*.DISTRICT VIl

Carden Johnston, M.D.Children's Hospital of Alabama1600 7th Ave., South

*.Suite 001.Birmingham, AL 35233-1711

DISTRICT Vlill

Donald E. Cook, M.D.The Monfort Children's Clinic947 First St.Greeley, CO 80631

DISTRICT IX

Lucy S. Crain, M.D.UCSF Box 0374400 Parnassus AvenueSan Francisco, CA 94143-0374

A.merican*Academy of*Pediatrics

I 1-.\: t~~~ - = (: t-- - -, .,

Dear Academy Fellow:In order to fulfill the admission requirements of AAP Bylaws, you are requested to:1 ) carefully review the following list of new applicants for Academy membership; and relay your reactionsdirectly to your District Chairperson, whose name and address is at the end of this list.

In submitting these names of board-certified pediatricians to you, it is understood that academic and pedi-atric credentials are not in question. Comments are requested concerning possible legal and/or ethicalsituations of which you might have personal knowledge.Send any comments on the following list of new applicants to your District Chairperson by May 15.

Maryland

Nirupama Mahidhara, M.D.119 Grist Stone WayOwings Mills, MD 21117

Gwen E. Foy Marcus, M.D.233 Carroll Rd.Riveria Beach, MD 21122-2903

New Jersey

John F. Fischer, M.D.16 Old Mine Rd.Lebanon, NJ 08833

Nina Aviva Gold, M.D.1-21 28th St.FairLawn, NJ 07410

Pennsylvania

Mark Alan Fogel, M.D.51 Levering Cr.BalaCynwyd, PA 19004-2609

Jung Sun Kim, M.D.8 Pike's WayCheltenham, PA 19012

Emergency Medicine SpecialtyFellowSteven John White, M.D.880 Hillhaven CourtNashville, TN 37220

Indiana

Susan Caldecott Dieterich, M.D.Methodist Hosp. of Indiana1701 N. Senate Blvd., A-6333Indianapolis, IN 46202

Michigan

Scott Henry Cooper, M.D.31095 Floralview Dr., So., #105Farmington Hills, MI 48331

Tahssin A. El-Husein, M.D.35450 Dequindre Rd., #105Sterling Heights, Ml 48310

Lois Gradith Lello, M.D.8865 Grove St., #1Berrien Springs, AAI 49103

Ohio

Philip R. Maur, M.D.3111 Neidhart Rd.Marion, OH 43302

Illinois

Julia Angelina De Bellis, M.D.400 N. McClurg Ct., #3815Chicago, IL 60611 -4350

Prashant Ganesh Deshpande, M.D.One Park Place8100 W. 119th St.Palos Park, IL 60464

Melissa Ann Dianovsky, M.D.1100 W. Central Rd., #201Arlington Heights, IL 60005

Joanne Mary Leahy-Auer, M.D.1445 Sunridge Dr.Bourbonnais, IL 60914

Nike Mourikes, M.D.2116W. CortezChicago, IL 60622

Minnesota

Donna Mae Milner, M.D.834A DParklcDkr.nn

~:St. Paul,MN 55118-2743

Wisconsin

Margaret Carroll Wilcots, M.D.I4410 Regent St.Madison,WI 53705

Wyoming

Linda Abu-Jaber Ammari, M.D.1115 Vanscay Dr.Gillette, WY 82718

Adelaide Lu Masakayan, M.D.1405 W. Maple St.Rawlins, \AY 82301

Alabama

Angelique Harris Murphy, M.D.C. Henderson Child Health CenterPO Box 928Troy, AL 36081

Gregory Jay Stark, M.D.4912 Creekwood Dr.Cottondale, AL 35453

Arkansas

Vince Calderon, M.D.4202 S. UniversityLittle Rock, AR 72204

Louisiana

Wlilliam Ricks Hanna, Jr, M.D.446 Linden St.Shreveport, LA 71104

Texas

Julia Fleckenstein Coutoumanos, M.D.6862 Grapevine Hwy.North Richland Hills, TX 76180

Maria Carol Jackson Fisher, M.D.3300 Matlock Rd.Arlington, TX 76015-2245

Farahaba Rajab Lakhdir, M.D.4525 Greenbriar Dr.Nacogdoches, TX 75961

Connecticut

John Gerald Pitegoff, M.D.20 High Point LaneWest Hartford, CT 06107-1135

Massachusetts

Marilyn Christine Augustyn, M.D.12 Stoneholm St. #611Boston, MA 02115-2915

Carmon Jalena Davis, M.D.84 Prescott St., #41Cambridge, MA 02138

Martha Potts Fishman, M.D.Pulmonary DivisionChildren's Hospital300 Longwood Ave.Boston, AAA 02115

Ophthalmology Specialty FellowO'lne McCabe, M.D.99 Waltham St.Lexington, AAA 02173

