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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 your reac-tions 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 that academic andpediatric credentials are not in question. Comments are requested concerning possible legal and/orethical situations of which you might have personal knowledge.Send any comments on the following list of new applicants to your District Chairperson by May 15.
Kathy Messina, M.D.1635 Barbara Ln.E. Meadow, NY 11554-4704
New York 3
Olubunmi Afonja, M.D.77 W. Haledon Ave.Haledon, NJ 07508-1323
Antonio Camilo, M.D.12 Dongan Place #308New York, NY 10040-1524
Michel Cohen, M.D.13 Harrison St.New York, NY 10013
Yineska Flores, M.D.645 N. Columbus Ave.Mount Vernon, NY 10552
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District of Columbia
Susan Cummings, M.D.1 11 Michigan Ave., NWWashington, D.C. 20010
Maryland
Iris Bazing, M.D.21 E. Hamburg St.Baltimore, MD 21230
Susan Klugewicz, M.D.1644 Angus Ct.Crofton,MD21114
Kevin Macready, M.D.144 Jefferson St.Annapolis, MD 21403
New Jersey
Cathleen Ballance, M.D.150 Kingsberry Dr.Somerset, NJ 08873
Helen Baluyot, M.D.13-34 Fourth St.Fairlawn, NJ 07410
Surgery Specialty FellowMike Chen, M.D.Division of Ped Surgery3 Cooper Plaza, Ste. 411Camden, NJ 08103
Pennsylvania
Debra Bogen, M.D.General Academic Pediatrics3705 Fifth Ave. G205Pittsburgh, PA 15213
Anne Callaghan, M.D.107 Luckie Ln.Media, PA 19063
Daniel Doyle, M.D.197 Logan St.Woodbury, NJ 08096-2659
Maureen Gilmore, M.D.1918 Wexford Rd.Palmyra, PA 17078
Congenital Heart SurgerySpecialty FellowRalph Siewers, M.D.Children's Hosp of PittsburghDept of Cardiothoracic Surgery3705 Fifth Ave.Pittsburgh, PA 15213-2583
Congenital Heart SurgerySpecialty FellowWilliam Novick, M.D.777 Washington, Ste. P215Memphis, TN 38105
Virginia
Wanda Ross, M.D.897 Gunston Ct.Newport News, VA 23608
Adnan Trabulsi, M.D.P.O. Box 1915Clintwood, VA 24228-1915
Atinuke Egbesemi-Rone, M.D.15324 Igleside Ave.South Holland, IL 60473
Daniel Eisenstein, M.D.Ste. B200750 Homewood Ave.Highland Park, IL 60035
Iowa
Elizabeth A. Ehrhardt, M. D.Ul Family Care Center3 Lions DriveNorth Liberty, IA 52317
Eyad Najdawi, M.D.2800 Pierce St., Ste. 207Sioux City, IA 51104
Kansas
Monica Pierson, M.D.20902 W. 63rd TerraceShawnee Mission, KS 66218-9101
Minnesota
Cathryn Angel, M.D.5778 Bryant Ln.Inrer Grove Hts., MN 55076
Shanna Bunce, M.D.2723 E. 1lst St.Duluth, MN 55812
Joanne Hilden, M.D.345 N. Smith Ave.St. Paul, MN 55102
William Rabe, M.D.15621 Andrie St., NWRamsey, MN 55303
Congenital Heart SurgerySpecialty FellowJoseph Dearani, M.D.Mayo Clinic200 First St., SWRochester, MN 55905
Missouri
Robert Sturdevant, D.O.802 N. Riverside, Ste. 250St Joseph, MO 64507
Anesthesiology Specialty FellowJay Androphy, M.D.Western Anes. Assoc., Inc.Ste. 20513537 Barrett Pkwy. Dr.St. Louis, MO 63021
