Chronic rhinosinusitis (CRS) is a chronic inflammatory disease of the nasal cavity and paranasal sinuses, and the pathological manifestations include mucus hypersecretion and mucosal inflammation induced by various inflammatory mediators. Macrolide antibiotics are widely used in the clinical treatment of CRS due to the anti-inflammatory and immunomodulatory effects. A low-dose, long-term oral macrolide antimicrobial method is recommended, and it is effective for non-allergic CRS without nasal polyps or eosinophilia, or with normal immunoglobulin E level. This paper reviews the mechanism, pharmacological characteristics and clinical application of macrolide antibiotics for CRS.