Uniformed Services East

Ursula Yvette Chesney-Graham, M.D.775 Magellan Dr.Fayetteville, NC 28311 -2000

New York 1

Joanne L. Beaubien, M.D.6 Strathallan Park, #3Rochester, NY 14607

New York 2

Eileen M. Duffy, M.D.9 Jordan Ave.Oyster Bay, NY 11771 -3506

Luis Oscar Herrera-Acevedo, M.D.857 Cliffside Ave.North Woodmere, NY 11581

Nasrullah Khan, M.D.720 Rugby Rd.Brooklyn, NY 11230

New York 3

Katherine K. Tan, M.D.31-55 47th St., #2nd FloorLong Island City, NY 11103

Delaware

Renee Jennine Grob, M.D.942-A Walker Rd.Dover, DE 19904

District of Columbia

Oxiris Barbot, M.D.1751 -C Corcoran St., NWWashington, DC 20009

California 1

John Joseph Dahmen, M.D.920 Cass St.Monterey, CA 93940

Kamyar Kalantar-Zadeh, M.D.175 Taraval St.San Francisco, CA 94116-1934

John A. Sieverding, M.D.1955 12th Ave.San Francisco, CA 94116-1305

Califomia 2

Sherine Mahfouz Bishara, M.D.222 Monterey Rd., Unit 305Glendale, CA 91206-2004

California 4

Shelley Tucker Chacon, M.D.5952 Littlefield Dr.Huntington Beach, CA 92648-1034

m1-

Florida

Kaneez Z. Agha, M.D.2641 Aston CircleMelbourne, FL 32940

Jennifer E. Fordan-Herman, M.D.2103 Korat LaneOrlando, FL 32810

Jose Francisco Salazar, M.D.12731 Chartwell Dr.Ft. Myers, FL 33912-4660

Arwar AAohiuddin Vardag, M.D., MBBS6156 NW 31 st Ave.Boca Raton, FL 33496

Georgia

Consuelo Beck-Sague, M.D.1600 Clifton Rd., MS C-12Atlanta, GA 30333

Kentucky

Laura Parrott White, M.D.5129 Dixie Hwy., #201Louisville, KY 40216

Puerto Rico

Lourdes Nieves-Vazquez, M.D.8 Calle 1Vistas del Rio, Apt. #1 OBBayamon, PR 00959

Tennessee

Janet Gwen Blackwell, M.D.2201 Murphy Ave., Suite 409Nashville, TN 37203

Kaukab Naseer, M.D.2665 Churchill Downs CircleChattanooga, TN 37421-1488

GibrL.Ful,M.D

The Hitchcock Clinic590 Court St.Keene, NH 03431 -1719

DISTRICT II

Louis Z. Cooper, M.D.St. Lukes Roosevelt Hospital1000 Tenth Ave.New York, NY 10019

DISTRICT III

Susan Aronson, M.D.605 Moreno RoadNarberth, PA 19072-1618

DISTRICT IV

E. Stephen Edwards, M.D.2800 Blue Ridge Blvd.Suite 501Raleigh, NC 27607-6496

DISTRICT V

Stanford A. Singer, M.D.16800 W. Twelve Mile Rd.Suite 205Southfield,MI 48076-2138

DISTRICT VI

Ordean Torstenson, M.D.1313 Fish Hatchery Rd.Madison,WI 53715

Arizona

Plastic Surgery Specialty FellowStephen Paul Beals, M.D.1331 N. 7th St., #250Phoenix, AZ 85006

Ophthalmology Specialty FellowJoseph Marion Miller, M.D.Dept. of OP1801 N. Campbell Ave.Tucson,AZ 85719-3665

Colorado

Branka Milosavljevic, M.D.183 S. 18th Ave.Brighton, CO 80601

Robert Thomas Underhill, M.D.431 Quincy St.Pueblo, CO 81004-3322

Uniformed Services West

Braden Alan Shoupe, M.D.238-B Hibiscus St.Honolulu, HI 96818

Washington

Badrossadat Badri Madani, M.D.18221 190th PI., NEWoodinville, WA 98072-6637

April 1998 AAP: Ne;v-vs 37

(330Bs~~~~~~~~~~1"I 3^e~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ t `

I

May23rd Annual Conference on Neonatal/PerinatalMedicine- May 22 - 24, 1998, at Hyatt RegencyLake Tahoe, Lake Tahoe, Nev. Contact: Donald E.Buchanan, M.D., 3196 S. Maryland Pkwy., Suite 405,Las Vegas, NV 89109. (702) 731-8553; fax (702) 873-9984; e-mail: DonBdotOaol.com.

Minnesota Chapter Annual Meeting and CMEProgramn- May 15 - 16, 1998, at Brooklyn Park,Minn. Contact: Julie Pierce, Executive Director, 1847N.W. 131st Ln., Minneapolis, MN 55118; phone/fax(612) 767-7805; e-mail: FortPierceOaol.com.

June

21st Annual Black Hills Seminar on Advances inClinical Pediatrics-Rapid City, S.D., June 17 - 19,1998. Sponsored by University of South Dakota Schoolof Medicine, Department of Pediatrics. Contact:Lawrence R. Wellman, M.D., Program Coordinator,

California

Monterey Bay Coast -Fourth BC/BE pediatrician forthriving practice in beautiful community with beaches,mountains, university. Level II nursery; new hospital.Flexible schedule. Fax c.v. to (408) 722-9604

Illinois

Excellent opportunity for BE/BC Neonatologist -inthe SwedishAmerican Children's Medical Center. Busyand expanding Level II+ Special Care Nursery with2,700 deliveries per year. Pediatric specialty team fromtop training programs includes neonatology, cardiology,GI, pulmonology, hem/onc, neurology, psych,immunology, ID, genetics, surgery, intensive care.Competitive salary and benefits, teaching opportuniffes.Close to Chicago, Madison, and Milwaukee. Call BarbFleeman, SwedishAmerican Health System, (815) 391-

7073 or fax (815) 391-7240.