Surgery Specialty fellowRandall Burd, M.D., Ph.D.Univ. Hospital & ClinicsDept. of Surgery#1 Hospital Dr.Columbia, MO 65212
Neurological SurgerySpecialty FellowBruce Kaufman, M.D.St. Louis Children's HospitalOne Children's PlaceSt. Louis,MO63110
Congenital Heart SurgerySpecialty fellowWilliam Robert Wilson, M.D.MA312, One Hospital Dr.Columbia, MO 65212
Nebraska
Congenital Heart SurgerySpecialty FellowKim Duncan, M.D.Children's Hospital8300 Dodge St., Third FloorOmaha, NE 681 14-4109
South Dakota
John Spangler, M.D.2905 S. 5th St.Rapid City, SD 57701
Alabama
Kathy Monroe, M.D.1729 Oxmoor Rd.Birmingham, AL 35209-4036
Arkansas
Joseph Thompson, M.D.UAMSDept of Pediatrics4301 W. Mackinaw St., Slot 512Little Rock, AR 72205
Louisiana
Godson Asamoa, M.D.1001 E. Dale St. #504New Iberia, LA 70560-4870
Michael Crapanzano, M.D.Ste. 1037777 Hennessey Blvd.Baton Rouge, LA 70808-4300
Carla Gayle, M.D.4429 Bancroft Dr.New Orleans, LA 70122-1203
Texas
Tammy Camp, M.D.P.O. Box 759Shallowater, TX 79363-0759
Michael Okogbo, M.D.403 N. HoustonP.O. Box 216Wildorado, TX 79098
Tom Tarkenton, D.O.The Medical Pavilion220 SW 26th Ave.Mineral Wells, TX 76067-9643
Congenital Heart SurgerySpecialty FellowDavid Cleveland, M.D.Ste. B3107777 Forest Ln.Dallas, TX 75230
Congenital Heart SurgerySpecialty FellowJames Duff, M.D.P.O. Box 301043533 S. AlamedaCorpus Christi, TX 78463-0104
Anesthesiology Specialty FellowMary Felberg, M.D.5523 Loch Lomond Dr.Houston, TX 77096
Congenital Heart SurgerySpecialty FellowLawrence Fox, M.D.801 Seventh Ave.Fort Worth, TX 76104
Congenital Heart SurgerySpecialty FellowJeffrey Heinle, M.D.Cook Children's Med. Ctr.801 Seventh Ave.Fort Worth, TX 76104
Congenital Heart SurgerySpecialty FellowSteven Leonard, M.D.Ste. C-3201935 Motor St.Dallas, TX 75235
Mai Abou Al-Seoud, M.D.P.O. Box 125Jeddah, 21411Saudi Arabia
Florida
Ana Alvarez, M.D.Nemours Children's Clinic807 Nira St.Jacksonville, FL 32207
Grisell Diaz De Villegas, M.D.2623 Yarmouth Dr.Wellington, FL 33414
Xiao Li, M.D.5100Jetsail Dr.Orlando, FL 32812
Kevin Maupin, M.D.5225 Carmel Heights Rd.Pensacola, FL 32504
Alvaro Moreno-Aspitia, M.D.10135 Gate Pkwy. N,. Apt #1507Jacksonville, FL 32246-8255
Mario Zambrano, M.D.14450 Glencairn Rd.Miami Lakes, FL 33016-1468
Orthopaedics Specialty FellowDennis Knapp Jr., M.D.83 W. Columbia St.Orlando, FL 32806
Georgia
Fiona Blair, M.D.5900 Hillardale Dr., Ste. 355Lithonia, GA 30058-3802
Robert Burnham, M.D.Roswell Pediatric Center1400 Alpha Ct., Ste. #100Alpharetta, GA 30004
Cathy Pak, M.D.2411 Crow Valley Rd.Dalton, GA 30720
Estonna Wells, M.D.4303 Millside Ct.Smyrna, GA 30080
Deborah Young, M.D.5558 Foxglen Cir.Lithonia, GA 30038
Kentucky
Congenital Heart SurgerySpecialty FellowErie Austin, M.D.201 Abraham Flexner Way, #1200Louisville, KY 40202
North Carolina
Mary Beth Ogle Helton, M.D.3903 Springstop Ln.Durham, NC 27705
Kathleen Stewart, M.D.5015 Kimblewyck Ln.Charlotte, NC 28226
