NEVV FELLOVVS.E ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~

Nada Salman, M.D., FAAPAbu-DhabiUnited Arab Emirates

Connecticut

Richard Herklots,M.D., FAAPDanielson, CT 06239

Massachusetts

Thomas Cody, M.D., FAAPDuxbury, MA 02331

David Hanauer, M.D., FAAPBrookline, MA 02446

Anesthesiology SpecialtyFellowSteven Zgleszewski,M.D., FAAPBoston, MA 02116

Rhode Island

Heather Chapman,M.D., FAAPCranston, RI 02905

Vermont

Sandra Kapsalis, M.D.,FAAPEssex Junction, VT 05452

New York 1

Kapriel Danadian,M.D., FAAPOneida, NY 13421

Steven Kamenir,M.D., FAAPSlingerlands, NY 12159

Cynthia Rand, M.D., FAAPRochester, NY 14625

Kenneth Sobel, M.D., FAAPElmira, NY 14905

Lisa Winchester,M.D., FAAPBuffalo, NY 14222

NewYork2

Neurological Surgery FellowMXark AAittler, M.D.FMPrANew Hyde Park, NY 11042

NewYork3

Anthony Barone,D.O., FAAPStaten Island, NY 10314

Sar-a Kenamore, M.D., FAAPTuckahoe, NY 10707

Rekha Sivadasan,M.D., FAAPWhite Plains, NY 10603

Dear Academy Fellow:In order to fulfill the admission requirements of AAP Bylaws, you are requested to:Carefully review the following list of new Fellows for Academy membership; and relay yourreactions directly 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 thatacademic and pediatric credentials are not in question. Comments are requested concerningpossible legal and/or ethical situations which you might have personal knowledge.Send any comments on the following list of new Fellows to your District Chairperson.

Delaware

John Grandy, M.D., FAAPHockessin, DE 19707

Maryland

Meghan Chiu, M.D., FAAPBroomes Island, MD 20615

Robert Gancayco,M.D., FAAPLaytonsville, MD 20882

Elisdel Garcia, M.D., FAAPFrederick, MD 21701

Patricia Hough, M.D., FAAPFrederick, MD 21704

Michael Skolnick,M.D., FAAPBroomes Island, MD 20615

Namrata Wheeler,M.D., FAAPBethesda, MD 20814

New Jersey

Olga Espinosa, M.D., FAAPNeptune City, NJ 07753

Pennsylvania

Panagiotis Georgelos,M.D., FAAPBroomall, PA 19008

Surgery Specialty FellowDavid Hackam, M.D., FAAPPittsburgh, PA 15213

Anesthesiology SpecialtyFellowBruce Levine, M.D., FAAPPhiladelphia, PA 19140

Fauzia Maqbool,M.D., FAAPSinking Spring, PA 19608

Dermatology SpecialtryFellowAndrea Zaenglein,M.D., FAAPHershey, PA 17033

West Virginia

Davangere Jayaram,M.D., FAAPCharleston, VWV 25302

:Elizabeth Morphis,.M.D.,FAAP*.Hartsville, SC 29550

:Tennessee

:Roger Coffman, M.D.,FAAP*Signal Mountain,:TN 37377-1500

*V\irginia

:Jeffrey Bobrowitz,M.D., FAAP

.:Chester, VA 23836

:Michael Ficenec,*M.D., FAAP.Charlottesville, VA 22911

:ChristineThorogood,M.D., FAAP*Chesapeake,VA23320

0

:Shelley Martin, M.D., FAAP*Baton Rouge, LA 70808

*Mississippi

*Andres Ramgoolam,:M.D., FAAP*Clarksdale,MS38614

*Oklahoma

*Jana Adams, M.D., FAAP.Oklahoma City, OK 73120

:Texas

:Anesthesiology Specialty*Fellow:Euleche Alanmanou,M.D., FAAP*Corpus Christi, TX 78414

