ry-f-4 17 .1 Dt L

In submifting these names of board-certified pediatricians to you, it is understood that academicand pediatric credentials are not in question. Comments are requested concerning possible legaland/or ethical situations of which you might have personal knowledge.Send any comments on the following list of new applicants to your District Chairperson by Dec. 15.

Dear Academy Fellow:In order to fulfill the admission requirements of AAP Bylaws, you are requested to:Carefully review the following list of new applicants for Academy membership; and relay yourreactions directly to your District Chairperson, whose name and address is at the end of this list.

Sean Bullen, M.D.#5 Edgehill Hts Phase 11St Thomas,Barbados

Di &* 9 IN0 10113 9 :I

: Pennsylvania0 Anna Kim, M.D.0

: 6603 Woodwell St.: Pittsburgh, PA 152170

Missour'l'

Gerry Gerry,10957 LydiaKansas City,

Alan SchwarOne ChildrelSaint Louis, I

Nebraska

Larry Brown4628 S. 25t[Omaha, NE

Louisiana

Marcia Engli5017 S. SaraNew Orlean

Texas

Laurie Alber120 W EdgiSan Antonic

Tessa Ander7 Waterwo(Mansfield, 1

Israel Mata,105 E. PolkPharr, TX 7E

WashingtonNew York 3

Karen Cole, M.D.50 E. Hartsdale Ave., #213Hartsdale, NY 10530

Naomi Dreisinger, M.D.3671 Hudson Manor Terr.Apt. 5CBronx, NY 10463

Deborah Levine, M.D.333 E. 34th St., Apt. 5-DNew York, NY 1001 6

Thelma Reyes, M.D.350 Albany St.Hudson Tower, Ground FlNew York, NY 10280

Liliya Slutsker, M.D.3419 Irwin Ave., Apt. 190Bronx, NY 10463

I OXA9

D'istrict of Columbia

Amy Castillo, M.D.8811 Colesville Rd.Apt. 504

. Indiana

* Ohio

06

0

0

t

6

6

0

Angela Beauchaine, M.D.4964 Bluff Dr. NEMoses Lake, WA 98837

David Brooks, M.D.1225 Yellowhawk PI.Walla Walla, WA 99362

Ellen Brooks, M.D.1225 Yellowhawk PI.Walla Walla, WA 99362

F-IN 2 W-AI lk't

,M.D.Ave.MO 64131

rtz, M.D., Ph.D.ms PI.M063110

i, M.D.Ih st.68107

:Mlok

Kimberley Brumleve, M.D.160 N. Galt Ave.Louisville, KY 40206

Kevin Jones, M.D.1 1 01 W Jefferson, Ste. TFranklin, IN 46131

MichipnBasma Abu-Ashour, M.D.885 Kings Park Rd.Monroe, Ml 48161

Daria Alexandrova, M.D.701 W WashingtonApt. #1 8Greeneville, Ml 48838

David Kleimai661 Farnum fMedia, PA 19

Tobey Kresel,1826 Shaw APittsburgh, P)

Eyda Samuel!220 E. Merm,Townhouse 4Philadelphia,

South Carol

Benjamin Ro(307 TeakwocWalterboro,

Esther Washi165 Ashley PP.O. Box 25CCharleston, E

Tennessee

Ara HanissiaiUT Medical400 MarketCollierville, T

Jai Kumar, N1240 E. Whi-Cookeville, I

Melissa Pete215 ScotlancNashville, Tt

Virginia

Robert Broul181 S. MainDanville, VA

Thom-cis COL105 RichesoLynchburg,

Duniya Lanc10608 LeavoFredericksbL

Michael VanPediatric Ca601 ChildreiSecond Fl

0

:Norfolk, VA

0

0

in, M.D.Rd.)063

M.D.We.A 15217

Is, M.D.iaid Ln..l 60,PA 19118

Maine

Michele Labotz, M.D.67 Cottage St.Bar Harbor, ME 04609

Massachusetts

Ricardo Munoz, M.D.611 Washington St.Unit 202Wellesley, MA 02481

Quebec

Marc-Andre Dugas, M.D.Dept. of Pediatrics2705 Boul LaurierSte-Foy, PQ GlV 4G2Canada

Uniformed Services-East

Cydney Fenton, M.D.13209 Schubert Pi.Silver Spring, MD 20904

Patricia Rinne, M.D.PSC 41 Box 1764APO, AE 09464

Susan Roberts, M.D.2214 Tunlaw Rd., NWWashington, DC 20007

OLWALxKt...

: Califomia I

4' Patricia Chank: 2500 Hospital16- .. I "I

g, M.D.tl Dr., #1 2

--A 40)9 lish, M.D.atogais, LA 70115

Mountain View, CA 9404

Jaime Garcia, M.D.123 Lauian Ct.Brentwood, CA 94513

Susan Mallory, M.D.1332 Nunneley Rd.Paradise, CA 95969

Sheralyn Wood, M.D.1484 Mariposa WayFairfield, CA 94533

Califom'la 2

Alice Diego-Malit, M.D.30 Mustang Rd.Rancho Palos Verdes, CA90275

Califomia 3

David Steele, M.D.2172 Fairfield St.San Diego, CA 921 1 0

Califomia 4

Robin Shaughnessy, MI300 Walnut St.Newport Beach, CA 926

-1 &II N L41

Florida

Jenn-Yu Lin, M.D.5637 Firestone Dr.Pace, FL 32571

Marlene Murphy, M.D.1711 Maple Leaf Dr.Windermere, FL 34786

Ma. Concepcion Prudencio,3856 Michael's Landing CJacksonville, FL 32224

Aina

idgers, M.D.od Dr.SC 29488

iington, M.D..kve.)917SC 29425

Ln, M.D.GroupBlvd., Ste. 102FN 38017

A.D.ite Oak Dr.TN 38501

n, M.D.d PI.N 37205

)thoracic Sgy.Ave.fl 45229

114

Rajiv Gupta, M. D.751 Forest Ave., Ste. 1 01Zanesville, OH 43701

Ha'ltham Haddad, M.D.27155 Chardon Rd.Ste. 305Richmond Hts, OH 44143

Congenital Heart SurgerySpecialty FellowJeffrey Pearl, M.D.

rtini, M.D.rewood PI.c), TX 78209

rson, M.D.od ct.TX 76063

I M.D.