Elizabeth Tilt, M.D.582 W. Park Ave.Morresville, NC 28115
South Carolina
Philip Mubarak, M.D.3769 Green Leaf Rd.Columbia, SC 29206
Tennessee
Ricardo Causo, M.D.802 Brookhollow Ln.Chattanooga, TN 37421
Rajesh Malik, M.D.A - 1/37 Chanakya PlaceNear C-1 JanakpuriDelhi, 110059India
Martin White, M.D.52 Arnold Park Dun LaoghaireCounty Dublin,Ireland
Connecticut
Ravi Prakash, M.D.80 Sherman St.Norwich, CT 06360
Massachussetts
Patricia Davis, M.D.Carney Pediatrics21 Dorchester Ave.Dorchester, MA02124
Kenneth Goldschneider, M.D.500C Falls Blvd., Apt. 3122Quincy, MA 02169-8173
E. Gruver, M.D.24 Beechwood Rd.Wellesley, MA 02482
Steven Lacy, M.D.Cambridge Family Health237 Hampshire St.Cambridge, MA 02139
Edward Levy, M.D.990 Dorchester Ave.Dorchester, MA 02125
Nova Scotia
Stephanie Lawson, M.D.lwk Hosp for Children5850 University Ave.Halifax, NS B3J 3E9Canada
Rhode Island
Roxanne Simmons, M.D.160 John Rezza Dr.North Attleboro, MA 02763
Uniformed Services-East
Samantha Baer, M.D.PSC 94, Box 663APO, AE 09824
New York 1
Robert Gadawski, M.D.5216 Bridle Path Ln.Lewiston, NY 14092
NewYork2
Eileen Kelly, M.D.1 10 Maybrook Rd.North Babylon, NY 11703-2909
Indiana
Tomas Deynes-Soto, M.D.1340 Fairfax Dr.South Bend, IN 46614
Thomas Eccles, M.D.321 N. Lincoln St.Bloomington, IN 47408
Michigan
Mary McCormick, D.O.Children's Hosp of Michigan3901 BeaubienDetroit, Ml 48201-2196
Rudolph Valentini, M.D.Children's Hospital of Michigan3901 Beaubien Blvd.Detroit, MI 48201-2196
Austin Yu, M.D.222 Virginia Ave.Ann Arbor, MI 48103-4132
Congenital Heart SurgerySpecialty FellowRalph Mosca, M.D.F7830 Mott1500 E. Medical Ctr. Dr.Ann Arbor, MI 48109-0223
Ohio
Diane Belardo, M.D.5215 Sherlin Ave., NWMassillon, OH 44646
Rina Lazebnik, M.D.23310 Wendover Dr.Beachwood, OH 44122
Mary Rita Murphy, M.D.7754 Country LaneChagrin Falls, OH 44023
Congenital Heart SurgerySpecialty FellowRoger B. B. Mee, M.D.Dept. of Pediatrics andCongenital Heart SurgeryCleveland Clinic, 9500 EuclidCleveland, OH 44195
Congenital Heart SurgerySpecialty FellowMichael Spector, M.D.11100 Euclid Ave.Cleveland, OH 44106-5011
Illinois
Bernhard Allgaier, M.D.701 Forum Sq.Apt 603Glenview, IL 60025
38 AAP News April 1999
i<i |- \ A_1 '! \_D(i-@t'-"1- -LIl (S=l_iti 11 5
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Congenital Heart SurgerySpecialty FellowJohn Morales, M.D.3533 S. AlamedaP.O. Box 30104Corpus Christi, TX 78463-0104
Maria Victoria Jimeno, M.D.Ste. #1201706 Meridian, SouthPuyallup, WA 98371
Richard Kynion, M.D.9869 Washington St.Fort Lewis, WA 98433-1412
Duska Thurston, M.D.6695 SE Arcadia Rd.Shelton, WA 98584
Nevada
Martha Knutsen, M.D.NICU, 3rd Fl.620 Shadow Ln.Las Vegas, NV 89106
Uniformed Services-West
Jeffrey Delaney, M.D.5931 Dupas St.Fort Hood, TX 76544
Karen Della-Giustina, M.D.1 0809 130th Ave. EPuyallup, WA 98374-2494
Dermatology Specialty FellowNeil Gibbs, M.D.284 Ocean View Ave.Encinitas, CA 92024-2622
Utah
