The invention discloses an azithromycin crystallization process with controllable crystal form and grain size. In azithromycin organic solution with the pH value of between 7.0 and 11.0 and the initial concentration of between 80 and 200g.L<-1>, inorganic sodium salt and a solventing-out agent are added, the crystallization temperature is controlled to between 10 and 90 DEG C, the stirring speed is controlled to between 10 and 1,000r.min<-1>, the crystallization is performed by the synergy of elution and salting out, suction filtration is performed after complete crystallization, washing is repeatedly performed by the solventing-out agent, and then vacuum drying is performed. In the process, the aims of stable preparation of crystal form and controllable grain size of the azithromycin are achieved by regulating and controlling preparation conditions. The azithromycin prepared by the crystallization process has the advantages of good stability of crystal form, high purity (more than 99 percent), uniform grain size, good luster, weak hydroscopic property and the like.