8577

: Silver Spring:Myra Grisso

. 1314 Riggs': Washington6

: Maryland

D,, MD 20910

0t

,b6

0

\Ailler, M.D.Wood Tr.und, TX 75022

Aorgan, M.D.rvhead Ln.ity, TX 77459

z, M.D.iesboro Dr'X 77035

lkilli 4.11

)m, M.D.St., NWi, DC 20009

D.

563

ADiv. of Cardio3333 Burnet)Cincinnati, 01

Illinois

Congenital HiSpecialty Fe/bHani HenneinDept. of ThorCardiovascule2160 S. 1 st AMaywood, IL

Kazi Majeed,2201 S. KokeApt. CSpringfield, IL

Steven Rock,271 0 WestbriBloomington,

Minnesota

Teresa Reid, I1207 Edlin PiMinneapolis,

Margarita A2901 Blue VFlower MOL

Avolonne N1 81 0 Arrov%Missouri Cii

Flor Munoz441 0 WaynHouston, Tj'

Colomdo

Stephanie F8015 W. Al#270Lakewood,

Oregon

Terry Brook4998 W. 4.Eugene, 01

UnIforme4

Kenneth Sl.7703 FloydSan Antoni

Nitin Chopde, M.D.13948 Baltimore Blvd.Laurel, MD 20707

Kimberly Cuomo, M.D.12 Theo Ln.Towson, MD 21204

Jonathan Ellen, M.D.

15

leart Surgerylowi, M.D.racic &ar Sgy.kve.60153

,M.D.. Mill Rd.

L 62707

M.D.rooki, IL 61704

New York I

Pedro Jakos, M.D.7120 Carstairs Cir.E Syracuse, NY 13057

Jennifer Jehrio, M.D.3725 N. Buffalo Rd.Orchard Park, NY 14127

New York 2

Greg Gulbransen, D.O.76 Aspen Dr. WWoodbury, NY 11797

Alissa Keschner, M.D.404 Court North Dr.Melville, NY 11747

Scoft Miller, M.D.50-01 245th St.Douglaston, NY 1 1 362

6915 Ridgewo'od Ave.Chevy Chase, MD 2081

Michelle Hearns, M.D.3019 Romaric Ct., Apt.Baltimore, MD 21209

Jack Ragheb, M.D.5808 Inman Park Cir., ARockville, MD 20852

New Jersey

Jamille Cooper, M.D.4307 Hunters Glen Dr.Plainsboro, NJ 08536

Chong-Hyo Park, M.D.1295 16th St.Fort Lee, NJ 07024

ighton, M.D.St.k24540

urtney, M.D.)n Dr.VA 24501

caster, M.D.rells Rd.urg, VA 22407

nce, M.D.irdiology!n's Ln.

. 23507

G

#110Harris, M.D.Jameda Ave.

CO 80226

ks, M.D..4th Ave.IR 97405

,,d Services-West

haffer, M.D.d Curl Dr.iio, TX 78284

M.D.11.MN 55416 M.D.

Cir. E.

46 AAP News November 1999

000*0*000000000000000000000000000000000000000000000000

Opportunity available in Western Massachusetts for a full-timeBC/BE pediatrician to join 14 pediatricians, 2 Med/Peds and3 PNPs in a 60+ physician multi-site, multi-specialty grouppractice. Interest in adolescent health care a plus. Affiliationwith tertiary teaching hospital. Call-rotation approximately3-4 times/mos. and portion of every third weekend.

Competitive compensation and comprehensive fringe benefitsprogram. Attractive Pioneer Valley location offers abundantcultural and recreational opportunities and quality schoolsystems. Ideal family location. Send c.v. to: Joanne Alderman,RN., MPH, Human Resources Manager of Provider Support,Medical West Associates, 444 Montgomery Street, Chicopee,MEDICAL MA 01020: Fax:

%VEST (413) 598-7115; or call(800) 457-6145. EOE

ASSOCIATESMulti-specialty Medical CAroup Practice

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Discount amount varies in some states. Discount not available in all states or in all GEICO companies. One group discount applicable per policy.Govemment Employees insurance Co. - GEICO General Insurance Co. - GEICO Indemnity Co. - GEICO Casualty Co. These shareholder-owned companies are not affiliated

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,-W-, L-.-i1,-;j 1-T\F-> -D( ) ( /T\1.

9

: DISTRICT I

: Eileen M. Ouell: Pediatric Neur: North Shore O: 57 Highland A: Salem, MA 01: e-mail: eouell(

0 DISTRICT 11

: Louis Z. Coop

DISTRICT III

Susan S. Aronson, M.D.605 Moreno Rd.Narbeth, PA 19072e-mail: saronson.aap.org

DISTRICT IV

E. Stephen Edwards, M.D.2800 Blue Ridge Blvd.Suite 501Raleigh, NC 27607e-mail: sewards.aap.org

DISTRICT V

Stanford A. Singer, M.D.36700 Woodward Ave.

0Suite 300Bloomfield Hills, MI 48304e-mail: ssinger.aap-org

DISTRICT VI

Ordean L. Torstenson, M.D.Dean Medical Center, SC1313 Fish Hatchery Rd.Madison, WI 53715e-mail: otorstenson.aap.org

DISTRICT Vil

L. Leighton Hill, MDOffice of AdmissionsBaylor College of MedicineOne Baylor Plaza, Rm. N104Houston, TX 77030e-mail: Ihill.aap.org

: DISTRICT X4-

: John Curran, M.D.: Office of the Dean0:MDC Box 49: 12901 Bruce B. Downs Blvd0" Tampa, FL 33612: e-niail: jairran.coml.nied-Lisf-edu0