Timothy Kutz, M.D.100 N. Medical Dr.Ste. 3400Salt Lake City, UT 841 13
Congenital Heart SurgerySpecialty FellowJohn Hawkins, M.D.100 N. Medical Dr.Salt Lake City, UT 841 13
Washington
Dimitri Christakis, M.D.U of Wa Campus Box 358853Dept of Peds., Ste. 300146 N. Canal St.Seattle, WA 98103-8652
Susan Sombatpanit, M.D.585 Hacienda Ave. #206Campbell, CA 95008-6517
Buenaflor Uy, M.D.18540 Citronia St. #105Northridge, CA 91324
Kelly Young, M.D.Harbor-UCLA Medical Ctr.1000 W. Carson St. Box 21Torrance, CA 90509
Congenital Heart SurgerySpecialty FellowVaughn Starnes, M.D.Childrens Hospital Los Angeles4650 Sunset Blvd. Ms #66Los Angeles, CA 90027
California 4
Amy Catherine Conrad, M.D.18862 Saginaw Dr.Irvine, CA 92612-3341
DISTRICT I
Eileen M. Ouellette, M.D., J.D.Pediatric NeurologyNorth Shore Children's Hospital57 Highland Ave.Salem, MA 01970
DISTRICT 11
Louis Z. Cooper, M.D.Department of PediatricsColumbia UniversityRoom BHS 1 14630 W. 168th St.New York, NY 10032
DISTRICT III
Susan S. Aronson, M.D.605 Moreno Rd.Narbeth, PA 19072-1618
DISTRICT IV
E. Stephen Edwards, M.D.2800 Blue Ridge Blvd.Ste. 501Raleigh, NC 27607-6496
DISTRICT V
Stanford A. Singer, M.D.36700 Woodward Ave.Ste. 300Bloomfield Hills, MI 48304-0908
DISTRICT VI
Ordean L. Torstenson, M.D.Dean Medical Center, SC1313 Fish Hatchery Rd.Madison, WI 53715-191 1
DISTRICT Vll
L. Leighton Hill, M.D.Office of AdmissionsBaylor College of MedicineOne Baylor PlazaHouston, TX 77030
DISTRICT Vlill
Jon R. Almquist, M.D.Virginia Mason Medical CenterDepartment of Pediatrics33501 First Way SouthFederal Way, WA 98003-6208
DISTRICT IX
Lucy S. Crain, M.D., M.P.H.UCSF Box 0374400 Parnassus Ave.San Francisco, CA 94143-0374
AmericanAcademy ofPediatrics
Arizona
Jennifer Cheng, M.D.4545 E Oregon Ave.Phoenix, AZ 85018
Arturo Gonzalez, M.D.9021 E. Sahuaro Dr.Scottsdale, AZ 85260-4511
Sue Johnson, M.D.5133 E. Crestview Dr.Paradise Valley, AZ 85253
Colorado
Gregory Brames, M.D.1725 E. Boulder Ste. 202Colorado Springs, CO 80909
Congenital Heart SurgerySpecialty FellowDavid Campbell, M.D.1056 E. 1 9th Ave., B200Denver, CO 80218
Congenital Heart SurgerySpecialty FellowDavid Clarke, M.D.1056 E. 1 9th Ave., Box 200Denver, CO 80218
California 1
Felix Conte, M.D.150 Hope Ln.Sonora, CA 95370
Kimberly Mar, M.D.4 Country Club PlazaOrinda, CA 94563
Mark McConnell, M.D.6520 Fall Rivers Dr.San Jose, CA 95120-4015
Kerin McTaggart, M.D.748 Wild Lilac Ct.Murphys, CA 95247
California 2
Asha Misra, M.D.320 Superior Ave., Ste. 240Newport Beach, CA 92663
Robert Posen, D.O.2529 Kiska Ave.Hacienda Hts., CA 91745-4822
r-A
April 1999 /-^MP News 39
After 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 wiLreless. It's private. It inspi'res letters like this. Andnow 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 why just "control" bedwetting with drugs when youcan CURE it! With the WIRELESS alarm that wakesthe BEDWETTER... not the whole housel!
