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Background and Importance 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.Aim and Objectives To analyse the criteria for prescribing antibiotic prophylaxis in patients undergoing ERCP and the degree of compliance with clinical recommendations.Material and Methods 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.Results 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).Conclusion and Relevance 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.Conflict of Interest No conflict of interest