Brian Sutcliffe, M.D.2900 NE 30th St., Apt. MlFort Lauderdale, FL 33306

Georgia

Kathryn Mc Leod, M.D -1 446 Harper St., HF 1 1 31Augusta, GA 30912

Gregory Melnikoff, M.D.1 1 23 Topaz WayMarietta, GA 30068

Elaine Youngblood, M.D.103 Ashwood Ct. NStockbridge, GA 30281

DISTRICT Vill

Jon R. Almquist, M.D.Virginia Mason Medical CenterDepartment of Pediatrics33501 First Way SouthFederal Way, WA 98003e-mail: jalmquist.aap-org

DISTRICT IX

Lucy S. Crain, M.D., M-PH.UCSF Box 0374400 Parnassus Ave.San Francisco, CA 94143e-mail: Icrain.aap.org

flefte, M.D., J.D.rologyhildren's HospitalAve.1970lette.aap.org

AmericanAcademy ofPediatrics

. - - t- ,

: Department of Pediatrics: Columbia University: Room BHS 114: 630 W. 168th St.:New York, NY 10032

: e-mail: lcooper.aap.org

)er, M.D.

Remember the first group

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The Nemours Cardioc Center at tie Alked 1. duPont Hospild for ChiWren in Wilmihgton, D96yare is recruifin ogy.9 6r 8 pediakk cardid posifions.These popfions indude 5 nonsinvasive pediakk cardiologisk for communi.based outoent pediatric cordio4y procike, and pedicdrk andneonatal consulkdW wvices. b addifion, we are recruifing 2 hospil4baied ioik cordi6logists wiC strong echocardiraOic skills; oddifional61al cardido es,.gy expertise is desirob6. We are also recruifing o third hospiloP sed pediakk coidiologist*& is capable parficipofing ininloyenhonal cothiferization procedures and 6icfioning independenh in diognosk cAelerizations.SuccessM condidates will be digiUe for a clinkal ocademk fige at& Thomas Jefferson Uniyersi.. at a level cornmensurate with experience.Candidolm ore expecW to havi excellent dinkd and inw"wxi sVills, as well as a defire to be pcNi of a le providing Ce highestquali. culting-edge surgical and medical core lo chiWren with head disease. A current license to procfice m icine in Woware, Pennsylvaniaand/6r New Jersey is highly desirable. Candidates must be BC/BE in pediakic cardiology.We Ar a compefiNe salary ond a comprehensive benefit pockoge is available. InteresW condidaim should 6ward Ceir currkulum vilae to:Wiliam L Nirwood, MD, PhD, Dimdw, Nomows twdiix Contw. Wep6w (302) 6514M, Fox (302) 651-5345 orE-Md rm: nwaAmmwLorg.

-for mom informcdion about theAllied 1. duPont Hospital for

Children and our emolo ent.op"ities, visit our Wib site:WWWAidsHealth.org

Ordering Reprintsreprints. ot specific articles, please contact: Donna Hoffman at AAP NEWS, 141 Northwest Point Blvd., PO Box 927, Elk Gr(

Phone: 847/981-7904,e Fax: 847/228-5088 E-mail: dhoffman.aap-org

November 1999 AAP News 47

etas muc out o our mem ersas ou om our uer Tst assoc at'loon.

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Di etappO relieves common cold symptomssuch as postnasal drip syndrome (PNDS)In fact, the ingredients in Dimetapp are recommended by The American College of ChestPhysicians as the most consistently effective sole treatment for PNDS-induced cough in adults'

Simpie symptom relief vs Tria inicO*:Half the dose, half the hassle* Provides relief at half the dose of Triaminic Syrup* Dimetapp costs over 40%/ less per dose2

#1I pediatrician-recommendedbrand for colds* Great grape taste* Alcohol-free* Can be given to children age 6 months and Up3* Trusted for over 30 years

ys^ 4 FL UV i.!NA") I

*Triaminic is a registered trademark of Novartis Consumer Health, Inc.References: 1. Irwin RS, Boulet L-P, Cloutier MM, et al. Managing cough as a defense mechanism and as a symptom: a consensus panel report of the AmericanCollege of Chest Physicians. Chest. 1998;114(2)(suppl):133S-145S. 2. Drug TopicsO Red BookO. Montvale, NJ: Medical Economics Company, Inc.,1997:854.3. Dimetapp Information Chart, Whitehall-Robins Healthcare.01999 Whitehall-Robins Healthcare, A Division of American Home Products Corporation WHR-2016 9/99

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VVell."F MEDICAL GROUPThe Sisters of the Third Order of St. Francis (OSF)have been providing medical care for residents ofIllinois, Iowa and AAichigan for more than 120 years.Their corporation, now known as OSF HealthCare,includes seven hospitals, two extended care facilities,an insurance company with its own managed careproducts, more than one dozen affiliated companiesproviding medical products and services, and OSFMedical Group, a multi-specialty physician group withmore than 220 providers in its multi-state service area.We now have general pediatrics opportunities in:

Peoria, Illinois * Escanaba, MichiganFor more information, please contact:

Wendy Bass at (800) 462-3621Fax (309) 685-2574

Email: wendy.bassEosfhealthcare.org

PE D IATR IC I NTEG RATIVEM~AEDICI-.FE RENCE

"Incorporating Evid ;> sed;Complementary/Alternative Medicine into Clinical Practice"

February 18, 19, 20, 2000 in Tucson, Arizona

C-ON FERENCE H1IGHL16HTS:Meet some of the country's leading authorities on pediatric integrativemedicine. Experience popular alternative therapies such as acupuncture,acupressure, touch therapy and guided imagery. Create strategies tointegrate altemative therapies into your own practice. Enjoy Tucson weatherin February. Relax in a four-star Westin hotel. All meals included in confer-ence registration.

SPONSORED BYTH E UN IVERS ITY OF ARIZONA

College of Medicine at the Arizona Health Sciences Center. In partnershipwith the University of Minnesota, Children's Hospital of Boston, APASpecial Interest Group on Holistic Medicine

CM/E ACCREDITEDFor more program information email pedsimc@peds.arizona.edu

visit the website www.crc.arizona.edu, call (520) 626-6858.

rAfter ten years of agonizing, diapers,and two ineffective drugs, our sonfinally has the confidence for a sleep-over, thanks to the Potty Pager.