The Potty Pager teaches bedwetters to respond normnally 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.
For complete information call: 800-497-6573 or 303-440-8517
Or visit our web site: w .pottypager.comIDEAS FORLIVING, INC. BOULDER, COLORADO 80304
'' j- ;--%i- -,"t>,_,I=}}.'t6F97_t Lj1A\ ;-j- iiI§ Ij \1oX
9>E2AS ~~~23rdAnnualt , t ~AMERSA9 J/) sNATIONAL CONFERENCEi 1̂999,tit November46, 1999
^lc ~~~Holiday InnOld Towne, Alexandria, VA
CONFERENCE FEATURES:a PlenarySessions
- Addiction and the Brain: Clinical Implications ofaDisease Model
- Strange Bedfellows: Coerced SubstanceAbuseTreatment in the New Drug Courts
- The Evidencefor Treatment Effectiveness, TreatmentOutcomes, and Cost Effectiveness in SubstanceAbuse Treatment
a Skill-Based Workshopsa Facult Mentoring ProgramaMeet the Professor Breakfast
- Scientific Research Presentafions
NEW FEATURE:Clinical Case Presentafions
Abstracts may be submitted electronically to:http:/ /amersa.orgDiwc inquiries to-. AMERSA (401) 785-8263or <doreenlEamersa.org
FLICO[DDNIEWeatherby Locums is the placement specialist Pe-diatricians count on most!
* Choose from a variety of locafions* Receive competitive compensation* Paid travel and housing* Paid occurrence-based malpractice insurance
We accomnmodate your special circumstances and pro-vide 24-hour assistance, seven days per week. Weatherbywill take care of it all.
For more detailed informafion on available assignments,visitour website atwuw.wbgit.com, call
Frank Phillips, SeniorVice President, 800 586 5022, ext 140or e-mail to: [email protected].
Prefeffd Pronder for the American Academy of Pediatrics
Weatherby Locums, Inc.Accurate and doendabk.
5352 NWI 21Ist Terrace * Ft. Lauderdae, FL 33309
Preliminary Announcement4hAna
Management of Complex Humanitarian Emergencies:Focus on Children and Families For Pediatricians, Primary Health Providers,
NGO Relief Professionals, and Mental Health ProfessionalsJune 21-25, 1999 Case Western Reserve University Cleveland, OH
Sponsored by University Hospitals of Cleveland andCo-sponsored by Case Western Reserve University School of Medicine
And Center of Excellence in Disaster Management & Humanitarian AssistanceUniversity of Hawaii, John A. Burns School of Medicine
Tripler Army Medical Center, HonoluluPresented by Rainbow Center for International Child Health
With the support of Center for International Health, Case Western Reserve University,American Academy of Pediatrics * International Pediatrics Association
Learning Objectives:After attending this program, participants will be able to:* Identify the most important problems and priorities in complex humanitarian emergencies.* Identify organizations most trequently involved in providing help in complex humanitarian emergenciesand define their roles and strengths.
* Identify the groups most vulnerable in complex humanitarian emergencies.* Do emergency nutritional assessments.* Do health profiles on refugee groups and plan interventions based on results.* Define common psychosocial issues of chiidren and the means to address them.* List basic points of international law including the Geneva Conventions that relate to all personsinvolved in complex humanitarian emergencies.
* List security issues that are important in complex humanitarian emergencies.*Employ skills in conflict resolution, negotiation and cross cultural communication.General Information: Maximum enrollment 50. Both dormitory and hotel housing available. Tuition$595. Discount available for limited number of residents.
For further information:Continuing Medical Education
University Hospitals of Cleveland11100 Euclid Avenue * Cleveland, OH 44106-6026
Phone (216) 844-5050Fax (216) 844-8133
Email: [email protected]
IE
Although theAcademy 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 modifythe wording of clas-sified ads. These changes are generally made in compliancewith the regulations of various federal and/or state com-missions against discrimination or because they might beinterpreted as being unlawful or in conflict with acceptedprofessional standards of medical practice.These advertising modifications are made to maintain aclassified section that is professionally responsible, lawful,scientific and free of discrimination.
