The athletics competition at the 1978 Central American and Caribbean Games was held at the Estadio Atanasio Girardot in Medellín, Colombia.

It was the first time that women's 1500 metres and 4 × 400 metres relay events were held at the Games. It was also the last appearance of women's pentathlon before being replaced by the heptathlon from the next edition on.

Event	Gold		Silver		Bronze
100 metres	Silvio Leonard  Cuba	10.10 GR	Osvaldo Lara  Cuba	10.11	Guy Abrahams  Panama	10.20
200 metres	Silvio Leonard  Cuba	20.49 GR	Anthony Husbands  Trinidad and Tobago	21.00	Guy Abrahams  Panama	21.15
400 metres	Alberto Juantorena  Cuba	44.27 GR	Joseph Coombs  Trinidad and Tobago	45.41	Seymour Newman  Jamaica	46.11
800 metres	Alberto Juantorena  Cuba	1:47.23 GR	Gerold Pawirodikromo  Suriname	1:47.46	Leandro Civil  Cuba	1:47.66
1500 metres	Luis Medina  Cuba	3:44.47	Eduardo Castro  Mexico	3:45.14	Osmán Escobar  Venezuela	3:45.89
5000 metres	Rodolfo Gómez  Mexico	13:55.08	Domingo Tibaduiza  Colombia	13:56.88	José Gómez  Mexico	14:27.33
10,000 metres	Rodolfo Gómez  Mexico	29:34.64 GR	Domingo Tibaduiza  Colombia	29:38.66	Luis Hernández  Mexico	30:23.84
Marathon	Radamés Vega  Puerto Rico	2:22:34 GR	Mario Cuevas  Mexico	2:23:07	José Granajo  Guatemala	2:26:04
110 metres hurdles	Alejandro Casañas  Cuba	13.67 GR	Mariano Reyes  Dominican Republic	14.68	Karl Smith  Jamaica	14.71
400 metres hurdles	Clive Barriffe  Jamaica	50.16 GR	Julio Ferrer  Puerto Rico	50.86	Alexis Misignak  Cuba	50.97
3000 metres steeplechase	José Cobo  Cuba	8:46.39 GR	Carlos Martínez  Mexico	8:52.13	Jaime Villate  Colombia	8:56.29
4 × 100 metres relay	Trinidad and Tobago Eldwin Noel Hasely Crawford Anthony Husbands Ephraim Serrette	39.13 GR	Cuba Juan Saborit Alejandro Casañas Silvio Leonard Osvaldo Lara	39.44	Dominican Republic Juan Contreras Gregorio García Enrique Almarante Rafael Félix	39.62
4 × 400 metres relay	Jamaica Clive Barriffe Oliver Heywood Floyd Brown Bert Cameron	3:03.76 GR	Trinidad and Tobago Anthony Myers Michael Paul Mike Solomon Joseph Coombs	3:05.01	Cuba Alexis Misignak Ernesto Vinent Carlos Álvarez Alberto Juantorena	3:05.57
20 kilometre road walk	Daniel Bautista  Mexico	1:29:10 GR	Raúl González  Mexico	1:31:58	Jorge Quiñones  Colombia	1:39:31
High jump	Richard Spencer  Cuba	2.12 GR	Rodolfo Madrigal  Costa Rica	2.12 =GR	Jamil Justiniano  Puerto Rico	2.09
Pole vault	Augusto Perdomo  Cuba	5.00 GR	Elberto Pratt  Mexico	4.80	Rubén Camino  Cuba	4.80
Long jump	David Giralt  Cuba	7.82 GR	Milán Matos  Cuba	7.77	Ron Chambers  Jamaica	7.77
Triple jump	Steve Hanna  Bahamas	16.60 GR	Juan Velázquez  Cuba	16.43	Alejandro Herrera  Cuba	16.10
Shot put	Humberto Calvario  Cuba	17.51 GR	Nicolás Hernández  Cuba	17.36	Jesús Ramos  Venezuela	16.83
Discus throw	Luis Delís  Cuba	58.62 GR	Julián Morrinson  Cuba	58.56	Brad Cooper  Bahamas	54.24
Hammer throw	Armando Orozco  Cuba	69.86 GR	Genovevo Morejón  Cuba	69.14	Luis Martínez  Puerto Rico	56.22
Javelin throw	Antonio González  Cuba	78.74 GR	Amado Morales  Puerto Rico	70.54	Reinaldo Patterson  Cuba	63.64
Decathlon	Rigoberto Salazar  Cuba	7483 GR	Miguel Subarnaba  Cuba	6954	José Montezuma  Venezuela	6842

