Antibiotics do not act alone but in conjunction with the host defence system. In particular, it has been shown that antibiotics can modify cytokine production. The authors reported here the effects of antibiotics which penetrate inside the cells, such as quinolones and macrolides, on the capacity of blood monocytes to produce IL-I alpha, IL-1 beta, TNF alpha and IL-6 in response to endotoxin. Antibiotics can exert a differential effect on cytokine production: in fact, quinolones, in vitro, at concentrations higher than 25 micrograms/ml decreased IL-1 beta, TNF alpha and IL-6, while they do not modify IL-1 alpha. Moreover, ciprofloxacin orally administered (25 mg/kg for 7 days) transitory increased cytokine production. These results are discussed in terms of tissue concentration. Among the same family of antibiotics such as macrolides, differences on cytokine modulation were observed: spiramycin and erythromycin increased IL-6 production while roxithromycin did not exert any significant effect. All these results tend to prove that some antibiotics are immunomodulators; however interactions between antibiotics and immune responses are complex and studies with patients with infections will be necessary to a better understanding of these relationships.