Oak Park/River Forest Infant Welfare Clinic -seeksBC/BE pediatrician for every Wednesday 9 a.m. to 12p.m. and six Saturday mornings/year. Clinic providesprimarily well child care, physicals, immunizations tochildren age 0-18. Interest in patient asthma educationpreferred. Fax resume at (708) 848-5855 or call

Massachusetts

Children's Hospital, Boston -Division of General

USD School of Medicine, 1100 S. Euclid Avenue,Sioux Falls, SD 57117-5039; (605) 333-7178; fax(605) 333-1585.

"Pediatrics by the Sea" -MAP Georgia Chapter, TheCloister, Sea Island, Ga., June 18-20, 1998. ContactLouise Pfingle-Jones, (404) 881-5094; fax (404) 249-9503; or e-mail: louiseEmag.org.

"Practical Topics in Children's Medicine" 22ndAnnual Florida Suncoast Pediatric Conference, June 26- 28, 1998, at Trade Winds Resort, St. Pete Beach, Fla.Sponsored by the University of South Florida College ofMedicine. Presented by All Children's Hospital. Forinformation call All Children's Hospital ConferenceAdministration, (813) 892-8834.

Pediatrics: Fellowship programs in General AcademicPediatrics, Pediatric Advocacy, Developmental-Behavioral Pediatrics, Developmental Disabilities,Primary Care Research, and Pediatric Health ServicesResearch are now open to application. Call for infor-mation: (617) 355-6714; fax (617) 355-7940.Applications should be sent to Judith Palfrey, M.D.,Chief, Division of General Pediatrics, Children'sHos-pital, 300 Longwood Ave., Boston, MAAA02115; e-mail: Palfrey@A1.Tch.Harvard.Edu.

Elizabeth (708) 848 0528.

KentuckyHazard Pediatrics -needs a pediatrician in Hazard, Ky.,in a fairly rural setting. All candidates welcome to apply.Send reply to Hazard Pediatrics, P.O. Box 2748,Pikeville, KY41502-2708.

Minnesota

New Ulm Medical Center -We are currently seeking athird consultant pediatrician to join 25-person multi-specialty dinic in south-central Minnesota. Roles includehigh risk delivery-room coverage, management of com-plex pediatric patients, consultation service for familypractice internally and from surrounding communities,managing growing premature infants, and developingyour own well-child practice. Every third call for consul-taffon with ER and after hours covered by primary care.Comprehensive training experience with diverse typesof patients preferred, including interest in behavior dis-orders. Outreach clinic development in process assignificant need exists. For more information, contactCarri Prudhomme, Allina Health system; fax c.v. to(612) 992-2927 or call (800) 248-4921.

New Me)dco

The Department of Pediatrics at the University of NewMexico Health Sciences Center seeks BE/BC pediatri-cians for ambulatory division, including YoungChildren's Health Center (YCHC), a community-basedprogram serving a low-income, predominantly Latinocommunity. Duties indude: clinical care of children ages

2AI)S BYE-MAILAAPNewscan now accept your classified adverdsing

by e-mail! Send ads to ppetersen@aap.org

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MX13-U. M98 * I ,IgRdFor registiation information,contact thle

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FOR COMPLETE INFO: 800-497-6573 OR 303-440-851|7

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38 AAP News April 1998

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0-17, and teaching. For YCHC, preferences are: bilin-gual in English/Spanish; 2 years or more generalpediatrics experience; experience with public sector pro-grams and underserved populations; experience withethnic or language minorities; knowledge of develop-mental disabilities in minority populations; experiencewith school-based health programs; and experience inmanagement and with multi-agency collaboration.Positions will remain open until filled. Pool will be activeuntil May 29, 1998. Applications will be acceptedthroughout this period. For complete information, inter-ested individuals should obtain a vacancyannouncement, and direct inquiries and/or CV with sig-nature and at least 3 letters of support to Carla Slezak,Administrator, Department of Pediatrics, University ofNew Mexico, School of Medicine, ACC-3rd Floor,Albuquerque, NM 871 31-531 1. Phone (505)272-5551; fax (505) 272-6845; or e-mailcslezakEsalud.unm.edu. List employment dates bymonth/year and indicate the requisition number971955*13 and job title on all correspondence. AA/EOE.

Oregon

Portland/Vancouver and Salem -Experience the bestof the Northwest! Practice in a stimulating professionalenvironment in one of the most successful managedcare systems in the country and enjoy a quality lifestyleinherent to the beautiful Pacific Northwest. Our physi-cian-managed multispecialty group providing care for420,000 Kaiser Permanente members has full-time and

part-time positions available for BC/BE pediatricians atour medical offices in Portland/Vancouver and Salem,Ore. In addition to general pediatrics, the practice willinclude urgent care call. We offer our physicians a com-petitive salary and a benefits package which includes agenerous retirement program, professional liability cov-erage, sabbatical leave and more. For informationregarding these exciting opportunities, please forwardc.v. to Marci K. Clark, Director of ProfessionalResources, Northwest Permanente, P.C., 500 N.E.Multnomah, Suite 100, Portland, OR 97232-2099;(800) 813-3763. EOE.

