It is now recommended as a second-line therapy.

Oral vancomycin (125 mg four times daily) is second-line therapy, but is often avoided due to concerns of converting intestinal flora into vancomycin-resistant organisms.

If the patient fails first line antibiotics, then second-line therapies should be employed, especially after appropriate culture and sensitivity testing.

For patients who have relapsed after platinum-based chemotherapy, second-line therapy can be considered.

Alemtuzumab is used as second-line therapy for CLL.

These drugs may therefore be effective as a second-line therapy for refractory prostate cancer previously treated with bicalutamide.

Fulvestrant provided effective second-line therapy in this setting for postmenopausal women who had relapsed or progressed after previous endocrine therapy.

"Although they are not clearly superior to newer agents, sulfonylureas remain a reasonable alternative as second-line therapy, especially if cost is an issue," they conclude.

The F.D.A. agreed, designating topotecan today as a second-line therapy.

If a patient is resistant to either cladribine or pentostatin, then second-line therapy is pursued.