room%T..=J\L.Y. l

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

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

Paul Martinez, M.D. :Robert Potlh57 Cedar St. *102 MirageStony Brook, NY 11790 .Renfrew, P/

Ghulam Mattoo, M.D., M.B., B.S.: _190-19A 71 Cres #2A .Fresh Meadows, NY 11365:

.KentuckyNora Wecker, M.D. :9 Plover Ln. :Kristina Kni!Hicksville, NY 1 1801 *2512 Chats

*ElizabethtoiNew York 3

:Mindy SteriJuan Fukuda, M.D. Cincinnati,k316 Boundary Ave. *CninaiStaten Island, NY 10306

*North CarMarla Guralnick, M.D.23 East 10th St., #712 .Marsha DaiNew York, NY 10003 :361 MSRB,

*Chapel Hill,Susmita Pati, M.D.253 W. 72nd St., Apt. #1003 *Diane MarsNew York, NY 10023 :4300 Cobs(

*Durham, N,Mandy Rappaport, M.D.101 W. End Ave., # 7C Samuel MuNew York, NY 10023 :703 Newm,

New Bern,

_ ~~~~~~~Jennifer Wi:918 Trentle

Maryland .Charlotte, I

Nina Kashtelyan, M.D. .South Car12-Rush Vine Ct.Owings Mills, MD 21117 .Shayla Eller

:964 RibautNew Jersey *Beaufort, S,

Stephen Amaefuna, M.D. *Neill Herrin169 Elmwood Ave. :900 PartridIrvington, NJ 07111 * Orangebur

Christina Piela, M.D. .Laura Ledlii536 Herbert Ln. :9 RichlandBrick, NJ 08724 *Ste. 110

:Columbia,'Jon Sicat, D.O.320 S. Harrison St.,#6K :HenryLemE Orange, NJ 07018 *2728 Suns(

:WestColurPennsylvania

Giih hr

Valerie Brown, M.D., Ph.D. * MUSC/Div825 N. 29th St., #4-D : CardiologyPhiladelphia, PA 19130 *RPO. Box 2!

:165 AshleyAnestesiologySeda/tyFellow CharlestonElizabeth Drum, M.D.103 Hewett Rd. *Asad Syed,Wyncote, PA 19095 :1002 Harpi

*Anderson,Anesthesiology Speaa/ty FellowJeffrey Galinkin, M.D. *Virginia129Q4 Karen ILn.Radnor, PA 19087 :Edward Ml

*10470 Bre(Asmita Joshi, M.D. :Fairfax, VA2002 TennysonCt.ANorristown, PA 19403 :_

Sikander Manzoor, M.D.153 Jarred St. :IndianaBrookville, PA 15825

:Alicia LeedRaymond Pitetti, M.D., M.PH. . 18448 Orii7009 Highland Creek Dr. * NoblesvilleBridgeville, PA15017:

h, M.D.I.Ct.A 1 6053

_!_114k

John Unison, M.D.6471 Woodhaven Ct.Avon, IN 46123

Michigan

Moharnmad Ghali, M.D., M.P.H.50 Butternut Ct.Chelsea, MI 48118

Rashed Hasan, M.P.P.O. Box 99148Troy, Ml 48099

David Sciamanna, D.O.230 Fairview Ave.Petoskey, Ml 49770

Ohio

0

0

: : Louisiana

1.

|:John Stock, M.1|.1218 E. Desert:Phoenix, AZ 85

.Colorado

*Shen Nagel, M:1565 Adams Si*Denver, CO 8C

*Sean O'Leary, I:1117 Mathews*Ft. Collins, CO

*Lisa Whiteside!:1565 Adams SI.Denver, CO 8C

*Hawaii

*Lisa Smith, M.[:95-1024 Kueni*Miliani, Hi 967

:New Mexico

:Dieter Dennig,*50 High SierraAlamogordo, r

:Hector Ocaran.200 N. Mesa F:Apt. #1311*El Paso, TX 79!

*Oregon

*Azimuddin Km: 1198 NW4th,*Ontario, OR 9'

*Uniformed Ser'*.Morgan Mand4903 Edgemo(

:Apt. 605*Bethesda, MD

*Utah

*Elizabeth Forbi*2479 S.400E:South SaltLake

*Washington

,D.:Broom Way5048

L.D.t.)206

M.D.

