Community-acquired pneumonia (CAP) remains a potentially lethal infection. Each year in the USA alone, there are 3-4 million cases, >600,000 hospitalisations, and >48,000 deaths. In order to fully understand how best to treat it the aetiologic pathogens must first be understood. CAP is not a single homogeneous entity; there are numerous potential aetiologic agents, the most important of which include Streptococcus pneumoniae and the atypical pathogens Mycoplasma pneumoniae, Chlamydia pneumoniae, and Legionella spp. Copathogens can occur in a significant proportion of cases, making management even more difficult. In elderly patients and those with comorbid conditions, Gram-negative rods, including Pseudomonas aeruginosa, must also be considered. For outpatients, macrolides can be used for those without any modifying factors, and for inpatients, macrolides would be given in conjunction with a β-lactam, such as cefotaxime or ceftriaxone. In such cases the β-lactam would provide coverage against the pneumococcus, Haemophilus influenzae, or Gram-negative rods, while the macrolide would target the atypicals. There are a number of reasons why macrolides are important in community-acquired pneumonia. They provide in vitro coverage of the main pathogens with proven efficacy from randomised controlled trials and 50 yrs of experience. Resistance is not a major problem, physicians are familiar with these agents, and they are known to be safe without any major cost or formulary issues. Hopefully, they will continue to be important and useful agents for a long time to come.