Daniel E. Turnbull

It's wireless. It's private. It inspires letters like this.And now it's CLINICALLY PROVEN EFFECTIVE.

In a two year clinical study at the University ofAlabama medical school, thePotty Pager has been proven 71% effective on hard-to-reach TEEN bedwet-ters. (Lo, Perez, Hanchrow and Joseph)

So whyjust "control" bedwetting with drugs when youcan CURE it! With the WIRELESS alarm that wakesthe BEDWETTER... not the whole house!

The Potty Pager teaches bedwetters to respond normally to bladder fullness.It uses a tactile alarm, much like a silent business pager. It is 100% safe, andcosts just $51.00 + S&H. It comes with a 30 day no-questions guarantee.

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Or visit our web site: www.pottypager.com

because life's challengingIenough without a bed-

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IDEAS FOR LIVING, INC. BOULDER, COLORADO 80304

November 1999 AAP News 49

I.;g E.S ,-;...-..,.

:Li0:: t:>E''tM'g': <<:.

:::: :..

i:7.

-

.

E. Mead JohnsonAwardfor Research in Pediatrics

Call for NominationsNom'inations are invited for the E. Mead Johnson Awardfor Research in Pediatrics for the year 2000. Each oftworecipients will receive an honorarium of $10,000 plus travelexpenses to attend the 2000 annual meeting of thePediatric Academic Societies (APSISPRIAPA) in Boston1where recipients wril present their research.

'Etliibility for the year a000 awards* Nominees must have recived thieir first doctoral degree

in 1980 or later. Excepdom to the sfipulaton may bemade by the committee' for individuals who haveintempted thelr research caneer kr 2 or more years butwho are otherwise eligble.Iimited to investipators in the Americas.

*Research must be related to peditrics and publishedrecently, perhaps coming to fruition or attaingrecognition dufing the past few years.

m Candidates are non tead by their Department Chair,past E. Mead Johnson Awrard recipientb, any scentificcolleague or members of the pediatik academic soceties.

The deadline for receipt of nominadons is December 6,1999. For futrther informationlniomination forms contact:

The Socitty for Pediatric Research3400 ROOM&rc Forest Dr., Ste. B7

The Woodland;, TX 77381(281) 41940012 Fas (281) 419-0082

E-MAil: infoOkpmprorl URL www.Aps-spr.org

CLASSIFIED ADVERTISING POLICYWhenyou need to contact pediatricians, contactAAlPNews. Each month more than 55,000 pediatricians,pediatricspecialists, third-yearpediatricresidentsand othersubscribersturn toAAPNewsforchild healthinformation they cannotget elsewhere. With a classified ad, you can speak directly to those readers.

50 AAPNews November1999

(.. .-. .- -i 1.-..,..ULr--:- -,-IA 0

Growing, four-physician, system-owned practice seeks BC/BE Pediatrician.Office just two blocks from 226-bed Chambersburg Hospital, including afull-time Pediatric Nurse Practitioner.

EY Chambersburg is located in southcentral PA -whereNEWYORKNIA you wilIl find the splendor of the mountains, lakes,

