This review by Annemieke van Eijk and Anja Terlouw looks at whether the antibiotic azithromycin is an effective option for treating malaria. Data from 15 trials with 2284 participants were considered. Results show that azithromycin used alone or in combination with other drugs did not perform well in comparison with other antimalarials, against Plasmodium falciparum or P. vivax malaria. The authors conclude that azithromycin has only weak antimalarial activity and does not have a role to play in current malaria control programs. However, because azithromycin has a different mechanism of action to other antimalarials and a good safety profile, it may offer future treatment options for pregnant women and children, especially if there are improvements in drug formulation.