PennsylvaniaPenn State Geisinger Health System -is currentlyseeking a BC/BE pediatrician to join its multispecialtygroup practice in State College, Penn. Join two otherpediatric physicians in this busy medical practice. Call isshared with nearby sister clinic and is 1:5. Administrativeopportunity available if desired. State College, locatedin the heart of Pennsylvania, is home to Penn StateUniversity. The area offers a tremendous amount ofeducational, cultural and recreational activities to enjoy.State College provides an excellent business climate andoffers a superior quality of life. We offer a competitivesalary and excellent benefit package. For additionalinformation, please contact: Penn State GeisingerProfessional Staffing (PP-AB), 100 North AcademyAve., Danville, PA 17822-1528. Phone (800) 845-7112; fax (800) 622-2515. E.O.E. M/F/H/V.

Director, Inpatient Pediatrics -Philadelphia area:"CHOP connection," a series of community hospitalinpatient units, managed by the Children's Hospital ofPhiladelphia (CHOP), is seeking candidates for Directorof Inpatient Pediatrics in its growing network. Thesepositions offer opportunities for combining clinical care,teaching and administration in the community and atCHOP. Children's Hospital of Philadelphia is recognizedas a world leader in pediatric medicine. Salary and ben-efits are highly competitive. For information contactMark Joffe, M.D., Director, Community PediatricMedicine, The Children's Hospital of Philadelphia, 34thand Civic Center Blvd., Philadelphia, PA 19104; (215)590-1944; e-mail: JoffeX?email.chop.edu. Principalsonly please.

Texas

a 20-county area of Central Texas. Inquiries includingcurriculum vitae and reference letters should be directedto David Anglin, M.D., "'Specially for Children,"Children's Hospital of Austin, 601 East 15th Street,Austin, TX 78701; phone (512) 324-8851; fax (512)324-8859; e-mail: DANGLINQ?mail.utexas.edu.

Austin -Pediatric Critical Care: "'Specially forChildren," Children's Hospital Sub-specialists of CentralTexas, seeks interested applicants for an outstandingpractice opportunity in pediatric critical care medicine.We seek a fellowship-trained, BC/BE individual withexcellent credentials and commitment to patient care,graduate medical education and program development.The Austin pediatric medical community is focused, uni-fied, and committed to the vision and mission of theChildren's Hospital ofAustin, an 82-bedfacility serving the 1.5 "We do themillion population of n: 1Ls TL-r-a

The Sisters of the Third Order of St. Francis (OSF) have beenproviding medical care for residents of Illinois, Iowa andMichigan for more than 120 years. Their corporation, nowknown as OSF HealthCare, includes seven hospitals, twoextended care facilities, an insurance company with its ownmanaged care products, more than one dozen affiliated com-panies providing medical products and services, and OSFAAedical Group, a multi-specialty physician group with morethan 220 providers in its multi-state service area. We now havegeneral pediatrics opportunities in:

Peoria, Illinois Bloomington, IllinoisEscanaba, Michigan

For more information, please contact:

Wendy Bass at (800) 462-3621; Fax (309) 685-2574; Email:wendy.bass@osfhealthcare.com

he health and well-being of our children is,Cdramatically influenced by images and

messages conveyed by the media. Health profes-sionals and parents have an enormous stake inensuring that the media's influence on our nation'syouth is positive. We can meet this goal throughmedia education, which includes development ofcritical thinking and viewing skills.

Panel discussions:* Documentary and Non-fiction* The Challenge of Cyberspace* Sex, Drugs and Violence: The Impact of the Media* Buying and Being: The Culture of Consumerism* Body Image, Gender and Indentity* Views on News in the '90s

June 28 - July 1 - Colorado Springs, Colorado

Who should attend:* Members of the medical, public healthand prevention communities

* Classroom teachers K-12 and other educators* Parent and child media advocates* Religious and community leaders* Academic researchers and leaders* Journalists and media professionals

Pgj- ~A collaboration of:7v1_ ~~American Academy of PediatricsPrtnership Center for Media Literacy

for Media Center for Substance Abuse Preventior/SAMHSAEducation Media Literacy Project at Clark University

CLASSIFIED ADVERTISING POLICY

Whenyou need to contactpediatricians, contactAAPNews. Each month more than 53,000pediatricians,pediatricspecialists, third-yearpediatric residentsandothersubscribers turn toAAPNewsforchild healthinformation they cannotget elsewhere. With a classified ad, you can speak directly to those readers.

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

Occassionally, it is necessary to modify the wording of classi-fied ads. These changes are generally made in compliancewith the regulations ofvarious federal and/or state comnmis-sions against discrimination or because they might beinterpreted as being urlawful or in conflict with accepted pro-fessional standards ofmedical practice.

These adverfising modifications are made to maintain a clas-sified section that is professionally responsible, lawful,scientific and free of discrimination.

AAPNEWS,PublishedMonfy ;) \Amerian Academy ofPecdiatrics

Elk Grove Vllage, IL 60009-0927

Publication ofan advertisement inAAP News neither consti-tutes nor imrplies a guarantee or endorsement byAAP Newsor the American Academy ofPediatrics ofthe product or ser-vice advertised or of the claims made for the product orservice by the advertiser.

Classification: Classified ads are accepted under BusinessServices, General Announcements, Medical Meetings,Physicians Wanted, Positions Wanted, Practices Available,Publications, Real Estate and Residencies/FellowshipsAvailable.

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. ContactAAPNews for display classifedad sizes and rates.

Formore infonmation, contact Pete Petersen, Classified AdCoordinator, at (800) 433-9016, ext. 7667. In Illinois, (847) 981-7667. Ad copy and payments may be sent to: Classified Ads,AAPNews, PO. Box 927, Elk Grove Village, IL 60009-0927.