tNNV^ )\ ~~farms, and countryside; coupled with theatre'r N \ ~~~~~music, skiing, fishing, hiking, and much more.

~~~~~gPhillXMv)phia For more infornation, call or send yourC Vto:

MARYLAND BaSmore v Marie Royce, DirectorofPhysicianRelationsWashington, DC 23 \/Summit Healthi\ <tz 2 ~ ~P.O. Box 308 * Chambersburg, PA 17201

Pic 1-800-758-8835VIR(;INIA9, FAX: 717-267-7769 www.summithealth.org

-NORTHEAST

WESTCHESTERCOUNTY, NEWYORK: Busywell-establishedpractice seeks BC/BE pediatrician with potential partnership.Mail CV to AAP1, P.O. Box 149, Bel Air, MD 21014.

SOUTHEAST

Rapidly growing solo pediatric office seeks BC/BE pediatrician.Call coverage with several pediatricians. Ten minutes from276-bed hospital averaging 92 deliveries per month. Ourgrowing community of 58,000 is convenient to a large met-ropolitan area, major universities and a nationally knownresort. Local wooded areas and a large lake available for var-ious recreational activities. Send CV to Medical BusinessConcepts, P.O. Box 1607, Dalton, GA 30722-1607.

MIDWEST

CHAIRPERSON, DEPARTMENT OF PEDIATRICS, COOKCOUNT"Y HOSPITAL seeks a dynamic pediatrician and expe-rienced medical administrator and academic physician to lead

0

Find out wvhat roll lk doing best adget someon to OaIo for doing it

Kathe ie WhiehornWe know what you do best and we arewilling to pay you,If you are a pediatrician on matemity leave, retired, or looking xfor a way to work from horne, considera rewarding opportunitywith drpaula.com the premiere website for pediatric andparenting advice. Our success has been overwhelming.However, it's becoming rnore difficult to handle the increasing jvolume of questions coming in. If you enjoy giving advice, joinour team and help make a difference in the lives of parents and their kids.-wDr. Paula

Ifyou are interestedgo to: dI,BXVwww.drpau1a.com/pedsearch rpala.

Although the Academy believes these classified ads are fromreputable sources, theAcademy does not investigate the offersmade and assumes no responsibility concerning them.

Occassionally, it is necessary to modify the wording ofclassifiedads. These changes are generally made in compliance with theregulations ofvarious federal and/or state commissions againstdiscrimination or because they might be interpreted as beingunlawful or in conflict with accepted professional standards ofmedical practice.These advertising modifications are made to maintain a clas-sified section that is professionally responsible, lawful, scientificand free of discrimination.

Publication of an advertisement in AAP News neither consti-tutes nor implies a guarantee or endorsement byAAP News or

the Arnerican Academy of Pediatrics of the product or serviceadvertised or of the claims made for the product or service bythe advertiser.

Classification: Classified ads are accepted under BusinessServices, General Announcements, Medical Meetings, Physi-cians Wanted, Positions Wanted, Practices Available, Publica-tions, Real Estate and Residencies/Fellowships Available.

Display Classified Ads: Camera-ready, 4-color, 3-color and2-color display classified ads are accepted under GeneralAnnouncements, Medical Meetings, Physicians Wanted,Positions Wanted, Practices Available and Residencies/Fellowships Available. Contact Roland Keve, TheWalchliTauberGroup for display classified ad sizes and rates.

For more information, contact: Roland Keve, The WalchliTauber Group, (410) 420-0311, or fax (410) 420-0711. Ad copyis to be sent to: TheWalchliTauberGroup, 1 12W. PennsylvaniaAve., Ste. 201, BelAir,MD 21014. Payments are to be mailed andmade payable toTheAmericanAcademy ofPediatrics, Dept. 77-5194, Chicago, IL 60678-5194.

AAP NEWSPublished MonthlyAmerican Academy of PediatricsP.O. Box 927Elk GroveVillage, IL 60009-0927

- I

ri

i }_ t-t _* _. __ _* -_c! L X k \L>d c: 0 i H * }ii H , i 1[ 2 Xt_ > P- :: i . J r _rD-_ _ .- _ _ 'Yt _ _ ............. -

References: 1. Greenberg RN. Overview of patient compliance with medication dosing: a literature review. Clin Ther.1984;6:592-599. 2. RedBook'r Update, Montvale, NJ: Medical Economics Co Inc, July 1998:22,24,26,27,71.

ZITHROMAXI{azithromycin for oral suspension)

BRIEF SUMMARY

INDICATIONS AND USAGEZITHROMAX' (azithromycin) is indicated for the treatment of patients with mild to moderate infections (pneumonia:see WARNINGS) caused by susceptible strains of the designated microorganisms in the specific conditions listedbelow. As recommended dosages. durations of therapy, and applicable patient populations vary among theseinfections, please see DOSAGE AND ADMINISTRATION for specific dosing recommendations,

Acute otitis media caused by Haemophilus influenzae, Moraxella catarrhalis, or Streptococcus pneumoniae.(For specific dosage recommendation, see DOSAGE AND ADMINISTRATION.)

Community-acquired pneumonia due to Chlamydia pneumoniae, Haemophilus influenzae, Mycoplasmapneumoniae, or Streptococcus pneumoniae in patients appropriate for oral therapy. (For specific dosagerecommendation, see DOSAGE AND ADMINISTRATION.)

NOTE: Azithromycin should not be used in pediatric patients with pneumonia who are judged to beinappropriate for oral therapy because of moderate to severe illness or risk factors such asany of the following: patients with cystic fibrosis, patients with nosocomially acquiredinfections, patients with known or suspected bacteremia, patients requiring hospitalization,or patients with significant underlying health problems that may compromise their ability torespond to their illness (including immunodeficiency or tunctional asplenia).

Pharyngitis/tonsillitis caused by Streptococcus pyogenes as an alternative to first-line therapy in individualswho cannot use first-line therapy. (For specific dosage recommendations, see DOSAGE AND ADMINISTRATION.)

NOTE: Penicillin by the intramuscular route is the usual drug of choice in the treatment of Streptococcuspyogenes infection and the prophylaxis of rheumatic fever. ZITHROMAX' is often effective in the eradication ofsusceptible strains of Streptococcus pyogenes from the nasopharynx. Because some strains are resistant toZITHROMAX', susceptibility tests should be performed when patients are treated with ZITHROMAX'. Dataestablishing efficacy of azithromycin in subsequent prevention of rheumatic fever are not available.

Appropriate culture and susceptibility tests should be performed before treatment to determine the causativeorganism and its susceptibility to azithromycin. Therapy with ZITHROMAXI may be initiated before results of thesetests are known; once the results become available, antimicrobial therapy should be adjusted accordingly.

CONTRAINDICATIONSZITHROMAX' is contraindicated in patients with known hypersensitivity to azithromycin, erythromycin, or anymacrolide antibiotic.

