Aggregate evidence quality: D; expert opinion and reasoning from first principles.
BenefitPrevention of complications, administration of effective therapy.
HarmAdverse effects of secondary antibiotic therapy.
CostDirect cost of medications, often substantial for second-line agents.
Benefits-harm assessmentPreponderance of benefit.
Value judgmentsClinician must determine whether cost and adverse effects associated with change in antibiotic is justified given the severity of illness.
Role of patient preferencesLimited in patients whose symptoms are severe or worsening, but caregivers of mildly affected children who are failing to improve may reasonably defer change in antibiotic.
Intentional vaguenessNone.