:Dara Dallas, M.D., FAAP*Galveston,TX77554

*Aurora Gilley, M.D., FAAP.Kingwood, TX 77345

:Omar Gomez, M.D., FAAP*Fort Worth, TX 76137

*Jennifer Steeger,:M.D., FAAP.Tyler, TX 75701

:Arizona

:Sophie Lanciers,M.D., FAAP

:Tucson, AZ85718

:Idaho

:Nancy Mann, M.D., FAAP.Pocatello, ID 83209

*Utah

Kathleen Adelgais,:M.D., FAAPSalt Lake City, UT 84102

Suzanne Holbrook,:M.D., FAAP*Salt Lake City, UT 84102

.California 1

:Sean Cooke, M.D., FAAP*Sacramento, CA 95823

*California2

|:Surgery Specialtry FellowIRobert Burns, M.D., FAAP

Los Angeles, CA 90027

*Paul Carbone, M.D., FAAP.Temecula, CA 92592

:Ericka Hong, M.D., FAAP*Chino, CA 91710

*Chia-Chieh Hu, M.D., FAA.Arcadia,CA91006

I

Catherine Jolma,M.D., FAAPTemecula, CA 92592

Soloman Laktineh,M.D., FAAPWhittier, CA 90605

Leanne Miller, M.D., FAAPAzusa, CA 91702

California 3

Irene Fu, M.D., FAAPChula Vista, CA 91911

California 4

Jennifer Linzmeyer,D.O., FAAPHuntington Beach,CA 92647

Alabama

Rifat Parwaiz, M.D., FAAPBayou La Batre, AL 36509

Barry Starr, M.D., FAAPBirmingham, AL 35212

Florida

David Berman, D.O., FAAPSt Petersburg, FL 33704

Thresia Gambon,M.D., FAAPMiami Beach, FL 33141

Hossain Marandi,M.D., FAAPSt Petersburg, FL 33716

Emergency MedicineSpecialty FellowDaniel O'Leary, M.D., FAAPTampa, FL 33606

Scott Osborne, M.D., FAAPSt Petersburg, FL 33701

Richard Wilde, M.D., FAAPWesley Chapel, FL 33544

Georgia

Frances Frigon, M.D., FAAPSavannah, GA 31404

Meenakshi Hari,M.D., FAAPKennesaw, GA 30144

Marta Rogido, M.D., FAAPAtlanta, GA 30322

Crystal White, M.D., FAAPAtlanta, GA 30316

Ontario

Jae Kim, M.D., Ph.D., FAAPToronto, ON M5G1 X8Canada

Illinois

Vishwanath Agrawal,M.D., FAAPNaperville, IL 60563

Sheba Antony, M.D., FAAPDarien, IL 60561

Roger McClintock,M.D., FAAPRochester, IL 62563

Jenny Tan, M.D., FAAPSt Charles, IL 60174

Iowa

Neeru Aggarwal,M.D., FAAPClinton, IA 52732

Kansas

Nicholas Pham, M.D., FAAPWichita, KS 67226

Minnesota

Laurel Anderson,M.D., FAAPMarine on St Croix,MN 55047

Young Juhn, M.D., FAAPRochester, MN 55902

Laura Mohling, M.D., FAAPChaska, MN 55318

Missouri

Allison King, M.D., FAAPClayton, MO 63105

Claudia Preuschoff,M.D., FAAPPoplar Bluff, MO 63902

Nebraska

Thomas Attard, M.D., FAAPOmaha, NE 68198

Wisconsin

Edward Muellerleile,M.D., FAAPMilwaukee, WI 53207

IArkansas

Josephine Co, M.D.,FAAP,Little Rock, AR 72211

:Louisiana

:Wei Gong, M.D., FAAP0Monroe, LA 71203

Indiana

Kellie Hughes, M.D., FAAPFishers, IN 46038

Christian Strachan,M.D., FAAPZionsville, IN 46077

Michigan

Erin Brackbill, M.D., FAAPYpsilanti, MI 48197

Kavitha Chintala,M.D., FAAPDetroit, Ml 48201

Jane Johnson, M.D., FAAPWaterford, Ml 48328

Gayathri Nair, M.D., FAAPHolt, Ml 48842

Ohio

Jeffrey Drasnin, M.D., FAAPCincinnati, OH 45202

Cardiolgy Specialty FellowPirooz Eghtesady,M.D., Ph.D., FAAPCincinnati, OH 45229

Cheryl Kirkby, M.D., FAAPGrove City, OH 43123

Lisa Krumm, M.D., FAAPGrove City, OH 43123

Joseph Leanza,M.D., M.H.S.Mason, OH 45040

Kalpana Mohan,M.D., FAAPCanton, OH 44704

Prabhu Parimi, M.D., FAAPBroadview Heights,OH 44147

I

3

North Carolina

James Robertson,M.D., FAAPMount Airy, NC 27030

South Carolina

Meghan Geils, M.D., FAAPCharleston, SC 29412 kP

302 AAP Nlews www.aapnews.org December 2003

---- - ---- -- 11 11111111 1111111 11 111111;

bb,IS l- 0

.:fff qffi00 Il IuS0 i00SS$00000 !0f0fi --q

DISTRICT I

Eileen M. Ouellette,M.D.. J.D.Pediatric NeurologyNorth Shore Children'sHospital57 Highland Ave.Salem, MA 01970-2197e-mail: eouellette?aap.org

DISTRICT II

Robert M. Corwin, M.D.Medical Director- MedBest251 Salina Meadows PkwySuite 100Syracuse, NY 13212-4572e-mail: rcorwin?aap.org

DISTRICT III

Alan E. Kohrt, M.D.Medical Director/Children's Health NetChildren's Hospitalof Philadelphia34th and Civic Center Blvd.Philadelphia,PA 19104-4399e-mail: akohrt?aap.org

DISTRICT IV

David T. Tayloe, Jr, M.D.2706 Medical Office PlaceGoldsboro, NC 27534-9460e-mail: sewardsEaap.org

N EVV.DISTRICT V

.Ellen Buerk, M:Oxford Pediati*5141 Morning:Oxford, OH 41e-mail: ebuerk

:DISTRICT VI

*.Kathryn Piziali:1314 Morrisor*Madison, WI,":e-mail: knichol

:DISTRICT Vll

:Gary Q. Peck,:Office of Publi*325 Loyola A\J:Suite 513*New Orleans,:LA70112-182e-mail: gpeck(