After all, practicing medicine is about people - not paperwork.We have practice opportunities available for all specialties in ournationally ranked medical centers and throughout our network ofcommunity-based health groups in northeastern and centralPennsylvania. A torch is not the answer to paperwork, we are.

We'll make all our resources available to you.

For more information, call Penn State GeisingerHealth System, Professional Staffing Office toll-free at1-800- 845-7112 or FAXus at 800-622-2515. RaL PennState Geisinger

Health Systeman equal opportunity employer

April 1998 ASS' NJevvs 39

CHARGEITYou can now charg yourAAPNews classifiedadverdsing costs on

your Visa orMasterCard credit crs.

So diarg ahead with yourplans to adverdse in

AAPNews.Call (800) 433-9016,et 7667 for dassified

aversing rates: and:XVfn

etis Offin N

MEDICAL GROUPKignt ining...

Well."

1998 National MediaEducation Conference

ired ofPaperworkWe let you prcie nmedcicne.

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Californ'ia

A well established, solo pediatric practice in the SanFrancisco area-Respond to: AAP News, Box 01228,141 Northwest Point Blvd., Elk Grove Village, IL 60007.

Connecticut

Pediatric Practice for sale - Beautiful CoastalConnecticut town, 45 miles north of New York.Established for 1 1 years. No managed care. Very lucra-tive. Solo pediatrician with every third or fourth nightcoverage. Hospital with Pediatric PA's and NBICU. Over800 families on waiting list. Closed to new patients forfive years. Could easily use two pediatricians. Pleasereply to Glenn Feole, P.O. Box 745, Westport, CT06880; e-mail: glenn.l.feole@SNET.net.

250-1441.

W onal'i -114 alsr

Siem Reap, Cambodia

Medical Director for the Angkor Hospital for Children- "Friends Without A Border," a nonprofit organiza-tion, seeks a medical director for 60-bed children'shospital to open in Fall 1998. Requires M.D. degree andprevious medical/administrative experience in develop-ing world. Send resume to 140 W. 22nd St., Suite 11A,New York, NY 1001 1; fax (212) 255-9060.

Access the best in pediatrics...

or facsimile (301) 921 -7915, attention Andrea Wergin.

Wisconsin

Baraboo-Everything you trained for as a pediatrician(except ventilator management)! Attend high-risk deliv-eries and ER resuscitations; act as a consultant, yet seeyour own patients for well child and sick visits. BC/BEpediatrician needed to join another pediatrician in a 14-member multispecialty group. Baraboo is a small townin beautiful south central Wisconsin, 45 minutes northof Madison. Level II nursery, 80-bed hospital with reg-ular subspecialist visits. ER covered 24 hours.Opportunity for resident teaching. Competitive salaryand benefits, possible financial assistance for practicedevelopment available to eligible physicians. Mailinquiries and CVs to Scott Lindblom, Dean MedicalCenter, 1808 West Beltline Hwy., Madison, WI 53715,or call (608) 250-1550 or (800) 279-9966; or fax (608)

VirginiaRichmond area-Part /full-time BC/BE pediatrician fordynamic, growing practice. Competitive salary witheventual partnership. Hospitals with full service pedi-atrics, NICU, PICU. Attractive planned communities.Excellent schools and recreational facilities. NearbyMedical College of Virginia. Extremely light call. SendCV or call Judith F. McGhee, M.D., 4902 MillridgePkwy., Midlothian, VA 231 12; (804) 744-1231; or fax(804) 744-9521.

Northem Virginia -Full-time opportunities available ata community hospital in Manassas. BC pediatricianneeded for an inpatient pediatric program. Practiceincludes coverage of 12-bed Pediatric Unit and pediatricconsultations in the ED. Attractive compensation andbenefits. Send c.v. to: Emergency Medicine Associates,9210 Corporate Blvd., Suite 210, Rockville, MD 20850,

IF SO, CHOOSE

-

_ AN INTENSIVE REVIEW OF PEDIATRICS

1a t~~~~~~~%Ou],ADOLESCENT MEDICINEDavid S. Rosen, MD, MPH, FAAPGENERAL PEDIATRICS/PRACTICE MANAGEMENTHoward Bauchner, MD, FAAPINFECTIOUS DISEASEGail Rodger, MD, FAAPNEPHROLOGYRichard Cohn, MD

OPHTHALMOlOGYKenneth Wright, MD, FAAPPULMONOLOGYRoxanne Marcffle, MD, FAAPRHEUMATOLOGYMaria D Perez, MD, FACR, FAAPCOURSE DIRECTORPaul Dworkin, MD, FAAP

WASHINGTOND C

The Westin HotelApril 18-22, 1998

COURtSE EACULTY

PREP The Course offers you:*Momre than 25 pediatric subspecialty areas,with a total of up to 46 Caegory I CME credithours available

* Content that is coordinated with the AmericanBoard of Pediatrics' Program for Renewal ofCertificalio in Pediatrics (PRCP) contentspecMfcations

* Strategies in case diagnosis and management* Small group settings, interactive sessionswith faculty

Enrollment is limited to 200.

For more information, please call the Academyat 800/433-9016, ext 6796 or 7657.Outside the Unitedi States and Canada,call 847/228-5005. You may fax a writtenrequest to 847/228-5059.

