The abnormalities in structure and respiratory function in children predispose to a higher incidence of infections in this age group. The basis mechanism of action of the macrolide antibiotics are bacteriostatic properties, resulting from blocking protein synthesis by interacting with the large ribosomal 50s and 23s subunits of ribosomal RNA. Macrolides have an additive nonantimicrobial properties. These properties include the effects on cells of the immune system, cytokine response, respiratory tract and metabolism of glucocorticosteroids. The paper presents the current knowledge of the mechanisms of action of this group of antibiotics. Macrolides reduce the number of neutrophils at the site of inflammation by inhibiting the secretion of chemotactic factors, blocking cell surface glikoproteins involved in the migration process and inducing apoptosis of inflammatory cells. Multidirectional influence of macrolide antibiotics on cytokine response is mainly based on reducing the secretion of pro-inflammatory cytokines and nitric oxide synthesis inhibition. In addition, they prevent the respiratory tract from P. aeruginosa colonization by inhibiting the production of: biofilm components, elements of quorum sensing (that enables communication between bacteria) and virulence factors. The use of macrolides also reduces production of mucus in respiratory tract and improves mucociliary clearance. In the treatment of cystic fibrosis, macrolides reduce overproduction of mucus in the airways and prevent colonization by P. aeruginosa. In addition, macrolides reduce the frequency of exacerbations and improve quality of life. However, significant improvement in spirometric parameters was not observed. Use of macrolides in the treatment of RSV infection reduces severe inflammatory response, airway hyperresponsiveness and mucus hypersecretion, which result in shorter hospitalization time and faster resolution of symptoms. These clinical effects of macrolides require additional well-documented research.