Ameriof Ped:*DEDICATEI

*DISTRICT VIII

*Jon R. Almquist, M.D.:Virginia Mason Medical*.Center:Department of Pediatrics33501 First Way SouthFederal Way,*WA98003-6208.e-mail: jalmquist?aap.org

:DISTRICT IX

:Burton F. Willis, M.D.*9900 Talbert:Suite 201*Fountain Valley,:CA92708-5153*e-mail: bwillis?aap.org

*DISTRICTX

.Charles Linder, M.D.:Medical College of Georgia1120 15th St.Rm. HF1117Augusta, GA 30912-0004*e-mail: clinderWaap.org

4\.D.tricsagSun Rd.15056-9722kEaap.org

Nichol, M.D.n St.53703-3812lO~aap.org

,M.D.lic Healthvenue

29Oaap.org

If you're looking for a healthcare setting where vou can feel personally and professionaUly at home, thenGundersen Lutheran is right where vou belong. Here, youl'll find metropolitan-scale medicine, educationand research amid a small to)wn character and comfort. Gunders-en Lutheran Medical Center, a 235-bedteaching hospital with a Level 1I trauma and emergency center, and its 45 medical facilities serve morethan 500,000 residents in three states. Within our multi-specialtv group practice, you'll work with morethan 440 medical staff members withihl a 25-clinic network practicinig in the L-a Crosse, Wisconsin area.

The Department of Pediatrics at Gundersen Lutheran is seeking a full-time pediatric gastroenterologist.The GI department has six board-certified adult gastroenterologists mild a state-of-the-art GI procedurelab available.

The Department of Pediatrics has 20 pediatricians, sLx PNPS, four NNPs, and one PA. Our pediatricsubspecialty areas include hematology/oncology, orthopedics, asthma/allergy/immunology,ophthalmo)logy, surgery, nieoniatology, netirodevelopment, neurology, genetics, and pediatric ICU. Thepediatric inpatient service also includes a twelve patient NICU, a four patient PICU, and a 20 patienltpediatric inipatient service.

We offer an excellent compensafion/benefits package, including relocationl expenses and continuingeducafion oppotlunities. Interested candidates should contact Gale Kreibich, Medical StafifI)evelopment, Gundersen Luthieran, 1910 South Ave., La Crosse, WI 54601 at (800) 362-9567, Ext. 56863, Email: gkreibicEgundluth.org or Dr. Richard Strauss, Chair, Dept. ofPediatrics, Gundersen Lutheran, 1836 South Ave., la Crosse, WI 54601 at (800) 362-9567,Ext. 52809, Email: rhstrauss@gundluth.org.

ican Academy.iatricsD TO THE HEALTH OF ALL CHILDREN .

We support a safe, healthy and drug-free work environment throughbackgrotind checks and controlled substance screening. EOFJAA.

www.gundtuth.org

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IDEAS FOR LIVING, INC. BOULDER, COLORADO

December 2003 www.aapnews.org AAP News 303

F EL LOVWVSRIv Wh16vv

PEDIATRIC GASTROENTEROLOGIST

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TheRightCre. RightHere. .M

Cireersen

The WVIRELESSalarni that wakes

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ADVANCES IN PEDIATRICS 2004This conference will provide the busy pediatrician with updates from

experts on the following common problems:Minimally Invasive Surgery Tonsillectomy / Adenoidectomy

Pediatrics Ortho Neonatal JaundiceSeizures ADD /ADHD

BOTOX / SpasticityWednesday, March 3, 2004

8:00 am-4:00 pmAdvocate Lutheran General Children's Hospital

Park Ridge, IL

This activity has been approved for AMA PRA CreditFor more information or a brochure, please contact bill.norrisgadvocatehealth.com,

or phone (847) 384-3608.z UNIVERSITYOF With more than 9,400 fullHime and part-time faculty and staff, the University of' V ~~~~Miami is the largest private employer inMiami-Dade County. We offer a| _ ~~~competitive and comprehensive benefit package which includes medical/dentalSHOOFMDCN coverage, tuition remission, 13 paid holidays and more!

Tociay, the University of Miami is the largest, most comprehensive privateresearch university in the southeastern United States with a well-earned reputation for academicexcellence. Make a difference and join our team of professionals in the following position:

Pediatric PulnmonoogistThe University of Miami/Jackson Memorial Medical Center is currently recruiting a full-timeboard certified/eligible Pediatric Pulmonologist or Allergist to join the other faculty members ofthe Division of Pediatric Pulmonology. Must have or be eligible for a Florida Medical license.Primary responsibilities will include daily operation of our comprehensive Cystic Fibrosis Centeraccredited by the CF Foundation. The clinical and research activities are conducted within astate-of-the-art facility - the new Batchelor Children's Institute. Ample opportunity exists forclinical and basic science research. Our clinical programs include an ACGME-accreditedFellowship Training Program (3 fellows), Asthma Center, and Lung Transplant Program. Inpatientand outpatient pediatric pulmonary function laboratories with exercise testing capabilities and afully equipped bronchoscopy suite are available.Send curriculum vitae to: Giovanni Piedimonte, MD, Director, Pediatric Pulmonary Division,University of Miami School of Medicine, 1580 NW 10th Ave., #125 (D-820), Miami, Florida 33136;Tel: (305) 243 3176; Fax: (305) 243-1262; or E-mail: gpiedirnofted.milarni.edu

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> \; X te(66qS EXHECLOI/STERs

June 16-19, 2004 * The Cloister *Sea Island, GeorgiaWilliam P. Kanto, Jr., MD, FAAP, Program Chair

Sponsored byGeorgia Chapter * American Academy of Pediatrics

Celebrating 50 years... .1954-2004!