Or write to:Meeting Services-RegistrationAmerican Academy of Pediatrics141 Northwest Point BlvdElk Grove Village, IL 60007-1098

ADOLESCENT MEDICINEGita Gidwani, MDALLERGYDennis R. Ownby, MD, FAAPDERMATOLOGYIawrence F. Eichenfield, MD, FAAD, FAAPGASTROENTEROLOGYMounif El-Yousef, MD, FAAPGENETICSH. Eugene Hoyme, MD, FAAPINFECTIOUS DISEASEPenelope H. Dennehy, MD, FAAPOTOLARYNGOLOGYRichard T. Miyamoto, MD, FAAPCOURSE DIRECTORRichard Evans, m, MD, MPH, FAAP

AHIA Category I Credit: 18 Hours

Forprogram information, contact:-CME COURSE REGISTRATIONAmerican Academy of Pediatrics141 Northwest Point BlvdElk GroveVillage, IL 60007-1098Toll-Free:800/433-9016, ext 6796 or 7657Outside the United States and Canada:847/228-5005, ext 6796 or 7657For discounted air and groundtransportation, contact theAAPTravel Office at 800/433-9016.

AmericanAcademy ofPediatrics

TheAmericanAcademyofPediatrics gratefullyacknowledges supportforits continuing medicaleducation courses in theform ofeducationalgrantsftom Johnson & JohnsonConsumer Products, Inc,and Wyeth-LederleVaccines and Pediatrics.

AMACategory1ICredit 18 Hours _

Forprogram information, contact:CME COURSE REGISTRATIONAmerican Academy of Pediatrics141 Northwest Point BlvdElk GroveVillage, IL 60007-1098Toll-Free: 800/433-9016, ext 6796 or7657Outside the United States and Canada:847/228-5005, ext 6796 or 7657For discounted air and ground transportation,contact thieAAPTravel Office at 800/433-9016.

4#

AmericanAcademy ofPediatrics

American Academyof Pediatrics

TheAmericanAcademy ofPediatrics gratefiillyacknowledges supportfor its continuing medicaleducation courses in theform ofeducationalgsrantsfrom Johnson & Johneson Consumer Psroducts, Incs,and Wyeth-Lederle VaccinesandPediatrices.

40 VXA./I< April 1998

ELDORADO HOTEL ANDSWEENEY CONVENTION CENTER

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COURSE FACULTY

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Zithromaxe~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~Vrl(aIthoyi oorulsuspension)

References: 1. Data on file. Pfizer Inc, New York, NY. 2. McLinn S, Williams D. High incidence ofStreptococcus pneumoniae and Haemophilus influenzae (beta-lactamase) resistance in recent otitis mediaclinical trial isolates. Presented at the 35th Interscience Conference on Antimicrobial Agents andChemotherapy; September 17-20, 1995; San Francisco, Calif. Abstract. 3. Hardy DJ, Hensey DM, BeyerJM, Vojtko C, McDonald EJ, Fernandes PB. Comparative in vitro activities of new 14-, 15-, and 16-membered macrolides. Antimicrob Agents Chemother. 1988;32:1710-1719. 4. Retsema J, Girard A,Schelkly W, et al. Spectrum and mode of action of azithromycin (CP-62,993), a new 15-membered-ringmacrolide with improved potency against gram-negative organisms. Antimicrob Agents Chemother.1987;31:1939-1947. 5. McLinn S. Double blind and open label studies of azithromycin in themanagement of acute otitis media in children: a review. Pediatr Infect DisJ. 1995;14:S62-S66.6. Khurana C, McLinn S, Block S, Pichichero M. Trial of azithromycin (AZ) vs Augmentin (AUG) fortreatment of acute otitis media (AOM). Presented at the 34th Interscience Conference on AntimicrobialAgents and Chemotherapy; October 4-7, 1994; Orlando, Fla. Abstract.

Augmentin (amoxicillin/clavulanate potassium) is a registered trademark of SmithKline BeechamPharmaceuticals

ZITHROMAX"(azithromycin for oral suspension)

BRIEF SUMMARY

INDICATIONS AND USAGEZITHROMAXe (azithromycin) is indicated for the treatment of patients with mild to moderate infections (pneumonia: seeWARNINGS) caused by susceptible strains of the designated microorganisms in the specific conditions listed below. Asrecommended dosages, durations of therapy, and applicable patient populations vary among these infections, please seeDOSAGE AND ADMINISTRATION for specific dosinQ recommendations.

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

Community-acquired pneumonia due to Chlamydia pneumoniae, Haemophilus influenzae, Mycoplasma pneumoniae,or Streptococcus pneumoniae in patients appropriate for oral therapy. (For specific dosage recommendation, see DOSAGEAND 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 as any of thefollowing: patients with cystic fibrosis, patients with nosocomially acquired infections, patients withknown or suspected bacteremia, patients requiring hospitalization, or patients with significantunderlying health problems that may compromise their ability to respond to their illness (includingimmunodeficiency or functional asplenia).

Pharyngitis/tonsillitis caused by Streptococcus pyogenes as an alternative to first-line therapy in individuals whocannot use first-line therapy. (For specific dosage recommendations, see DOSAGE AND ADMINISTRATION.)

