Recent reports have suggested that long-term administration of erythromycin (EM) appears to ameliorate some of chronic inflammatory processes where macrophages and lymphocytes play important roles. Our study was initiated to examine the effect of EM on monocyte-macrophage lineage in vitro. EM (1 approximately 100 micrograms/ml) significantly increased the number of adherent monocyte-derived macrophages after 7 days of culture. The combination of EM and macrophage colony stimulating factor (M-CSF) synergistically increased the number of monocyte-derived macrophages, while the combination of EM and granulocyte-macrophage colony stimulating factor exerted an additive effect. Culture with EM induced the expression of a surface antigen CD71, one of the activation markers of macrophages as compared with control cultures. The combination of EM plus M-CSF significantly enhanced H2O2-producing capacity of those cells as compared with M-CSF alone. A differentiation process of monocytoid THP-1 cells was also augmented by EM. These results indicate that EM promotes differentiation of human monocyte-macrophage lineage, altering their functions.