For information contact Nefertiti Yungai * (404) 881-5091 * Fax (404) 249-9503nyungaiEmag.org, or visit our Web site at www.gaaap.org

Santa Fe is one of thes ii-ost widelk, kiiowni cities in the wnorldl. "Thte Citvr Differ-elt't is 7,000( feet'abovc sea level witlh nearbvt pealks as ilglih .Ls 14.00() fet, and has a rich traldit'ioii as a CUtUltralkl diNel'seniationial art center ;ind offers a ftill range of~outdoor recrealtional activities.

St. Vincent Hospitall is al iion-profit., 268-beod, Level III TIraun-ia Center, accredited by JCAHO).Oltii pedialtrics clinic has anlOopportunlity -or a1 BC'/BE pediatrician to join a six pediatricil/TNgroup clS soon as pzossible. Inpatienlt and otitpatictit responsibiltity arid v*rk,r i-casonable call scieodtile.Competitive salary allid excellent ben)efits.For information or to apply, please contact:

Crvst,ll von WNhis permiaii,D)irector. Phvsician Recr-tiitrnent & Relations,50.5/82()-5779 or 50)5/603A-0370, Fax505995)490 N95-g'2( iv

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^ Oiie 1-iiile pitr-htise -tio licen1sefee or aiiinilal contract* Personliized with practice tifmne, address atid phonle niio1lbers* Contpwlilant witli the mtost receittgiiidelities. I'riii t as ntaiiy or asfjew as yoit like Piermed, IncDigital TeJ}ip la tes Advaiitages: htf2-to'R.i1-Kisz IS'IS* Rapid anid thorough documentatioii of each encouiiter* Age-appropriate historv, physical exam, procedures and assessmelit/plan sections* Sliare a commoni designi: check boxes, coluimns, symptom lists and more* Provided in Adobe PDF format on a CD-RO.N4

304 AAP News www.aapnews.org December 2003

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CLASSIFIED ADVERTISING POLICYWhen you need to contact pediatricians, contactAAP News. Each month more than 57,000 pediatricians, pediatric specialists, third-year pediatricresidents and other subscribers turn toAAP Newsfor child health information they cannotget elsewhere. With a classified ad, you can speak directlyto those readers.

CLAS SI FlI EDADS

vvXvss. wliffirilvwu uumm. uUmualni VI utulwlag ludlaM LautaIawlwimvgillym yray aliurig *1InuvlMlas se DOSANE^D ADMINSRTO for spefck dosing recomeddovns

Afterte diagnoi of seiomembra'nous cofts has been estabished, thaeutc measures should be inKOW. Middcase of pseudownSmnous oolti usually respond to disontinuat on of the drug alone. In moderate to sevre cases,consdraon sthould be given to manoW t with fluids anld elecs,r¢ protin supplerentation, and ftretrent withan anfbacterial drug clinically effective against aosW7ium dffliecolitis.

PRECAUTIONSGeneral: Because azithromycin is principally eliminated via the liver, caution should be exercised when azithromycinis administered to patients with impaired hepatic function. Due to the limited data in subjects wih GFR <10 mUmin,caution should be exercised when prescribing azithromycin in these patients.The following adverse events have been repoorted with macrolide products: ventricular arrhytmias, including

ventricul archycardia and torsade depoines in indivduals with prolnged QT irtervals.There has been a spontaneous report from the post-marketing experience of a patient with previous hisory of

arrhthfmias who experienoed tosd de pointes and subsequerd myocardial infarctin following a course ofazithromycin therapy.InfmonnUn for Patients: ZITHROMAX* oral suspension can be take with or without food.

Patients should also be cauffoned not to take aluminum- and magnesium-=otaining antacids and azithromnycinsimulaneously.

Thle patient should be directed to discontinue azithronrycin immediately and contac a physician H arry signs of analleric reaction occur.Drug bdtioms: Co-administsafo of neffinavir at steadystate with a single oral dose of azithromosn resubtd inir resed azithmycin serum concritrations. Ahough a dose adjustrnent of azftromnycin is not recommended whenadministered in cornbnation wnth nelfinavir, close mwonitng for knww side effects of azithromycin, such as Ih/r enzymleabnormalities and hearing impairment, is wafanted. (See ADVERSE REACTIONS.)

Azithmmrycin did not affect the prothrombin firme response to a single dose of warfarin. However, prudent medicalpractice dictates careful monitoring of prothrombin time in all pafients treated with azithmmycin and warbarinconcmitanUy. Concurrent use of macrolkdes and watarin in clinical pracfie has been associated with increasedanfcoagulant effects.