NOTE: PenicilIlin by the intramuscular route is the usual drug of choice in the treatment of Streptococcus pyogenesinfection and the prophylaxis of rheumatic fever. ZITHROMAXI is often effective in the eradication of susceptible strains ofStreptococcus pyogenes from the nasopharynx. Because some strains are resistant to ZITHROMAXO, susceptibility testsshould be performed when patients are treated with ZITHROMAXO. Data establishing efficacy of azithromycin in subsequentprevention of rheumatic fever are not available.

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

CONTRAINDICATIONSZITHROMAXI is contraindicated in patients with known hypersensitivity to azithromycin, erythromycin, or any macrolideantibiotic.

WARNINGSSerious allergic reactions, including angioedema, anaphylaxis, and dermatologic reactions including Stevens JohnsonSyndrome and toxic epidermal necrolysis have been reported rarely in patients on azithromycin therapy. Although rare,fatalities have been reported. (See CONTRAINDICATIONS.} Despite initially successful symptomatic treatment of theallergic symptoms, when symptomatic therapy was discontinued, the allergic symptoms recurred soon thereafter in somepatients without further azithromycin exposure. These patients required prolonged periods of observation andsymptomatic treatment. The relationship of these episodes to the long tissue half-life of azithromycin and subsequentprolonged exposure to antigen is unknown at present.

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

In the treatment of pneumonia, azithromycin has only been shown to be safe and effective in the treatment ofcommunity-acquired pneumonia due to Chlamydia pneumoniae, Haemophilus influenzae, Mycoplasmapneumoniae, or Streptococcus pneumoniae in patients appropriate for oral therapy. Azithromycin should not beused in patients with pneumonia who are judged to be inappropriate for oral therapy because of moderate tosevere illness or risk factors such as any of the following: patients with cystic fibrosis, patients withnosocomially acquired infections, patients with known or suspected bacteremia, patients requiringhospitalization, elderly or debilitated patients, or patients with significant underlying health problems that maycompromise their ability to respond to their illness (including immunodeficiency or functional asplenia).

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

Treatment with antibacterial agents alters the normal flora of the colon and may permit overgrowth of clostridia. Studiesindicate 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. Mildcases of pseudomembranous colitis usually respond to discontinuation of the drug alone. In moderate to severe cases,

consigeetwtderation should be given to managmn wih fluids and electrolytes, protein supplementation, and treatment with anantibacterial drug clinically effective against Clostridium difficlile colitis.

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

There are no data regarding azithromycin usage in patients with renal impairment; thus, caution should be exercised whenprescribing azithromycin in these patients.

The following adverse events have not been reported in clinical trials with azithromycin, an azalide; however, they havebeen reported with macrolide products: ventricular arrhythmias, including ventricular tachycardia and torsades de pointes, inindividuals with prolonged QT intervals.

There has been a spontaneous report from the post-marketing experience of a patient with previous history of arrhythmiaswho experienced torsades de pointes and subsequent myocardial infarction following a course of azithromycin therapy.Information for Patients: Patients should be cautioned to take ZITHROMAX8 suspension at least one hour prior to a mealor 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 shouid be directed to discontinue azithromycin immediately and contact a physician if any signs of an allergicreaction occur.Drug Interactions: Aluminum- and magnesium-containing antacids reduce the peak serum levels (rate) but not the AUC(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 administered in multiple dosesresulting in therapeutic steady-state levels of theophylline is not known. However, concurrent use of macrolides andtheophylline has been associated with increases in the serum concentrations of theophylline. Therefore, until further dataare available, prudent medical practice dictates careful monitoring of plasma theophylline levels in patients receivingazithromycin 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 warfarin concomitantly.Concurrent use of macrolides and warfarin in clinical practice has been associated with increased anticoagulant effects.

The following drug interactions have not been reported in cli'nical trials with azithromycin; however, no specific druginteraction studies have been performed to evaluate potential drug-drug interaction. Nonetheless, they have been observedwith macrolide products. Until further data are developed regarding drug interactions when azithromycin and these drugs areused concomitantly, careful monitoring of patients is advised:

Digoxin-elevated digoxin levels.Ergotamine or dihydroergotamine-acute ergot toxicity characterized by severe peripheral vasospasm and 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 performed toevaluate carcinogenic potential. Azithromycin has shown no mutagenic potential in standard laboratory tests'. mouselymphoma assay, human lymphocyte clastogenic assay, and mouse bone marrow clastogenic assay. No evidence of impairedfertility due to azithromycin was found.

Pregnancy: Teratogenic Effects. Pregnancy Category 13: Reproduction studies have been performed in rats and mice atdoses up to moderately maternally toxic dose levels (i.e., 200 mg/kg/day). These doses, based on a mg/m2 basis, areestimated to be 4 and 2 times, respectively, the human daily dose of 500 mg. In the animal studies, no evidence of harm tothe fetus due to azithromycin was found. There are, however, no adequate and well-controlled studies in pregnant women.Because animal reproduction studies are not always predictive of human response, azithromycin should be used duringpregnancy only if clearly needed.Nursing Mothers: It is not known whether azithromycin is excreted in human milk. Because many drugs are excreted inhuman milk, caution should be exercised when azithromycin is administered to a nursing woman.Pediatric Use: (INDICATIONS AND USAGE.)

