Azithromycin (AZM), primarily recognized for its antibiotic properties, has gained attention for its ability to modulate the immune system and reduce inflammation. This review explores the impact of AZM on various immune cell types, including T cells, B cells, and natural killer (NK) cells, and its potential in treating chronic inflammatory and autoimmune conditions. AZM inhibits the mTOR signaling pathway in T cells, thereby limiting both T cell proliferation and cytokine production. It also affects B-cell function by modulating pathways such as NF-κB and CD27, thereby influencing antibody synthesis. In NK cells, AZM reduces cytotoxicity and cytokine release while preserving cell viability. The drug’s effects on immune responses, particularly on vaccination responses and reduced antibody levels, have important clinical implications. While AZM shows potential for managing conditions such as graft-versus-host disease and asthma, its varied effects highlight the need for further investigation. Further understanding of these mechanisms is crucial for optimizing AZM’s therapeutic use and minimizing unwanted immune suppression.
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