80524

s, M.D.It.)206

D.la st.789

,M.D.Dr.MM 88310

iza, M.D.dills Dr.

912

William Bonadio, M.D.6393 Oakgreen Ave.Hastings, MN 55033

Kulkanya Chokephaibulkft, M.D.2357 Ramkamhaeng Rd.Huamark BangkapiBangkok 10240Thailand

Maries Joseph, M.D.c/o Dr. Jose JosephFMHS UAE UniversityP.O. Box 17666Al AinUnited Arab Emirates

Connecticut

Navyn Naran-Jinnah, M.D.403 Unquowa Rd.Fairfield, CT 06430

Massachusetts

Anesffesiology Sped*/t FellowRobert Brustowicz, M.D.231 Dorset Rd.Waban, MA 02468

Urology Spedaft FellowBartley Cilento, M.D.6 Devonshire Dr.Canton, MA 02021

Mark Curdo, M.D.2 Seneca Ln.Wilmington, MA 01887

Charlotte Harward, M.D.257 Regency Park Dr.Agawam, MA 01001

Carla Hilsten, M.D.357-R High St.Newburyport, MA 01950

Amy Kasper, M.D.Pediatric/Adolescent Medicine2207 Boston Rd.Wilbraham, MA 01095

New York 1

Correne Curtin, M.D.308 Bennington Hills Ct.W. Henrietta, NY 14586

Todd Giombetti, M.E).9% AleI Ct.-0-

Delmar, NY 12054

Pengxin Lin, M.D.6211 Johnston Rd.Hampshire #6Albany, NY 12203

Kathleen Terrence, M.D.175 Becker Rd.Lisbon, NY 13658

New York 2

Jesse Ko, M.D.57-40 244th St., Apt. 1Douglaston, NY 11362

.l

:Ruchir Agrawal, -M.D.*4650 Lakeshore Dr., #44Shreveport, LA 71109

.Melanie Gilfour, M.D.:101 E. Fairway Dr., Ste. 508*Covington, LA 70433

:Shankar Lakhani, M.D.4650 Lakeshore Dr., Apt. 139*Shreveport, LA 71109

:Ashley Lucas, M.D..2620 State St.*.New Orleans, LA 70118

*Oklahoma

*Rowena Baumgartner, M.D.:2830 E.82nd St.*Tulsa,OK74137

*Beatrice Newell, M.D.|:4806 SE Redbud PI.

Lawton, OK73501

*Texas

*Cynthia Beamer, M.D.7418 Wild Eagle*San Antonio, TX 78255

*Michael Deitchman, M.D-.:8312 Shady Oaks Dr.*N Richland Hills, TX 76180

Christopher Gulde, M.D.:13274 Hunters Breeze*San Antonio, TX 78230

.Matthew Hay, M.D.:17 Campeche Cir.*Galveston, TX 77554

*David Lakey, M.D.Pulmonary & Inf. Dis. Ctr.:11937 US Hwy.2'71.Tyler,TX75708

:JenniferMacia, M.D., M.P.H*5107 Evergreen St.Bellaire, TX 77401

Roseller Tapangan, M.D.:2710 Emerald Lake Dr.

isely, M.D.sworth Dr.iwn, KY 42701

,n, M.D.View PI.OH 45209

rolina

tvenport, M.D.CB#72201,NC 27599

shall, M.D.;cook D)r.IC 27707

irray, M.D.ian Rd.NC 28562

'illard, M.D.eCt.NC 28211

rolina

nberger, M.D.t Rd.;C 29902

ig. M.D.ige Rd.rg, SC 29118

ie, M.D.IMedical Pk.

SC 29203

ion, M.D.;et Blvd., Ste. 105mbia, SC 29169

ali, M.D..of Ped.