Event	Gold		Silver		Bronze
100 metres	Silvia Chivás  Cuba	11.47	Lelieth Hodges  Jamaica	11.63	Isabel Taylor  Cuba	11.74
200 metres	Silvia Chivás  Cuba	23.01 GR	Janice Bernard  Trinidad and Tobago	24.01	Maureen Gottshalk  Jamaica	24.42
400 metres	Aurelia Pentón  Cuba	50.56 GR	Beatriz Castillo  Cuba	51.27	Helen Blake  Jamaica	53.40
800 metres	Aurelia Pentón  Cuba	2:01.38 GR	Charlotte Bradley  Mexico	2:03.58	Nery McKeen  Cuba	2:04.48
1500 metres	Charlotte Bradley  Mexico	4:30.78 GR	Ileana Hocking  Puerto Rico	4:35.88	Susana Herrera  Mexico	4:39.62
100 metres hurdles	Grisel Machado  Cuba	13.31 GR	Marisela Peralta  Dominican Republic	14.23	Carmen Zamora  Cuba	14.29
4 × 100 metres relay	Cuba Grisel Machado Silvia Chivás Carmen Valdés Isabel Taylor	44.37 GR	Jamaica Leleith Hodges Dorothy Scott Maureen Gottschalk Jacqueline Pusey	44.41	Trinidad and Tobago Rebeca Roberts Joane Gardner Janice Bernard Esther Hope	45.13
4 × 400 metres relay	Cuba Ana Guibert Ana Fidelia Quirot Beatriz Castillo Aurelia Pentón	3:31.34 GR	Jamaica Ruth Williams-Simpson Norma Lee Maureen Gottschalk Helen Blake	3:41.69	Puerto Rico Angelita Lind Ileana Hocking Madeline de Jesús Vilma Paris	3:46.58
High jump	Angela Carbonell  Cuba	1.75 GR	Grace Jackson  Jamaica	1.70	Elisa Ávila  Mexico	1.65
Long jump	Shonel Ferguson  Bahamas	6.41	Ana Alexander  Cuba	6.25	Eloína Echevarría  Cuba	6.12
Shot put	Hilda Ramírez  Cuba	17.00 GR	Marcelina Rodríguez  Cuba	14.97	Vicky López  Puerto Rico	13.42
Discus throw	Carmen Romero  Cuba	60.54 GR	María Cristina Betancourt  Cuba	57.58	Selene Saldarriaga  Colombia	41.28
Javelin throw	María Caridad Colón  Cuba	63.40 GR	María Beltrán  Cuba	54.86	Guadalupe López  Mexico	49.80
Pentathlon	Elida Aveillé  Cuba	3636	Alix Castillo  Venezuela	3625	Laura Vázquez  Mexico	3511

Rank	Nation	Gold	Silver	Bronze	Total
1	Cuba (CUB)	27	13	9	49
2	Mexico (MEX)	4	6	6	16
3	Jamaica (JAM)	2	4	5	11
4	Bahamas (BAH)	2	0	1	3
5	Trinidad and Tobago (TTO)	1	4	1	6
6	Puerto Rico (PUR)	1	3	4	8
7	Colombia (COL)	0	2	4	6
8	Dominican Republic (DOM)	0	2	1	3
9	Venezuela (VEN)	0	1	3	4
10	Costa Rica (CRC)	0	1	0	1
	Suriname (SUR)	0	1	0	1
12	Panama (PAN)	0	0	2	2
13	Guatemala (GUA)	0	0	1	1
Totals (13 entries)		37	37	37	111

• Montesinos, Enrique (2013). "The Oldest Regional Games: Central American & Caribbean Sports Games" (PDF). CACSO. Retrieved 2015-09-27.
• "Central American and Caribbean Games (Men)". GBR Athletics.
• "Central American and Caribbean Games (Women)". GBR Athletics.