Drug irnteracfion studies were perforrned wfth azithromycin and other drugs likeelyto be co-administered. Mme usedin therapeutic doses, azithromycin had a modest effect on the pharmacolinetics of atorvasStain, carbmiazepne,cefirizine, didanosine, efavirenz, fluconazole, inldinavir, midazoiam, rifabutin, sildenafl, theophyline (intravenous andoral), triazolam, trimethopdriVsutfmrethoxazole or zidovudine. Go-administration vifth efavirenz, or fluconazole had arnodest effect on the pharmacokiretics of azithromycin. No dosage adjustment ot either dnug is recornmended whenazithromycin is coadministered with any of the above agenits.

Irnteracfions with the drugs listed below have not been reported in clinical trials with aziffhrornycin; however, nospecific drug interaction studies hav been perfonned to evaluate potentia drug-drug interactiDn. Nonetheless, thehave been observed with mnacrolide products. Until further data are develope regaring drug interactiors whenazfthromycin and these drugs are u:sed concomitantly, careful monitoring of paWtiet is advised:

Digoxin elevated digoxin concentrations.Ergotamine or dlhydroergotamiercue ergot toxicity characterized by severe pertpheral vasospasm anddysesthesia.Terfenadine, cyclosporine, hexobarbital and phenyoin cocnmns.

Laboratory Test lnteracffors: There are no repofted laboratory test interactions.Caruinogenesiis, Mutagenesis, Impainnent of Fertility: Long-terrn studies in animals have not been performed toevaluate carcinogenic potentia. Az thromycin has shown no mutageic potential in standard laboratory tests: mouseIyrphoma assay, human lymphocyte clastogenic assay, and mouse bone marrow clasogenic assay. No evidenc ofimpaired fertgityb due to azithrornycin was found.Pmgnancy Teratogenic Effects. Pregnancy Category B: Reproduction studies have been performed in rats and miceat doses up to moderately maternally toxic dose concentrations (i.e., 200 mg/kg/day). These doses, based on amg/rn' basis, are estimated to be 4 and 2 Umes, respecfively, the human daiiy dose of 500 mg. In the animal studies,no ev ence of harm to the fetus due to azithromycin was found. There are, however, no adequate and well-controlledstudies in pregnant women. Because animal reproduction studies are not atways predictive of human respors,azithromycin should be used during pregnancy only it clearly needed.Nufsing Mothe: It is not known whether azfthromycin is excreted in human milk. Because many drugs are excretedin human milk, caudon should be elxercise when azithromycin Is administered to a nursing woman.Pediatrc Use: (See INDICATIONS AND USAGE and DOSAGE AND ADMINISTRATION.)

Although theAcademy believes these classified ads are from reputablesources, the Academy does not investigate the offers made and assumesno responsibility concerning them.

Occasionally, it is necessary to modify the wording of classified ads.These changes are generally made in compliance with the regulations ofvarious federal and/or state commissions against discrimination orbecause they might be interpreted as being unlawful or in conflict withaccepted professional standards of medical practice.

These advertising modifications are made to maintain a classifiedsection that is professionally responsible, lawful, scientific and free ofdiscrimination .

Publication of an advertisement in AAPNews neither constitutes norimplies a guarantee or endorsement by AAP News or the AmericanAcademy of Pediatrics of the product or service advertised or of theclaims made for the product or service by the advertiser.

Classification: Classified ads are accepted under Business Services,General Announcements, Medical Meetings, Physicians Wanted,Positions Wanted, Practices Available, Publica- tions, Real Estate andResidencies /Fellowships Available.

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

For more information, contact: Roland Keve, The Walchli TauberGroup, (443) 512-8899, ext. 101 or fax (443) 512-8909. Ad copy is to besent to: The Walchli Tauber Group, 2225 Old Emmorton Rd., Ste. 201, BelAir, MD 21015. Payments are to be mailed and made payable to TheAmericanAcademyofPediatrics, Dept. 77-5194, Chicago, IL60678-5194.

Augmentin (amoxicillin/clavubanate potassium) is a registered tradernark of GlaxoSmithKline.

ZffHROMAXO(azitromycin ofo oral s1upension)

BRIEF SUMMIARYINDICATIONS AND USiAGE

ZITHROMAX (azithromycin) is indicated for the treatnment of patiernts with mild to moderate inftecfions (pneumonia:see WARNINGS) caused by susceptible strains of the designated microorganisms in the specific conditiorts listedhAlnw A-q mw.mmmAnrlw rLmamm drifxninnq nf thprAnu 2nrl ;mnlirmh1p n2tiknt nnru d2finn v2rv nmnnn thoeme infhr4innc

Acute Otifis Media (total dosage regimen: 30 mgtkg, see DOSAGE AND ADMINISTRATIION): Safety andeFWtm in the treatmevnt of children wWh otitis media under 6 monf of age have not been established.

Community-Acquired Pneumonia (dosage regimnen: 10 mglk4 on Day 1 follovwed by 5 mg/k on Days 2-5): Safetyand effecfveness in the treatmerd of children with community-acquired pnemonia under 6 rnonth of age have notbeen establshe. Safety anld effectiv#les for prneurnonia due to ChlanydWa pneumoniae and Mycq#smpneumoniaewere documented in pediatric clinical trias. Safety and effectieness for pneumonia due to Haernophilusinfluenzaeand Streptococus pneumwniae were not docurnented bacteriologically in the pediatric dinical tria due todiffiutty in obtaining specimens. Use of azithrornycin for thes two microorganisms is supported, however, byevidence from adequate and welFcontrId studies in aduits.