150915yAve.i, SC 29425

1, M.D.)ers WaySC 29621

ian, M.D.wook Ln.)H 43209

3SAe

Robert Engea&hardt, M.D.ty Ave.IH 45211

%, - D*

:6350 GlenwaCincinnati, Ol

*Steven Morm:1913 Waterbi*Columbus, O

*Illinois

*Stephen Neul:607 Juniper R*Glenview, IL

Shoshana Wa:536Wesley AEvanston, IL

Stephanie WI:6128 S. India.Chicago, IL 6

:Minnesota

:Clifford Wu,*RPO. Box 577:1324 Fifth N(New Ulm, MI

.Missouri

*Beverly Brow:1990 Longvi(*Cape Girarde

TiEffany Johns,:6436 Oak St.*Kansas City, I

Karla Lester,:8903 Pendlel*Brentwood, t

:North, Dakc

:Carla Zacher,8716 Briardal

.Bismarck, NE

1:Wisconsin

DoroaWalev*North 1377 '*Marinette, \A

. Harlingen,: Gina Viktc: 10214 Wz*. Irving, TX

. Arizona

i, TX 78550

ri, M.D.It.12601

orin, M.D.'aters Dr.75063

_!_MIorris, M.D.,ckinridge Ln.-x 22030

iberger, M.D.id.60025

askow, M.D.Ave.60202

'hyte, M.D.ina Ave.i0637

M.D.

lorth St.iN 56073

zi, M.D.Ave.17914

rvices-Westleville, M.D.Or Ln.

>20814

c

les, M.D.

,Crty,UT84115

,a/ty FellowtM.D.

)8403

in, M.D.ew St.mau, MO 63701

son, M.D

MO 6411 3

M.D.btn Ave.MO 63144_ota

;, M.D.tie Dr.D 58504

. UrologySpeci: Byron Joyner,,: 401 N. 11th S. Tacoma,WA'S

* Wyoming: Robert Vigner* 545 E. llth St. Casper, WY 8:

Califomia 1

0

* Sima Asadi, M: 16720 Avenue* Madera, CA 9.

* California 2

: Oved Fattal, h1717 Stoner A

* Los Angeles, C

%.D.e 17 1/213637

Tracy Baser-Decker, M.D.2566 W. Wayward Wind WayTucson, AZ 85745

Leeanne Coakley, M.D.2525 E. Drachman St.Tucson, AZ 85716

Robin Laks, M.D.655 W. Sierra Madre Ave.Gilbert, AZ 85233

na-Jedmecak, M.D.Shore Dr.VI 54143Jy, M.D.

iental Oak Ct.aI, IN 46060

\/.D.Wve., #1 16'fi'A 90025

2134 AAPNews November2000

pl- -44

November2000 AAPNews 23!-5

ecRerzg(3xcn-v9~~~~~~~~~~~~~~~~~~~~~-"W -

DISTRICT I

*Eileen M. OuellE:Pediatric Neurc*North Shore Cl:Hospital*57 Highland A\:Salem, MA 01 c

*e-mail: eouellel

:DISTRICT II

:Robert M. ConsMedical Direct(

:251 Salina Meg.Suite 100:Syracuse, NY 1*e-mail: rcorwin

*DISTRICT III

.Alan E. Kohrt,:Medical Directi*Children's Heal:Children's Hosl*Philadelphia:34th and Civic*Philadelphia, P*e-mail: akohrt(

DISTRICT IV

*E. Stephen Edw,:2800 Blue Ridg(*Suite 501:Raleigh, NC 27(*e-mail: sewards,

DISTRICT V

*Stanford A. Sink:36700 Woodwi*Suite300Bloomfield Hills

:e-mail: ssingerCe

:DISTRICT VI

:Kathryn Piziali t*1314 Morrison:Madison, WI 5'*e-mail: knichol(

*DISTRICT Vll

*L. Leighton Hill:Office of Admi!*Baylor College:One Baylor Pla;*Houston, TX 7.)e-mail: Ihill?aa

*DISTRICT Vill

*Jon R. Almquis,:Virginia Mason I*Department of:33501 FirstWc*Federal Way, V:e-mail: jalmqui

DISTRICT IX

*Burton F. Willis:11160Warner:Suite 101*Fountain Valle~:e-mail: bwillis(c

*DISTRICT X

*Charles Linder,:Medical ColleE1120 15th St:Rm HF 1117*Augusta, GA 3:e-mail-. clinder,

.Americ

.Acaden*.Pediatr.