WARNINGSSerious allergic reactions, including angioedema, anaphylaxis, and dermatologic reactions including StevensJohnson Syndrome and toxic epidermal necrolysis have been reported rarely in patients on azithromycin therapy.Although rare, fatalities have been reported. (See CONTRAINDICATIONS.} Despite initially successfulsymptomatic treatment of the allergic symptoms, when symptomatic therapy was discontinued, the allergicsymptoms recurred soon thereafter in some patients without further azithromycin exposure. These patientsrequired prolonged periods of observation and symptomatic treatment. The relationship of these episodes to thelong tissue half-life of azithromycin and subsequent prolonged exposure to antigen is unknown at present.

If an allergic reaction occurs, the drug should be discontinued and appropriate therapy should be instituted.Physicians should be aware that reappearance of the allergic symptoms may occur when symptomatic therapyis discontinued.

In the treatment of pneumonia, azithromycin has only been shown to be safe and effective in thetreatment of community-acquired pneumonia due to Chlamydia pneumoniae, Haemophilus influenzae,Mycoplasma pneumoniae, or Streptococcus pneumoniae in patients appropriate for oral therapy.Azithromycin should not be used in patients with pneumonia who are judged to be inappropriate for oraltherapy because of moderate to severe illness or risk factors such as any of the following: patients withcystic fibrosis, patients with nosocomially acquired infections, patients with known or suspectedbacteremia, patients requiring hospitalization, elderly or debilitated patients, or patients with significantunderlying health problems that may compromise their ability to respond to their illness (includingimmunodeficiency or functional asplenia).

Pseudomembranous colitis has been reported with nearly all antibacterial agents and may range inseverity from mild to life-threatening. Therefore, it is important to consider this diagnosis in patientswho present with diarrhea subsequent to the administration of antibacterial agents.

Treatment with antibacterial agents alters the normal flora of the colon and may permit overgrowth of clostridia.Studies indicate that a toxin produced by Clostridium difficile is a primary.cause of "antibiotic-associated colitis."

After the diagnosis of pseudomembranous colitis has been established, therapeutic measures should be initiated.Mild cases of pseudomembranous colitis usually respond to discontinuation of the drug alone. In moderate to severecases, consideration should be given to management with fluids and electrolytes, protein supplementation, andtreatment with an antibacterial drug clinically effective against Clostridium difficile colitis.

PRECAUTIONSGeneral: Because azithromycin is principally eliminated via the liver, caution should be exercised when azithromycinis administered to patients with impaired hepatic function.

There are no data regarding azithromycin usage in patients with renal impairment-, thus, caution should beexercised when prescribing azithromycin in these patients.

The following adverse events have not been reported in clinical trials with azithromycin, an azalide; however,they have been reported with macrolide products: ventricular arrhythmias, including ventricular tachycardia andtorsades de pointes, in individuals with prolonged OT intervals.

There has been a spontaneous report from the post-marketing experience of a patient with previous history ofarrhythmias who experienced torsades de pointes and subsequent myocardial infarction following a course ofazithromycin therapy.Information for Patients: Patients should be cautioned to take ZITHROMAX' suspension at least one hour prior toa meal or at least two hours after a meal. This medication should not be taken with food.

Patients should also be cautioned not to take aluminum- and magnesium-containing antacids and azithromycinsimultaneously,

The patient should be directed to discontinue azithromycin immediately and contact a physician if any signs of anallergic reaction occur.Drug Interactions: Aluminum- and magnesium-containing antacids reduce the peak serum levels (rate) but not theAUC (extent) of azithromycin absorption.

Administration of cimetidine (800 mg) two hours prior to azithromycin had no effect on azithromycin absorption.Azithromycin did not affect the plasma levels or pharmacokinetics of theophylline administered as a single

intravenous dose. The effect of azithromycin on the plasma levels or pharmacokinetics of theophylline administeredin multiple doses resulting in therapeutic steady-state levels of theophylline is not known. However, concurrent useof macrolides and theophylline has been associated with increases in the serum concentrations of theophylline.Therefore, until further data are available, prudent medical practice dictates careful monitoring of plasmatheophylline levels in patients receiving azithromycin and theophylline concomitantly.

Azithromycin did not affect the prothrombin time response to a single dose of warfarin. However, prudent medicalpractice dictates careful monitoring of prothrombin time in all patients treated with azithromycin and warfarinconcomitantly. Concurrent use of macrolides and warfarin in clinical practice has been associated with increasedanticoagulant effects.

The following drug interactions have not been reported in clinical trials with azithromycin; however, no specificdrug interaction studies have been performed to evaluate potential drug-drug interaction, Nonetheless, they havebeen observed with macrolide products. Until further data are developed regarding drug interactions whenazithromycin and these drugs are used concomitantly, careful monitoring of patients is advised:

Digoxin-elevated digoxin levels,Ergotamine or dihydroergotamine-acute ergot toxicity characterized by severe peripheral vasospasmand dysesthesia.Triazolam-decrease the clearance of triazolam and thus may increase the pharmacologic effect of triazolam.Drugs metabolized by the cytochrome p450 system-elevations of serum carbamazepine, terfenadine, cyclosporine,hexobarbital, and phenytoin levels.

Laboratory Test Interactions: There are no reported laboratory test interactions.Carcinogenesis, Mutagenesis, Impairment of Fertility: Long-term studies in animals have not been performedto evaluate carcinogenic potential. Azithromycin has shown no mutagenic potential in standard laboratory tests:

., i i r_-;:-4 I ID i/T\

a dedicated faculty and residency group that delivers overxOOO patient days and xOOO ambulatory encounters/year. Thechairperson at Cook County Hospital will also serve as vice chairof the Department of Pediatrics at Rush Medical College. Theinstitutional mission is to serve the medically indigent and iscommitted to diversity at all organizational levels. Interestedcandidates may send CV to Carolyn Lopez, M.D., chair, Search

-(11th Annual Lloyd Noland), at the Wyndham Palace, WaitDisney World, Florida, March 15-18, 2000. Call, fax or write:George M. Converse 111, M.D., FAAP, Department of MedicalEducation, Lloyd Noland Foundation, P.O. Box 925, Fairfield,AL 35064-0925. Phone (205) 783-5276 (voice & fax). Visit theLloyd Noland CME Web site: http://www.Iloydnolandcme.org.