Pharyngiffs/TonsiHlitis (dosage regirnen: 12 mg/g on Days t -5): Safety and effectveness in the treatff of childrenwith pharyngiWlonsillitis under 2 years of age have not been established.

Studies evaluatng the use of repeated coums of therapy have not been conhdused.Geriatric Use: PhamrnacoWkiec parameter in okler volunteers 165 85 years old) were simflar to those in youngervolunteers (18 40 years old) for the 5-day ftweapeubc regirmen. Dosage adjustrn,et does not appear to be necessary forolder patierft wit nomral rena and hepatic funcSon roeiving treatment wit ttis dosage regane

In multiple-dose clinical triaK of oral azithrornycin, 9YO of pafint were at least 65 years of age (458/4949) and 3%of patients (1444949) were at least 75 years of age. No overall differences in safety or effviss were observedbetween these sublects and younger subjects, and other reported clinical experience has not identified dtferences inresponse between the elderly and younger paffents, but greater sensitivity of some older individuals cannotbe ruled out.ZITHROMAX(@ for oral suspension t00 mg/5 mL contains 3.7 mg of sodium per 5 mL of constituted

solution. ZiTHROMAX( for oral suspension 200 mg/5 mL contains 7.4 mg of sodium per 5 mL of constitutedsoluffon.

ADVERSE REAICTIONSIn ctiniral trials, most of the reported side effects were mild to moderate in severity and were reversible upondiscordtinuation of the drug. Potentially serious side effects of angioedema and cholestatic jaundice were reportedrarely. Approximately 0.7°1/o of the patients (adults anad children) from the 5-day multiple-dose ciinica trialsdiscortinued ZITHRO (azithromycin) therapy because of treatment-related side effects. In adults given 500mg/day for 3 days, the disconitinuation rate due to treatrnent-related side effects was 0.4%. In cdinical trials in childrengiven 30 mg/kg, either as a single dose or over 3 days, discontinuation from the trias due to treatrnent-related sideeffects was approximates 1%. (See DOSAGE AND ADfMIIIATISTON.) Most of the side effects leading todisconitnuation were retate to the gastrointestinal tract, e.g., nausea, vomiting, diarrhea, or abdominal pain.Clinical:Childrn: Single anedMutiple-dose regirnens:The bpes of side effects in children were comparable to those seen inadults, with different incidence rates forthe dosage regimens recomrnended in children.

Acute Otifs Media: For the rcmmmended totW dosage regimen of 30 mg%, the rnost freqiuerd side effects (21%)attributed to treatment were diarrhe, abdominal pain, vomfifng, nausea and rash. (See DOSAGE ANDADMINISTRATION.) The bidence based on dosing regimen, is described in the table be ow:

1-day 4.3%o 1.4% 4.9O lo0*o .Wo3-day !2.6% 1.7% 2.30/ 0.4% !0.6%5- 1.8%/ 12Yo 1.1% 0.5°h i0.4%Community Acquired Pneumonia: For tile recommended dosage regimen of 10 mg*kg onl Day 1 follove by

5 mg/kg on Days 2-5, fth most frequent side effects attributed to treatmer t were diarrhlea/loose stools (5.8Yo),abdorninal pain, vomiffng, nausea (1 .9°1/o each), and rash (1.V6%).

PharyngitisitonsilWis: For the recommended dosage regirnen of 12 mg/k on Days 1-5, the rnost frequent sideeffects attributed to treatrnent were diarrhea (5.4%), vomifing (5.6%), abdominal pain (3.4YO), nausea (11.8o), rash(0.7%), and headache (1.1%).

Wfth any of the treatnnet regimens, no other treatrnent-related side effects occurred in children treated withZITHROMAXwith a frequency greater than 1%. Side effects tha occurre with a frequency of 1% or less included thefollowing:Cardiovascuslar. Chest pain.Gastointestinal: Dyspepsia, constipation, anorexia, enteritis, flatulenc, gastritis, jaundice, loose stools and oralmoniliasis.Hmatologic and LylWfic: Anemia arW leukopenia.Nervou Sydem: Headache (otitis media dosage), hyp)erkinesia, dizziness, agitaion, nervousness and insomnia.Genral: Fe.ver, face edema, faigue, fungal infection, malaise and pain.Allorgk: Rash and allergic reaction.Respiratory: Cough increased, pharyngTtis, pleural effusion and rhinitis.SWdn and Appendages., Eczema, fungal demiatfis, pruritus, sweafing, urticaria and vesiculobullous rash.Specal Sense: Conjunctiviis.Post-Marketing ExperEence:Adverse events reported with azithromycin dunng the post-mnarketing period in aduit and/or pediatric patients forwhich a causal reltonship may not be estatlished include:Albtfgk: Arthralgia, ederna, urtcaria and angioedeffa.Cardlvaular: Arrhythmias including ventricular tyarydia and hypotension.Gastrintestinal: Anorexia, comsfipabon, dyspepsia, flatulence, vorniting/diarrhea rarely~resultfing in dehydration,pseudomembranous colitis, pancreatitis, oral candidiasis and rare reports of tongue discoloratin.General: Asthenia, paresthesia, fatigue, rnalais and anaphylaxis (rarely fatal).GenHtourinasty: Interstial nephrfits and acute renal failure and vaginitis.Hlematpolefk: Tharombocytopenia.Lhor/Billary: Abnormnal liver function including hepatiHis and cholestatic jaundice, as well as rare cass of hepaticnecrosis and hepatic failure, sorme of which have resutted in death.Nom Systm: Convulsions, dtzzinessJverfio, headache, somnolenc, htyperactivit, nervousrness, agitation and