Mahindokht Jafari, D.O.1047 Fountain Springs Ln.Glendora, CA 91741

Hannah Kim, M.D.3910 Emerald St., Apt. 210Torrance, CA 90503

Dana Kosmala, D.O.P.O. Box 70062Riverside, CA 92513

Swapna Kudtarkar, M.D.1169 Clark St.Riverside, CA 92501

Nadia NodoustChnstensen, M.D.1815-A Pullman Ln.Redondo Beach, CA 90278

Praful Sarode, M.D.27 DecenteIrvine, CA 92614

California 4

Mina Ghebrial, M.D.1812 Bridle Path WaySanta Ana, CA 92705

:Alabama

:Michelle Fri*316 Kirkwc:Dothan, Al

:Douglas M*P.O. Box 6E:Winfield, A

:Gomathy l\*3041 Easte*MontgomE

:Karole Nelk*3614 Vicks*Birminghar

:Florida

Alice Blavo:15636 SW*.Pembroke

Kelli Cross,:1016 3rd'5:Saint Peter

*Cheryl Ma:7441 Coro*Orlando, F

*Aparecida Menezes, M.D.:P.O. Box 113105Miami, FL 33111

*Georgia

:Margaret Boudreaux, M.D.:6535 TylerWay*Cumming,GA30040

*SoniaGeorge, M.D..215 Towergate PI.:Atlanta, GA 30350

:Steven Morse, M.D.* 111 Grays Creek Ct.*Savannah, GA 31410

*Erick Naka-Mizrahi, M.D.:1914 Connemara Dr.*Chamblee,GA30341

*RobertWhipple, M.D.*55 Bay Dr.*Newnan, GA 30263

.Earl Young, M.D.*2145 E/W Connector:Apt. 409*Austell, GA 30106

11

fards, M.D.,-e Blvd.

607;@aap.org

ger, M.D.,ard Ave.

5, MI 48304gaap.org

;t, M.D.Medical Centerf Pediatrics'ay SouthNA 98003list?aap.org

s, M.D.rAve.

!y, CA 92708§aap.org

II _:

reeman, M.D.ood Dr.L 36303

IcBride, M.D.,86%L 35594

Mohan, M.D.zrn Blvd.ery, AL 36116

Ison, M.D.sburg Dr.m, AL 35213

ette, M.D., J.D.:)logyhildren's

,ve.970!tteX?aap.org

win, M.D.,or- MedBestbadows Pkwy

13212riEaap.org

Nichol, M.D.ISt.i'3703Waap.org

r, M.D.ge of Georgia

30912rEaap.org

-,anny ofliCS

), D.O./ 16th St.Pines, FL 33027

0, M.D.St. Nrsburg, FL 33701

iddox, M.D.:)y Rd.FL 32835

M.D.tor/11th Net;pital of

Center Blvd.:'A 19104;e aap.org

1, M.D.issionsof MedicineLza, Rm. N10470301p.org

e,

N

BOULDER, COLORADO 80304IDEAS FOR LIVING, INC.

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

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CLASSIFIED ADVERTISING POLICYWhenyou need to contact pediatricians, contactAAPNews. Each month more than 55,000 pediatricians, pediatricspecialists,third-year pediatric residents and othersubscribers tuArn toAAPNewsforchild health information theycannotgetelsewhere.With a classified ad, you can speakdirectly to those readers.

Baltimore and Washington. The opportunitydoes not qualify as a J-1 Visa Waiver site. Forfurther information contact: PhysicianRecruiter, toll free (888) 268-4382 or fax CVto: (301) 665-4521. EOE

General Pediatrics- Continuity Clinic Director- The Division of General Pediatrics andEmergency Care at the Medical College ofVirginia of Virginia Commonwealth Universityis seeking a general pediatrician to fill the posi-tion of Director of the Residents' Continuityclinic. The successful candidate for this positionwill be a BC/BE pediatrician with significantexperience in primary care teaching and/orpractice administration. Such experience mighthave been gained in either academic or com-munity-based practice and/or fellowship.Faculty rank and compensation will be basedon the applicant's credentials. For further infor-mation contact: Lindsey K. Grossman, Chair,Division of General Pediatrics and EmergencyCare, MCV/Virginia Common-wealthUniversity, P.O. Box 980506, Richmond, VA23233, by phone (804) 828-0099 or fax (804)828-6301. MCV/VCU is an AffirmativeAction/Equal opportunity employer. Women,minorities and persons with disabilities areencouraged to apply.

Southeast

Join 1.5 pediatricians in a thriving NortheastArkansas community of 22,000 near metro-politan areas. Good schools, churches, andnice folks. A ready-made, enjoyable practiceawaits you. Call (870) 239-5437.

