of cholangitis and choledocolitiasis. <h3>Results</h3> The mean age was 76±14 years, with a predominance of females (53.7%). The most commonly used antibiotics were ciprofloxacin (CIP,47.8%), Piperacillin/Tazobactam (PTZ,20.9%), PTZ+Amoxicillin/Clavulanic Acid in de-escalation (PTZ+AMC,16.4%) and PTZ+CIP in de-escalation (4.5%). CIP was administered mainly to patients with choledocholithiasis (68.7%) without cholangitis, with normal transaminases (65.6%). Average duration: 4.3 days. PTZ was prescribed mainly in cholangitis (57.1%), with mild elevation of transaminases (64.3%). Average duration: 9.6 days. PTZ+AMC were mainly used in cholangitis (72.7%), with a higher proportion of normal ALT/AST (72.7%). Average duration: 12.1 days. PTZ+CIP was administered predominantly in choledocholithiasis with recent history of cholangitis (<1 month) and mild elevation of transaminases (66.7%). Mean duration: 16.5 days. Significant associations were found between the prescribed antibiotic and the presence of cholangitis (p<0.001). There was no relationship between the prescribed antibiotic and previous hospitalisation (p=0.924), previous biliary prosthesis (p=0.945), AST elevation (p=0.514) or ALT (p=0.954). Logistic regression identified AST elevation as predictor of cholangitis (OR=38.6;p=0.017), without significant predictors for choledocholithiasis (χ2=9.87;p=0.196). <h3>Conclusion and Relevance</h3> CIP is suitable for mild choledocholithiasis, while PTZ or combinations such as PTZ+CIP are reserved for cholangitis or at-risk patients. The duration of treatment increases significantly in the presence of cholangitis, consistent with clinical guidelines and the individualisation of antibiotic management according to risk and severity. <h3>Conflict of Interest</h3> No conflict of interest