Objective To investigate the efficacy of endoscopic retrograde cholangiopancreatography( ERCP) in the treatment of acute obstructive suppurative cholangitis( AOSC),and to examine the results of bile bacterial culture and drug susceptibility test. Methods A retrospective analysis was performed on 150 AOSC patients who were admitted to the Fifth Affiliated Hospital of Zunyi Medical University from November 2009 to November 2014. All patients underwent ERCP. The bile of patients was collected during treatment. Antibiotics were chosen according to the results of bile bacterial culture and drug susceptibility test. The efficacy of ERCP was assessed. Comparison of continuous data between groups was made by independent- samples t test,while comparison of categorical data by chi- square test. Results The rate of successful intubation was 92%( 138 /150),and the rate of effective drainage was 94. 2%( 130 /138). After treatment,the 130 patients treated with effective drainage had significantly reduced total bilirubin and direct bilirubin( 60. 3 ± 43. 4 μmol/L vs 110. 2 ± 53. 1 μmol/L,t = 8. 56,P < 0. 05; 35. 5 ± 23. 6 μmol/L vs 65. 5 ± 33. 2 μmol/L,t = 8. 65,P < 0. 05) and a significantly reduced percentage of neutrophils( 65. 2% vs83. 4%,χ2= 11. 85,P < 0. 05). The results of bile bacterial culture showed that Gram- negative bacteria were found in 85. 7%( 78 /91) of positive specimens. The β- lactam antibiotics with enzyme inhibitor could be used as the preferred drug,and carbapenems as second- line drugs. Conclusion ECRP is a simple and effective therapy for AOSC. Antibiotics,chosen based on the results of bile bacterial culture,can quickly relieve symptoms of poisoning and prevent drug resistance.