ADOLESCENT MEDICINE SEMINAR -(8th Annual LloydNoland), at the Buena Vista Palace, Walt Disney World, Florida,Feb. 2-5, 2000. Call, fax or write: George M. Converse III,

Committee, c/o Department of Family Practice, 1900 W. Polk, M.D, FAAP, Department of Medical Education, Lloyd Noland PEDIATRICS UPDATE -(7th Annual Lloyd Noland)13th Floor, CCAB, Chicago, IL 60612; fax (312) 633-8813. Foundation, PO. Box 925, Fairfield, AL 35064-0925. Phone Head Island, SC, April 19-22, 2000. Call, fax or write: G(EOE/AAEmployer. (205)783-5276(voice&fax). VisittheLloyd NolandCMEWeb M. Converse III, M.D., FAAP, Department of Me

site: http://www.lloydnoIandcme.org. Education, Lloyd Noland Foundation, P.O. Box 925, FaiPEDIATRICIAN-A unique opportunity for a full-time BC/BE AL 35064-0925. Phone (205) 783-5276 (voice & fax). Vipediatrician to join McLaren Health Care Corporation deliver- PEDIATRICS SEMINAR "ADVANCES & CHANGING TRENDS" Lloyd Noland CME Web site: http://www.Iloydnolandcrf

diltoneorgebdcalrfield,sit thee.org.

ing care in the rural Northern Michigan loca-tions. The position requires a rotation betweentwo family care centers and outpatient workonly. Share call with another experienced pedi-atrician. Regional medical center with Level Inursery and 24-hour ER physician. Referralcenter one hour away has Level I nursery andpediatric ICU. Very competitive salary, full ben-efit package, relocation expenses, CME andmuch more! Does not qualify for underservedarea. For more information please contact:Courtney Cole, Physician Recruitment, 401 S.Ballenger Hwy., Flint, Ml 48532, (810) 342-1050 or fax CV to (810) 342-1076.

PEDIATRICIAN - TWIN CITIES: Park NicolletClinic, one of the largest multispecialty clin-ics in the United States, is seeking a BC/BEpediatrician to join the Pediatric Departmentat Park Nicollet Clinic - Shakopee. Practiceincludes managing the acute and chronic careof patients along with well-child care visits.Excellent schools and an abundance of year-round recreational and cultural activities makethe Twin Cities a wonderful place to work andlive. For immediate consideration, pleasefax/send/e-mall CV to Missy Fisher,HealthSystem Minnesota Park Nicollet Clinic,Professional Practice Resources - 7N, 3800Park Nicollet Blvd., St. Louis Park, MN 55416;fax: (612) 993-2819; phone: (612) 993-6025;e-mail: fishem@hsmnet.

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CHILDREN'S CLINICS -Seeking BoardCertified/Board Eligible pediatrician to provideprimary care for children with special healthcare needs. Primary care clinic is housed insame facility that provides and coordinatessubspecialty care for these patients. Clinic timeis shared with one other pediatrician. Inpatientresponsibilities include serving as the attendingfor patients admitted with medical diagnosesas well as providing pediatric consultation forsurgical inpatients. Call will average one weekper month. Other responsibilities may includeattending cerebral palsy or meningomyelocelemultispecialty clinics on a regular basis, pro-viding comprehensive evaluations and recom-mendations for patients and physicians wholive in surrounding communities, and part-timemedical director role for the larger clinic.Program is affiliated with a university medicalcenter with an opportunity for teaching.Bilingual Spanish/English is a plus. Interestedcandidates should submit CV to: Children'sClinics for Rehabilitative Services, Attn: JudithKeagy, Executive Director, 2600 N. WyattDrive, Tucson, AZ 85712.

mouse lymphoma assay, human lymphocyte clastogenic assay, and mouse bone marrow clastogenic assay.No evidence of impaired fertility due to azithromycin was found.Pregnancy: Teratogenic Effects. Pregnancy Category B: Reproduction studies have been performed in rats and miceat doses up to moderately maternally toxic dose levels (i.e., 200 mg/kg/day). These doses, based on a Mg/M2 basis,are estimated to be 4 and 2 times, respectively, the human daily dose of 500 mg. In the animal studies, no evidenceof harm to the fetus due to azithromycin was found. There are, however, no adequate and well-controlled studies inpregnant women. Because animal reproduction studies are not always predictive of human response, azithromycinshould be used during pregnancy only if clearly needed.Nursing Mothers: It is not known whether azithromycin is excreted in human milk. Because many drugs are excretedin human milk, caution should be exercised when azithromycin is administered to a nursing woman.Pediatric Use: (INDICA;llONS AND USAGE.)

Acute Otitis Media (dosage regimen: 10 mg/kg on Day 1 followed by 5 mg/kg on Days 2-5): Safety andeffectiveness in the treatment of children with otitis media under 6 months of age have not been established.

Community-Acquired Pneumonia (dosage regimen: 10 mg/kg on Day I followed by 5 mg/kg on Days 2-5): Safetyand effectiveness in the treatment of children with community-acquired pneumonia under 6 months of age have notbeen established. Safety and effectiveness for pneumonia due to Chlamydia pneumoniae and Mycoplasma pneumoniaewere documented in pediatric clinical trials. Safety and effectiveness for pneumonia due to Haemophilus influenzaeand Streptococcus pneumoniae were not documented bacteriologically in the pediatric clinical trial due to difficultyin obtaining specimens. Use of azithromycin for these two microorganisms is supported, however, by evidence fromadequate and well-controlled studies in adults.

Pharyngitis/Tonsillitis (dosage regimen: 12 mg/kg on Days 1-5): Safety and effectiveness in the treatment ofchildren with pharyngitis/tonsillitis under 2 years of age have not been established.

Studies evaluating the use of repeated courses of therapy have not been conducted.Geriatric Use: Pharmacokinetic parameters in older volunteers (65-85 years old) were similar to those in youngervolunteers (118-40 years old) for the 5-day therapeutic regimen. Dosage adjustment does not appear to be necessaryfor older patients with normal renal and hepatic function receiving treatment with this dosage regimen.

ADVERSE REACTIONSIn clinical trials, most of the reported side effects were mild to moderate in severity and were reversible upondiscontinuation of the drug. Approximately 0.7% of the patients (adults and children) from the multiple-dose clinicaltrials discontinued ZITHROMAX' (azithromycin) therapy because of treatment-related side effects. Most of the sideeffects leading to discontinuation were related to the gastrointestinal tract, e.g., nausea, vomiting, diarrhea, orabdominal pain. Potentially serious side effects of angioedema and cholestatic jaundice were reported rarely.Clinical: Adults: Multiple-dose regimen. Overall, the most common side effects in adult patients receiving amultiple-dose regimen of ZITHROMAX' were related to the gastrointestinal system with diarrhea/loose stools 15%).nausea 13%). and abdominal pain 13%) being the most frequently repo~rted.

