PURPOSE OF REVIEW: To assess the most recent evidence for macrolide therapy in chronic rhinosinusitis (CRS). RECENT FINDINGS: Macrolides play a significant role in a select group of patients with CRS. Low-serum and tissue eosinophilia in patients who do not respond to corticosteroid therapy appeared to be an effective predictor of a CRS phenotype suitable for a trial of long-term macrolide therapy. Therapies using half a dose for longer than 12 weeks have noted good outcomes. SUMMARY: The anti-inflammatory and immunomodulatory effects of macrolides have been demonstrated in several studies. Macrolides have shown an important role in patients who are nonresponsive to corticosteroid therapies, therefore patient selection is key. Previous inconsistencies in results may be due to poor patient selection.