Background: Cholangitis represents a surgical emergency which has to be managed without delay. Surgical decompression and antimicrobial therapy remain the cornerstones of this condition. However, it is important to institute the correct antimicrobial therapy considering the local resistance patterns. The resistance β-lactams has become very rampant and is mostly due to Extended Spectrum Beta lactamases (ESBL). Carbapenems are commonly used in these cases but resistance to these agents by carbapenemase enzyme production is rising. Such strains are resistant to all β-lactams and might carry plasmid-borne genes for resistance to other classes of antibiotics as well. There are a limited number of agents available for treatment of such organisms.