Tilmicosin, a new macrolide antibiotic, 20-deoxo-20-(3,5-dimethylpiperidin-l-yl)desmycosin, formerly identified as EL-870, has been evaluated in three experiments as a single subcutaneous injection at dosages of 10, 20 or 30 mg/kg for the treatment of naturally occurring pneumonia in neonatal calves. Male Holstein calves, under five days of age, were shipped from Wisconsin and housed in pens. They were assigned sequentially to a treatment group when their temperature was greater than or equal to 39.7 degrees C for two consecutive days or greater than or equal to 39.7 degrees C and signs of respiratory disease were present. Clinical signs were evaluated daily for 14 days after the tilmicosin treatment. Calves that died and those that survived for the 14 day experimental period were examined post mortem. Treatment with tilmicosin was effective at all dosage levels, as determined by significant (P less than or equal to 0.05) reductions in body temperature within 24 hours, in the number of animals that died, in the incidence and severity of clinical signs, in the number of Pasteurella species found in lung tissue and in the severity of the pneumonic lesions. In two of the three experiments severe outbreaks of cryptosporidiosis resulted in significant mortalities within a few days after the arrival of the calves. Treatment with tilmicosin was effective against respiratory disease even in the presence of this severe concurrent disease.