Abstract: Azithromycin was usually used in short-term anti-infection therapy in the past. However, azithromycin has been found to have many non-antibacterial effects in recent years. Many foreign guidelines recommend it for the adjuvant treatment of respiratory diseases such as asthma, bronchiectasis and chronic obstructive pulmonary disease. Due to the long-term application of azithromycin for the purpose of non-antibacterial effects, it has the characteristics of long treatment course and wide application range. Therefore, its potential safety problems(such as increased bacterial drug resistance, cardiotoxicity, hearing loss, etc.) have attracted extensive attention and controversial. This paper aims to describe the research status of safety of azithromycin in the process of long-term application, in order to objectively and correctly understand its potential risks and provide help and reference for clinical decision-making.