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A Sacred Cow

Arch Intern Med. 2004;164:1725-1727.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

For the diagnosis and management of community-acquired pneumonia, the routine gram staining and culture of expectorated sputum is a hallowed, time-honored tradition of dubious value. The overall recent trend has been, finally, to relegate this sacred cow of a test to the quaint pastures of history, but some steadfastly cling, with purple-stained fingers, to the hope that expectorated sputum analysis, as it is currently applied, can somehow reliably improve clinical decisions when managing patients with community-acquired pneumonia. The usefulness of this test in the management of community-acquired pneumonia has never been convincingly demonstrated in a clinical setting, and today the article García-Vázquez and colleagues¹ again underscore that point.

Recent trends that favor a diminished role for sputum gram staining and culture in management algorithms and all the attendant controversies are well reflected in 2 major practice guidelines.^2-3 The American Thoracic Society (ATS) guidelines, with which we agree, do not recommend . . . [Full Text of this Article]

J. Mark Madison, MD; Richard S. Irwin, MD

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