syncope.Psychialr: Aggressive reaction and anxiety.Skin/Appendages: Pruritus, rarely serious skin reactions including erythema multforrme, Steverns JohnsonSyndrorme and toxic epidermal necrolyis.Special Sensesi Hiearng disturbances including hearing lms, deafness and/or finnitus and raire reports of tasteperverson.Laboratory AbnormaliUles:Children: One, Thm88 and FNe Day Rzegime: Laboratory data collected from comparative clinical trials employngtwo 3-* regimens (30 mgkg or 60 mgtkg in divded doses over 3 days), or two 5-day regimens (30 mg/k or 60mg/kg in divied doses over 5 days) were similar for regimens of azfthiromycin anld all comparators combinted, withmost clinically significant laboratory abnorrnalities occurring at incidences of1-5%. Laboratory data for patients receiving 30 mg/kg as a single dose were collected in one single center trial. Inthat trial, an absolute neutrophil count between 500 1500 cells/mm' was observed in 1G(4 patients receving 30mg/kg as a single dose, 9162 patients receivng 30 ffng/kg9iven over 3 days, and &/63 comparator patients. No pafienthad an absolute neutrophil cournt <500 cells/Fmm3. (See DOSAGE MiD ADMIiNISTRATION.)

In muitiple-dose clinical trials involving approxirnately 4700 pediatric patierts, no pafients discortinueci theapybecause of trubeadn-reated laboratory abnormaiities.

DOSAGE AND ADMINISTRATION (See INDICATIONS JUND USAGE.)ZlITROMAX for oral sulspension can be taken with or without food.Acute OUftis Media: The recommencied dose of ZITHlROMAX for oral suspension for the treatmenet of children withacute otitis mnedia is 30 mgtk given as a single dose or 10 mg/kg once daily for 3 days or 10 mg/kg as a single doseon the first day followedi by 5 mfg/lday ont Days 2 through 5. The safety of re-dosing azfthromycin in children whovomit after receiving 30 rng/kg as a single dose has not been establishedi. In cliniai studies intvoivng 487 pafientswfith acute otitis media given a single 30 mglkg dose of azithromycin, eight patients who vomited within 30 minutesof dosing were r-dosed at the same total dose.Community-Acquired Pneumonia: The recommended dose of ZITHROMAXO for oral suspension for thetreat met of children with community-acquired pneurnonia is 10 mg/kg as a sftle dose on the first day foJlowed by5 mg/kg on Days 2 through 5.PharyngffiVtionsillHis: The recommended dose of ZITHROMAX for children with pharynitis/tonsillitis is12 mgfg once daily for 5 days.FortreredeblledproduclInforruionpleaserekrto lbefullprwscibinginformaSon orcall 1-800 879-3477.

Rev.1 October 2002

Children: (See PRECAUTIONS--Pdiatric Use.)AuRe otits media caused by hfarulphilus influenzae, Moraxellb catarrh7alis or Streptococcus pnurmoniae. (For

specific dosage recommendabon, see DOSAGE AND ADMINISTRATION.)Comm ntyacquired pneumonia due to Chlamuydia pneumoniae, Haemophi/us infkuenizae, Mycoplasma

pneumoniae or Streptococcus pneurnoniae in patients appropriate for oral therapy. (FDr specific doaerecommerEdaon, see DOSAGE AHD ADMINISTRATION.)NOTE:Azth omycin should not be used in padialri patients with pneumonia who are judged to be

inappropriate for oral therap because of moderate to sevre illness or risk btaoms such as any of thefollowing: patients wihb cysfi fibrosis, patients with nosocomhialy acquired infectlons, patients wihhknwn or suspoected bactemmis, patients requiring hospitalization, or patients with significantundertyng hcsffl pmWboms tht may compmomise their abilifty to respond to their illinss (includingimnmunodeficiency or functional asplenla).

Pharyngitis/tnsillitis caused by Streptococcus pyogenes as an altemafive to fist-fine therapy in irndhivuals whocannot use first-line tUwapy. (For specific dosage recommndon, see DOSAGE AND ADMINISTRATION.)

NOTE: PeniciPin by the intramuscular route is the usual drug of choice in the teatment of Streptococculs pyogenesiryfectin and the prophlais of rheurniac fever. ZITHROMAX is often effecfive in the eradicaion ofsuscepffble strains of Streptococcuspyogesfrom the nasophary Because some strains are resistanttoZITHROMAXO, susceptibility tests should be perfomned wtle pafients arie trated with ZllROMA). Dataestablishing effiay of azithromrycin in subsequent prevention of rheumatic fever are not available.

Appropriate culture and suscepfb#Ry tests should be performed before treahrnent tD determnine the c-ausati orgaismand its suscepfbblity to azithromycin. Therapy wuE ZlTROMAX9may be initte before results of thiese tests are Mown;once the resuts becorn available, anfimicrobial therapy should be adjusted accordngly.