Acute Otitis Media (dosage regimen: 10 mg/kg on Day 1 followed by 5 mg/kg on Days 2-5): Safety and effectiveness inthe 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 1 followed by 5 mg/kg on Days 2-5): Safety andeffectiveness in the treatment of children with community-acquired pneumonia under 6 months of age have not beenestablished. Safety and effectiveness for pneumonia due to Chlamydia pneumoniae and Mycoplasma pneumoniae weredocumented in pediatric clinical trials. Safety and effectiveness for pneumonia due to Haemophilus influenzae andStreptococcus pneumoniae were not documented bacteriologically in the pediatric clinical trial due to difficulty in obtainingspecimens. Use of azithromycin for these two microorganisms is supported, however, by evidence from adequate and well-controlled studies in adults.

Pharyngitis/Tonsillitis (dosage regimen: 12 mg/kg on Days 1-5): Safety and effectiveness in the treatment of children withpharyngitis/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 younger volunteers(18-40 years old) for the 5-day therapeutic regimen. Dosage adjustment does not appear to be necessary for older patientswith 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 anid were reversible upondiscontinuation of the drug. Approximately 0.7% of the patients (adults and children) from the multiple-dose clinical trialsdiscontinued ZITHROMAXI (azithromycin) therapy because of treatment-related side effects. Most of the side effectsleading to discontinuation were related to the gastrointestinal tract, e.g., nausea, vomiting, diarrhea, or abdominal pain.Potentially serious side effects of angioedema and cholestatic j'aundice were reported rarely.Clinical: Adults: Multiple-dose regimen: Overall, the most common side effects in adult patients receiving a multiple-doseregimen of ZITHROMAXI were related to the gastrointestinal system with diarrhea/loose stools (5%), nausea (3%), andabdominal pain (3%) being the most frequently reported.

No other side effects occurred in patients on the multiple-dose regimen of ZITHROMAXO with a frequency greater than1%. 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 j'aundice.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 ZITHROMAXO were related to the gastrointestinal system and were more frequently reported than in patientsreceiving the multiple-dose regimen.

Side effects that occurred in patients on the single one-gram dosing regimen of ZITHROMAX3I with a frequency of 1% orgreater included diarrhea/loose stools (7%), nausea (5%), abdominal pain (5%), vomiting (2%), dyspepsia (1 %), and vaginitis01 %).Single 2-gram dose regimen: Overall, the most common side effects in patients receiving a single 2-gram dose ofZITHROMAXO 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 (7%), abdominal pain (7%),vaginitis (2%), dyspepsia (1 %), and dizziness (1 %). The maj'ority of these complaints were mild in nature.Children: Multiple-dose reglimens: The types of side effects in children were comparable to those seen in adults, withdifferent 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 on Days 2-5, themost frequent side effects attributed to treatment were diarrhea/loose stools (2%), abdominal pain 12%), vomiting (1 %), andnausea (1 %).

Community-Acquired Pneumonia: 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 (5.8%), abdominal pain, vomiting,and nausea 11.9% each), and rash 11.6%).

Pharyngitis/tonsillitis: For the recommended dosage regimen of 12 mg/kg on Days 1-5, the most frequent side effectsattributed to treatment were diarrhea/loose stools (6%), vomiting (5%), abdominal pain 13%), nausea (2%), andheadache 11 %).

With either treatment regimen, no other side effects occurred in children treated with ZITHROMAXI with a frequency ofgreater 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 adult and/orpediatric 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.Liver/Biliary: Abnormal liver function including hepatitis and cholestatic jaundice.Nervous System: Convulsions.Skin/Appendages: Rarely serious skin reactions including erythema multiforme, Stevens Johnson Syndrome, and toxicepidermal necrolys'is.Special Senses: Hearing disturbances including hearing loss, deafness, and/or tinnitus, rare reports of taste disturbances.Laboratory Abnormalities: Adults: Significant abnormalities (irrespective of drug relationship) occurring during the clinicaltrials were reported as follows: with an incidence of 1-2%, elevated serum creatine phosphokinase, potassium, ALT (SGPT),GGT, and AST lSGOT);- with an incidence of less than 1%, leukopenia, neutropenia, decreased platelet count, elevated serumalkaline phosphatase, bilirubin, BUN, creatinine, blood glucose, LDH, and phosphate.

When follow-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 all reported at afrequency 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 ZITHROMAXI for oral suspensionfor the treatment of children with acute otitis media and community-acquired pneumonia is 1 O mg/kg as a single dose on thefirst day (not to exceed 500 mg/day) followed by 5 mg/kg on days 2 through 5 (not to exceed 250 mg/day).Pharyngitis/Tonsillitis: The recommended dose for children with pharyngitis/tonsillitis is 12 mg/kg once a day for 5 days(not to exceed 500 mg/day).ZITHROMAXI for oral suspension should be given at least I hour before or 2 hours after a meal.ZITHROMAXI for oral suspension should not be taken with food.

More detailed professional information available on request.Revised January 1997

WA97 @US.~~~~~~~~~~~~~~IPharmaceuticalsZCl178(D~1997, Pfizer Inc

The antibiotic solutionwith predictable results in

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Key Pathogens:H influenzae, S pneumoniae, and

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Predictable Results:Proven as effective as

AugrnientinOl 5,6:P

Predictable Convenience:The only 5-day, once-daily

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Predictably VWell Toleratd:

Only 0.3% discontinuation dueto side effects

The most frequent side effects are

diarrhea/loose stools (2%), abdominal pain (2%),vomiting (1%), and nausea (1%). Zithromaxe

(azithromycin) is contraindicated in patients withknown hypersensitivity to azithromycin,erythromycin, or any macrolide antibiotic.

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