Published Monthlyy
P.O. Box927Elk GroveVillage, IL 60009-0927
Publication of an advertisement in AAP News neither con-stitutes nor implies a guarantee or endorsement by AAPNews or the AmnericanAcademy ofPediatrics ofthe productor service advertised or of the claims made for the productor service by the advertiser.
Classification: Classified ads are accepted under BusinessServices, General Announcements, Medical Meetings, Physi-ciansWanted, PositionsWanted, Practices Available, Publica-tions, Real Estate and Residencies/FellowshipsAvailable.
DisplayClassifiedAds: 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 AAP News for display clas-sifed ad sizes and rates.
Formore information,contact: Pete Petersen, ClassifiedAdCoordinator, at (800) 433-9016, ext. 7667. In Illinois, (847)981-7667. Ad copy and payments may be sent to: ClassifiedAds,AAPNews, PO. Box927, ElkGroveMlilage, IL60009-0927.
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 affiliatedcompanies providing medical products and services, andOSF Medical Group, a multi-specialty physician group withmore than 220 providers in its multi-state service area. Wenow have general pediatrics opportunities in:
Peoria, Illinois * Escanaba,, MichiganFor more information, please contact:
Wendy Bass at (800) 462-3621; Fax (309) 685-2574;Email: [email protected]
40 AvAP News April 1999
A CME Meeting in Practical Pediatric Topicsand a Practice Management Seminar
X ARA,) THE ~~~~CLOISTERS
June 17-19, 1999 * The Cloister * Sea Island, GeorgiaMartin H. Greenberg, MD, Program Chair
Sponsored by-Georgia Chapter/American Academy of Pediatrics
For information contact Meg Evans * (404) 881-5067 * Fax (404) 249-9503 * mevansEmag.org
CLASSIFIEDADVERTISING POLICY
Whenyou need to contactpediatricians, contactAAPNews. Each month more than 55,000pediatricians,pediatric specialists, third-year pediatric residents and other subscribers turn toAAPNewsfor childhealth information they cannotgetelsewhere. With a classified ad, you can speak directly to those readers.
MEDICAL GROUP
"We do theRight Thing...
Well."
AS0130l3-EMi ~~~~~l - - ----~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~I !%,:~~~~~~~~~~~~~~~~~~~~~~~~%
R ol_ece 1. Greenberg RN. Overview of patient compliance with medication dosing: a literature review. Clin Ther.1984;6:592-599. 2 RedBook' Update, Montvale, NJ: Medical Economics Co Inc; July 1998:22,24,26,27,71.
ZffHROMAX*(azithfomycin for oral suspension}
BRIEF SUMMIARY
INDICATIONS AND USAGEZITHROMAXI (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 recomrmendation, see DOSAGE AND ADMINISTRATION.)
Conimunity-acquired pneumonia due to Chlamydia pneumoniae, Haemophilus influenzae, Mycoplasmapneumoniae, or Streptococcus pneumoniae in patients appropfiate for Dral therapy. (For specific dosagerecommendation, see DOSAGE AND ADMIINISTRATION.)
NOTI.: 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 requiringl hospitalization,or patients with significant underlying health problers that may compfomise their ability torospond to their illness (including immunodeficiency or functional asplenia).
Pharyngitis/tonsillitis caused by Streptococcus pyogenes as an alternative to first-line therapy in individualswvho 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 Stfeptococcuspyogenes infection and the prophylaxis of rheumatic fever. ZITHROMAXI is often effective in the eradication ofsusceptible strains of Streptococcus pyogenes from the nasopharynx. Because some strains are resistant toZITHROMAXI, susceptibility tests should be performed when patients are treated with ZITHROMAXI. 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 ZITHROMAX" may be initiated before results of thesetests 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 anymacrolide antibiotic.
