A retrospective study was carried out of 74 elderly patients with obstructive jaundice undergoing percutaneous transhepatic cholangiography (PTC) and/or percutaneous biliary drainage (PBD) in order to assess the effect of prophylactic antibiotics on the incidence of fever and sepsis complicating these procedures. Seventeen patients underwent PTC alone, while 57 had both PTC and PBD. Fifty-three patients had either primary or metastatic malignancy. In the other patients with benign disease, choledocholithiasis was the most common reason for undertaking these procedures. Prophylactic antibiotics were given in 80% of cholangiographies and 93% of biliary drainage procedures. There was an overall incidence of sepsis of 13.5%. Enterobacter cloacae and Acinetobacter anitratus were the most common blood culture isolates in patients with malignant biliary obstruction. The incidence of fever was no different between patients who underwent PTC alone compared with those who had PTC and PBD. Of 24 patients who developed fever, two died secondary to sepsis. Although there was no difference in the rate of sepsis and febrile episodes between the two groups, the risk of septic episodes and mortality emphasizes the need for antibiotic prophylaxis and early therapy in elderly patients undergoing percutaneous biliary drainage procedures.