CONTRINDICATIONSZITROMAX is contraindicated in pafients with known hypersensitivity to azithromycin, erythromycin or anymacrolie anRibiotic. WMNINGSSerious allergic reactions, including angioedema, anaphylaxis, and dermtOologic reactiorns including StevensJohnson Syndrorne and toxic epiderrnal necrolyss have been reported rarely in patients onl azithrornycin thempy.Afflough rare, fatalifies have been reported. (See CONTOINICATIONS.) Despite initially successful symptoratictreatmntM of the allergic symptoms, when symptomatic therapy was discorinued, the allergic symptorns recurredsoon threafr in some patients wiRhout frher atfrmycin exposure. These pafients required prolongedperiods of observation and symptomatic treatment. The relationship of these episodes to the long tissue half-fie ofazithromycin and subsequent prolonged exposure to ar tigen is unknown at presenL

If an allergic reaction occurs, the drug should be discortinued and appropriate therapy should be instffhuted.Physicians should be aware that reappearance of the allergic symptorns may occur whwen symptomatic therapy isd scontinued.

In th nutent of pneumonia, azhnyi has only been shown to be safe and offuciv in the treabnent ofcommuniy-ac,uired pneumonia due to QzkNWdis pnovmoniae, Herrphilus Inflo e, Nbo pkmpnoumonh0s or Sbetococ:us pneamonis in patierds approprbate for mul drapy. Azithmmycn shwW not beused in patints with pneumonia who are Judged to be Inappropriate for ofal therapy becuse of modrate tosem lllnes or ris fatos wch as any of the following: pafents wffl cysli fibmss, patiends wihhnesocomially acquired infecUons, patienXt with known or suspected bacteremia, paffets requiringhospitallwation, oeJdly or debilftbtd patlenX, or patients with significant undertlfng healih problems that maycomprmise their abiliqy to respond to ftr Illness (including Immunodeficiency or hunctlonal asplenia).Pseudomembranous colflls has been reported with nearly all antibacteral agents and may range in smrqt

from mild to 1lifsatbning. Therefome, it Is important to consider this diagnosis In paUents who preent wHhdlarn1hea subsequent to the administation of ;ntibactral ages.

Treatmen;t uith aftilbacterial agents alters the norrnal flora of the colon and may permit overgrawth of rdostfidiaStudies indicate tha a toxin produce3d by Closftidium drffiile is a pnmary cause of "anbkti c-associated colitis."

HARRIET LANE - REPORT TO DEVELOPINGCOUNTRIES -The Children's HealthOrganization Relief and Educational Services(CHORES) and Sepracor Inc. need your helpin collecting used copies of the Harriet LaneHandbook (15th Edition ONLY) so that wemay ship them to pediatric practitioners indeveloping countries. Please ship to:CHORES, 1015 Atlantic Blvd. #155, AtlanticBeach, Florida 32233. We thank you. Checkout CHORES - www.chores4kids.org. at1 21670 0 2003 Pfizer Inc. All rights reserved.

December 2003 www.aapnews.org AAP News 305

New York -I am a Pediatrician looking fora full- or part-time clinic/practice setting inthe New York City area. Please call Susan at(212) 717-9505.

NORTHEAST

LOWER FAIRFIELD COUNTY, CONNECTI-CUT - Full-time partnership track positionavailable for BC/BE pediatrician. Join sevenother doctors in a two office, fast growingestablished practice. Hospital affiliation withLevel II nursery and pediatric in-house cov-erage. Competitive salary with excellent ben-efits. Fax CV to (203) 324-8539.

MID-ATLANTIC

BE/13C Pediatrician for a small group servinghigh medicaid population. On call 1 in 2.Covering 3 academic hospitals in CentralNew Jersey. Competitive salary and benefits.Fax resume to (908) 351-7212.

SOUTHEAST

ENERGETIC BC/BE PEDIATRICIAN WANTEDto join dynamic academically-oriented,nationally respected practice in Dade,Broward and Palm Beach County, Florida.Immediate openings in our Palm Beach loca-tions. Unparalleled lifestyle for primary carepediatrician with exceptional salary and ben-efits. Reply to: Pediatric Associates, PA 4620N. State Rd., 7 Ste. 316, Lauderdale Lakes, FL33319, Attention: Peter Shulman, M.D.,Physician Recruiting, or fax a current CV to(954) 967-6410.

Kentucky: BC/BE Pediatrician needed inHPSA location. J-1, Hl B permanent residentor U.S. citizen all welcome. Computer liter-acy preferred. Send CV to: AAP 6, P.O. Box969, Abingdon, MD 21009.

NORTHWEST

Montana - PediatricianThe Great Falls Clinic is seeking a PrimaryCare Pediatrician to join a 12-memberPediatric Department in a rapidlyexpanding 100+ provider, multi-specialtyorganization. We offer a benefit packageand salary leading to partnership. If inter-ested, send CV and professional goals to:Greg Hagfors, Administrator, P.O. Box501 2, Great Falls, MT 59403. E-mail:greg.hagforsEgfclinic.com. Web site:www.gfclinic.com.

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