WARNINGSSerious allergic reactions, including angioedema, anaphylaxis, and dermatolosgic 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 recurrd soon thereadtr in some patients wit'nout further azithronycin 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 treatmnot of pneumonia, azithromycin has only been shown to be safe and effective in theetront of commnuity-acquired pneumonia due to Chlamydis pneurnonike, Hasmopbilus influwnze,Mcopw pneumonim, or Straptococcu pneumonim in patients appropriate for oral thorapy.Azihromycin should not be used in pationts with pneumonia who are judged to be inappropriate for oraltharapy becomeo of modorate to severe illnss# or risk factors such as any of tha following: patients withcystic fibrosis, patieRts with nosocomially acquired infections, patienis with known or suspectedbacteromia, potionts requiring hospitalization, elderly or dobiliatatd pationts, or patients with significantnderlying health problems tlhat may comnpromise their ability to rospond to their illness (including
immuodeficiency or fvnctonal asplonia).Pasudomembranous colitis has ben reported with nearly all antibacterial agents and may mnge in
srlyt fro mild to life-threatenling. Tbrew, it is imsportant to considor this diagnosis in patientswbo0 present with diarrhea subsequent to the administaion of antibacteorial agonts.
Treatmnent 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 mDderate to severecases, consideration shguld be given to management with fluids and electrolytes, protein supplementation, andtreatment with an antibacterial drug clinically effective against Clostridium difficile colitis.
PRECAUTIONSGor-al: 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 re-ported 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.Infonmation for Pedatiet 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 lnbractions: Aluminum- and magnesium-containing antacids reduce the peak serum levels (rate) but not theAUC (extent) of azithromycin absorption.
Administration of cimetidine 1800 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 cytDchrome P450 system-elevations of serum carbamazepine, terfenadine, cyclosporine,hexobarbital, and phenytoin levels.
laboratory sto InbractioRs: There are no reported laboratory test interactions.Carcinowenosis, Mlutagenesis, Impairment ofFhrtility. Long-term studies in animals have not been performedto evaluate carcinogenic potential. Azithromycin has shown no mutagenic potential in standard laboratory tests:
I
Longwood Ave., Boston, MA 02115. e-mail:Palfrey@Al .Tch .Harvard .Edu
MISSOURI -Join two neonatologists in thisextremely active practice. Highly competitive, six-fig-ure income guarantee with incentives and bonuses.Located in an area that is on the list of top ten most"livable" cities in the United States. Easy access to allrecreational activities plus all the academic and cul-tural activities associated with the nationally recog-
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California
A well-established solo pediatric practice in the SanFrancisco Bay area -Owner retiring. Respond to:phone: (650) 877-0857, fax (650) 570-5500.
June
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July
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Massachusetts
Children's Hospital, Boston, Division of GeneralPediatrics -Fellowship programs in: GeneralAcademic Pediatrics, Pediatric Advocacy, Develop-mental-Behavioral Pediatrics, DevelopmentalDisabilities, Primary Care Research and PediatricHealth Services Research are now open to applica-tion for July 2000. Call for information: (617) 355-6714; fax (617) 355-7940. Applications should besent to Judith S. Palfrey, M.D., Chief, Division ofGeneral Pediatrics, Children's Hospital, 300
mouse lymphoma assay, human Iyphocyte 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 matemally 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-ontrolled studies inpregnant women. Because animal reproduction studies are not always predictive of human response, azithromycinshould be used during pregnancy only if clearly needed.Nursing Mothem 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.Pediatrc 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 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 1 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 Mycw#asma 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 evaluatingl the use of repeated courses of therapy have not been conducted.Geriatric Use: Pharmacokinetic parameters in older volunteers l65-85 years old) were similar to those in youngervolunteers (18-40 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: Aduns: Multiple-dose regimen: Overall, the most common side effects in adult patients receiving amultiple-dose regimen of ZITHROMAXI were related to the gastrointestinal system with diarrhea/loose stools (5%).nausea (3%), and abdominal pain (3%1 being the most frequently reported.
