We report on two homeless, HIV-infected patients with intravenous drug abuse developing a generalized rash composed of angiomatous papules. Based on the clinical manifestations, routine histology and sequencing of bacterial 16S rRNA the diagnosis of bacillary angiomatosis (BA) was established. In addition to treating the underlying HIV infection, the patients received azithromycin leading to complete regression of the cutaneous lesions. These cases highlight the clinical efficacy of azithromycin in the treatment of bacillary angiomatosis. Compared to the first line treatment of BA with erythromycin, azithromycin has a better tolerability, shows a more favorable drug-drug interaction profile and, most importantly, can be given once daily due to its superior pharmacological properties. Collectively, azithromycin poses an attractive alternative in the treatment of BA, especially in patient populations with low treatment adherence.