Inhaled antibiotics have been used since the 1940s for the treatment of chronic respiratory system infections. Initially, they were used as aerosolized forms of antibiotics intended for parenteral administration. Such preparations had certain drawbacks, such as significant irritation of the respiratory tract, leading to the adaptation and development of formulations safe for inhalation. The main advantages of inhaled antibiotics compared to intravenous and oral administration are direct delivery of the active substance to the lungs, reduced systemic absorption, and fewer systemic side effects. The first antibiotic approved for this mode of administration was tobramycin, specifically for controlling chronic colonization of Pseudomonas aeruginosa in patients with cystic fibrosis. In addition to tobramycin, other inhalation antibiotics such as aztreonam, colistin, levofloxacin, and amikacin are successfully and safely used. Off-label use of parenteral gentamicin via inhalation is also practiced. The use of inhaled ceftazidime, fosfomycin, vancomycin, and teicoplanin has shown promising results, but these antibiotics are still in different stages of clinical trials. The most common indications for their use include cystic fibrosis, bronchiectasis, chronic obstructive pulmonary disease, infections caused by non-tuberculous mycobacteria and pneumonia associated with mechanical ventilation. Such antibiotic formulations require special devices for delivery to the lungs, such as nebulizers and dry powder inhalers, and the choice of device depends on the indicated antibiotic and the patients' needs.