We were surprised and disturbed to read a summary of Bartlett and Mundy's excellent review of community-acquired pneumonia [1] under the subtitle "Review Supported Treatment Guidelines" in the Update in Pulmonary Medicine by Niederman and Peters [2]. Although Niederman and Peters acknowledge that Bartlett and Mundy advocate sputum Gram stain and culture in hospitalized patients with community-acquired pneumonia in an attempt to guide initial antimicrobial therapy and confirm microbial cause, they state that "Bartlett and Mundy's review of the pathogens that cause pneumonia led to the conclusion that the American Thoracic Society [ATS] guidelines for treatment of hospitalized patients with community-acquired pneumonia are appropriate." Conclusion by whom? Certainly not Bartlett and Mundy, who recommend therapy based on the results of microbiological stains of sputum and blood cultures [1]. For patients who must be treated empirically because of inability to obtain sputum or a nondiagnostic Gram stain, Bartlett and Mundy's recommendations are similar to those proposed by the ATS [3]. However, the ATS guidelines advocate empirical therapy for all patients, a position clearly not supported by Bartlett and Mundy's review.

In an era of increasing microbial resistance and the need to contain health care costs, many experts continue to believe that a recommendation to treat all patients hospitalized with community-acquired pneumonia with broad-spectrum, empirical antibiotic therapy is ill-advised. We think that the manner in which Bartlett and Mundy's review was presented in the Update was misleading. The Annals readership expects and deserves better.