No other side effects occurred in patients on the multiple-dose regimen of ZITHROMAX" with a frequency greaterthan 1%. Side effects that occurred with a frequency of 1% or less included the following:Cairdiovascular Palpitations, chest pain.Gastrointeninal: Dyspepsia, flatulence, vomiting, melena, and cholestatic jaundice.Genitourinar:. Monilia, vaginitis, and nephritis.Nervous Sygm: Dizziness, headache, vertigo, and somnolence.General: Fatigue.Allergic: Rash, photosensitivity, and angioedema.Single l-gram dose regimerr. Overall, the most common side effects in patients receiving a single-dose regimen of1 gram of ZITHROMAXI were related to the gastrointestinal system and were more frequently reported than inpatients receiving the multiple-dose regimen.
Side effects that Dccurred in patients on the single one-gram dosing regimen of ZITHROMAX" with a frequency of1% or greater included diarrhea/loose stools (7%), nausea (5%), abdominal pain (5%), vomiting (2%), dyspepsia (1%),and vaginitis ll %).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 (18%), diarrhea/lDose stools (14%), vomiting (7%), abdominal pain (7%),vaginitis (2%), dyspepsia (1%), 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 (2%), abdomninal pain (2%),vomiting (1%), and nausea (1%).
Community-Acquired PneumDnia: 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 (5.8%),abdominal pain, vomiting, and nausea ll.9% each), and rash ll.6%).
Pharynvgitis/tomsillitis: For the recommended dosage regimen of 12 mg/kg on Days 1-5, the most frequent sideeffects attributed to treatment were diarrhea/loose stools l6%), vomiting (5%), abdominal pain (3%). nausea (2%),and headache 0l%).
With either treatment regimen, no other side effects occurred in children treated with ZITHROMAX" with afrequency of greater than 1%. Side effects that occurred with a frequency of 1% or less inoduded the following:Cardiovascular Chest pain.Gastrointostindl: Dyspepsia, constipation, anorexia, flatulence, and gastritis.Neirvous Syn: Headache lotitis media dosage), hyperkinesia, dizziness, agitation, nervousness, insomnia.Goner l: Fever, fatigue, malaise.Allergic: Rash.Skin and Appendages: Pruritus, urticaria.Special Senws: 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:Allerglic: Arthralgia, edema, urticaria.Cardiovascular Arrhythmias including ventricular tachycardia.Gestrointestial: Anorexia, constipation, dyspepsia, flatulence, vomiting/diarrhea rarely resulting in dehydration.General: Asthenia, paresthesia.Genitourinary: Interstitial nephritis -and acute renal failure.Uvor/Biliarf. Abnormal liver function including hepatitis and cholestatic jaundice.Nervous Syst: 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.IaboratoryAbnorm lities: Adufts 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 (SGPT), GGT, and AST (SGOT); with an incidence of less than 1%, leukopenia, neutropenia,decreased platelet count, elevated serum aikaline 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 allreported at a frequency of less than 1%, but were similar in type to the adult pattern.
DOSAGE AND ADMSINISTRATION (See INDICATilONS AND USAGE.)Acuto Otitis Media aned Conmmwity-Acquired Pneurnonia: The recommended dose of ZITHROMAXO for oralsuspension fDr 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).ZUTHROMAX"for oral suspcnsion should be given at least I hour before or 2 houn after a meal.ZITHROMAX for oral suspion should not betakeon withfood.More detailedprofessional information available on requestRevised January 1997
ZC21 9A98
April 1999 AAP News 41
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P.O.Box927 ElkGroveVillage, IL 60009-0927
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once-dily dose(efcc ta' as o ou ite ains otk
COVERAGE OF KEY RESPIRATORY PATHOGENS
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,#-.T Y P I C A LStreptococcus pneumnieHa'amophilus ionfluenzaeMoraxella catarrh7alis
A-TYPICA LChlamydia pneumoniaeMycoplasma: pneumoniae
* 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%).Zithromaxg (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, orSpneumoniae, and community-acquired pneumonia due to Cpneumoniae, H influenzae, Mpneumoniae, 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 immunodeficiency or functional asplenia).
ZItrmx
Please see briefsummary ofprescribinginformation on adjacentpage.
