For over twenty years, due to its unique pharmacokinetic profile, i. e. clinical efficacy, simple dosing and good tolerability, azithromycin was the preferred antibiotic, especially for the treatment of acute respiratory infections. As a result of an increasing trend in pneumococcal resistance to penicillin and macrolides, azithromycin has lost this prime position, but it still remains an important and indispensable antibiotic. Due to the inefficacy of beta-lactam antibiotics, azithromycin remained the first-line antibiotic for the treatment of atypical pneumonia and pertussis. Furthermore, combined with beta-lactam antibiotics, it plays a major role in the treatment of severe cases of pneumonia. Azithromycin is an alternative choice for the treatment of upper respiratory tract infections (pharyngitis, sinusitis, and otitis media) and acute COPD exacerbations in patients allergic to beta-lactam antibiotics. New discoveries regarding immunomodulatory and anti-inflammatory effect of macrolides have led to the use of azithromycin in patients with cystic fibrosis and other chronic respiratory diseases.

Zbog jedinstvene farmakokinetike, odnosno kliničke učinkovitosti, jednostavnog doziranja i dobre podnošljivosti azitromicin je dvadesetak godina imao status izuzetno poželjnog antibiotika, posebno u liječenju akutnih respiratornih infekcija. Pojavom sve učestalije rezistencije pneumokoka na penicilin i makrolide taj je primat sada potisnut, no i danas je azitromicin vrlo važan i nezaobilazan antibiotik. Zbog neučinkovitosti beta-laktamskih antibiotika azitromicin je ostao antibiotikom prvog izbora u liječenju atipičnih pneumonija i hripavca. Također ima vrlo važnu ulogu u liječenju težih oblika pneumonija u kombinaciji s beta-laktamskim antibioticima. U liječenju bakterijskih infekcija gornjeg dijela dišnog sustava (faringitis, sinusitis, otitis media) te akutnih egzacerbacija kronične opstruktivne plućne bolesti azitromicin je alternativni izbor pri alergiji na betalaktamske antibiotike. Nova saznanja o imunomodulaciji i protuupalnom ucinku makrolida pozicionirala su uporabu azitromicina u cističnoj fibrozi i drugim kroničnim bolestima dišnog sustava.