No other side effects occurred in patients on the multiple-dose regimen of ZITHROMAX' with a frequency greaterthan I%. Side effects that occurred with a frequency of 1% or less included the following:Cardiovascular: Palpitations, chest pain.Gastrointestinal: Dyspepsia, flatulence, vomiting, melena, and cholestatic jaundice.Genitourinary: Monilia, vaginitis, and nephritis.Nervous System: Dizziness, headache, vertigo, and somnolence.General: Fatigue.Allergic: Rash, photosensitivity, and angioedema.Single 1-gram dose regimen: Overall, the most common side effects in patients receiving a single-dose regimen of1 gram of ZITHROMAX;R were related to the gastrointestinal system and were more frequently reported than inpatients receiving the multiple-dose regimen.

Side effects that occurred in patients on the single one-gram dosing regimen of ZITHROMAX' with a frequency of1% or greater included diarrhea/loose stools 17%). nausea (5%), abdominal pain 15%), vomiting (2%), dyspepsia (11%),and vaginitis (11%).Single 2-gram dose regimen: Overall, the most common side effects in patients receiving a single 2-gram dose ofZITHROMAX' were related to the gastrointestinal system. Side effects that occurred in patients in this study with afrequency of 1% or greater included nausea 118%), diarrhea/loose stools (14%), vomiting 17%), abdominal pain (7%),vaginitis (2%), dyspepsia il %), and dizziness (1 %). The majority of these complaints were mild in nature.Children: Multiple-dose regimens: The types of side effects in children were comparable to those seen in adults,with different incidence rates for the two dosage regimens recommended in children.

Acute Otitis Media: For the recommended dosage regimen of 10 mg/kg on Day 1 followed by 5 mg/kg onDays 2-5, the most frequent side effects attributed to treatment were diarrhea/loose stools 12%), abdominal pain 12%),vomiting (1 %), and nausea (11%).

Community-Acquired Pneumonia: For the recommended dosage regimen of 10 mg/kg on Day 1 followed by5 mg/kg on Days 2-5, the most frequent side effects attributed to treatment were diarrhea/loose stools l5.8%).abdominal pain, vomiting, and nausea (1.9% each), and rash 11.6%).

Pharyngitis/tonsillitis: For the recommended dosage regimen of 12 mg/kg on Days 1-5, the most frequent sideeffects attributed to treatment were diarrhea/loose stools (6%), vomiting (5%), abdominal pain (3%), nausea (2%),and headache (1%).

With either treatment regimen, no other side effects occurred in children treated with ZITHROMAXI with afrequency of greater than 1%. Side effects that occurred with a frequency of 1% or less included the following-,Cardiovascular: Chest pain.Gastrointestinal: Dyspepsia, constipation, anorexia, flatulence, and gastritis.Nervous System: Headache (otitis media dosage), hyperkinesia, dizziness, agitation, nervousness, insomnia.General: Fever, fatigue, malaise.Allergic: Rash.Skin and Appendages: Pruritus, urticaria.Special Senses: Conjunctivitis.Post-Marketing Experience: Adverse events reported with azithromycin during the post-marketing period in adultand/or pediatric patients for which a causal relationship may not be established include:Allergic: Arthralgia, edema, urticaria.Cardiovascular Arrhythmias including ventricular tachycardia.Gastrointestinal: Anorexia, constipation, dyspepsia, flatulence, vomiting/diarrhea rarely resulting in dehydration.General: Asthenia, paresthesia.Genitourinary: Interstitial nephritis and acute renal failure.Uver/Biliary: Abnormal liver function including hepatitis and cholestatic jaundice.Nervous System: Convulsions,Skin/Appendages: Rarely serious skin reactions including erythema multiforme, Stevens Johnson Syndrome, andtoxic epidermal necrolysis.Special Senses: Hearing disturbances including hearing loss, deafness, and/or tinnitus, rare reports of tastedisturbances.Laboratory Abnormalities: Adults: Significant abnormalities (irrespective of drug relationship) occurring duringthe clinical trials were reported as follows: with an incidence of 1-2%, elevated serum creatine phosphokinase,potassium, ALT ISGPT), GGT, and AST lSGOT); with an incidence of less than 1%, leukopenia, neutropenia,decreased platelet count, elevated serum alkaline phosphatase, bilirubin, BUN, creatinine, blood glucose, LDH,and phosphate.

When foliow-up was provided, changes in laboratory tests appeared to be reversible.In multiple-dose clinical trials involving more than 3000 patients, 3 patients discontinued therapy because of

treatment-related liver enzyme abnormalities and 1 because of a renal function abnormality.Children: Significant abnormalities (irrespective of drug relationship) occurring during clinical trials were allreported at a frequency of less than 1%, but were similar in type to the adult pattern.

DOSAGE AND ADMINISTRATION (See INDICATIONS AND USAGE.)Acute Otitis Media and Community-Acquired Pneumonia: The recommended dose of ZITHROMAX' for oralsuspension for the treatment of children with acute otitis media and community-acquired pneumonia is 10 mg/kg asa single dose on the first day (not to exceed 500 mg/day) followed by 5 mg/kg on days 2 through 5 (not to exceed250 mg/day).Pharyngitis/Tonsillitis: The recommended dose for children with pharyngitis/tonsillitis is 12 mg/kg once a day for5 days (not to exceed 500 mg/day).ZITHROMAXO for oral suspension should be given at least I hour before or 2 hours after a meal.ZITHROMAX" for oral suspension should not be taken with food.More detailedprofessional information available on requestRevised January 1997

(C 1998, Pfizer Inc ZC21 9A98

November 1999 AAP News 51

Pediatric Health D

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COVERAGE OF KEY RESPIRATORY PATHOGENS

T Y P I C A L AT Y P I C A LStreptococcus pneumoniae Chlamydia pneumoniaeHaemophilus influenzae Mycoplasma pneumoniaeMoraxella catarrhalisl

* BETTER COMPLIANCE MAY IMPROVE PATIENT OUTCOMES'* COSTS LESS THAN MOST BRAND-NAME ANTIBIOTICS'* PROVEN TOLERABILITY

In acute otitis media, the most common side effects are diarrhea/loose stools (2%), abdominal pain (2%),vomiting (1 %), and nausea (1 %). In community-acquired pneumonia, the most common side effects arediarrhea/loose stools (5.8%), abdominal pain, vomiting, and nausea (1.9% each), and rash (1.6%).Zithromax'R' (azithromycin for oral suspension) is contraindicated in patients with known hypersensitivityto azithromycin, erythromycin, or any macrolide antibiotic.

Zithromax is indicated for pediatric infections such as acute otitis media due to H influenzae, M catarrhalis, orS pneumoniae, and community-acquired pneumonia due to C pneumoniae, H influenzae, M pneumoniae, orS pneumoniae.Oral azithromycin should not be used in pediatric patients with pneumonia who are judged to be inappropriatefor oral therapy because of moderate to severe illness or risk factors such as any of the following: patients withcystic fibrosis, patients with nosocomially acquired infections, patients with known or suspected bacteremia,patients requiring hospitalization, or patients with significant underlying health problems that may compromisetheir ability to respond to their illness (including immunodeticiency or tunctional asplenia).

Please see brief summary of prescribinginformation on adjacent page.