ENERGETIC BC/BE Pediatrician wanted to joindynamic academically-oriented, nationally-respected practice in Dade, Broward and PalmBeach County, Florida. Unparalleled lifestylefor primary care pediatrician with exc'eptionalsalary and benefits. Reply to: PediatricAssociates, PA, 4620 North State Rd. 7, Ste.316, Lauderdale Lakes, FL 33319, Attention:Peter Shulman, M.D., Physician Recruiting, orfax a current CV to (954) 967-2624.

Midwest

Janesville & Edgerton, Wisconsin - DeanMedical Center, a 410-physician multi-spe-cialty group, is actively recruiting for a BE/BCPediatrician to join its Clinics in Janesville andEdgerton, Wisconsin. This position wouldrequire working mornings at the EdgertonClinic and afternoons at the JanesvilleRiverview Clinic. A rotating call schedule ofone-in-six weekdays and one-in-seven week-ends is shared. Janesville, population 60,000,is a beautiful, family-oriented communitywith excellent schools and abundant recre-ational activities. A two-year guaranteedsalary, incentive and benefits will be pro-vided. Contact-Leigh Ann Promraning, DeanMedical Center, 1808 West Beltline Hwy,Madison, Wisconsin 53715, or call (608)250-1217 or Fax: (608) 250-1441, ore-mail:pomraning-leighannEssmhc.com.

Madison, Wisconsin - Dean Medical Center, a410 physician multi-specialty group, is activelyrecruiting for a BE/BC Pediatrician to join itsClinic in Madison, Wisconsin. Call is sharedequally among the 1 1 member department.

Dean staffs a 24-hour nurse triage phonesystem with backup by on-call physicians.Physicians admit to St. Marys Hospital thathas a level III nursery staffed by neonatolo-gists and a staffed PiCU. Opportunity toteach medical students, pediatric, and FP res-idents. A two year guaranteed salary, withincentive and benefits will be provided.Contact Leigh Ann Promraning, DeanMedical Center, 1808 West Beltline Hwy,Madison, Wisconsin, 53715, or call (608)250-1217 or Fax: (608) 250-1441, ore-mail:pomraning-leighannQ?ssmhc.com.

Southwest

California - Neonatologists BC/BE positionsavailable throughout the Los Angeles areawith large physician-owned private/academicmulti-hospital-based private practice groupspecializing in Neonatology and PediatricIntensive Care. Competitive starting salarywith profit sh'aring, bonus and long-termemployment options, clinical positions neededwith academic association available. Positionsavailable immediately. Contact: PediatricCritical Care Medical Group, 5400 Balboa Blvd,Ste. 331, Encino, CA91316, (818)461-8888.

BEAUTIFUL TAOS, NSEW MEXICO! Want to-utilize your training/skills for a diverse/grate-ful population? Consider this interesting prac-tice in a Rocky Mountain setting. Join 3.5 pedi-atricians (all excellent credentials) providingprimary/specialty care to rural/small townpopulation of 35,000 in two northern NewMexico counties. As the only pediatricians,they see everything from well babies to young

Northeast

Seeking Board Certified/Board EligiblePediatrician for hospital-based practice in asso-ciation with Fairfield County's premier hospi-tal. Guaranteed competitive salary, excellentbenefits and reasonable work schedule includ-ing limited night-call coverage. Full- and part-time positions available. Mail C.V. to: RoySchutzengel, M.D., Chair, Department ofPediatrics. St. Vincent's Medical Center, 2800Main St., Bridgeport, CT 06606, e-mail toschutziestaol.com or fax: (240) 331-7307.

Mid-Atlantic

Maryland - Nine Pediatrician group seekingBE/BC associate to join thriving, well-estab-lished practice. Active newborn/pediatric serv-ice along with close affiliation with academiccenters. Family-oriented community in grow-ing area within easy access of Washing-ton/Baltimore. Send CV to: The PediatricCenter, 1 475 Taney Ave., Frederick, MD21702 or fax at (301 ) 695-8604.

Pediatrics - Expansion Pediatric position inHagerstown, MD. 2001 residents enco-uragedto apply. Join 3 BC Pediatricians and a CRNPin this busy private practice. Guaranteed salaryand competitive benefit package. The com-munity is family-oriented and friendly with anexcellent hospital, outdoor recreational activ-ities, and cultural activities. It also has excellentschools, reasonable real estate and is locatedin scenic Western Maryland, 1 hour from

2001 E. Mead Johnson Awardfor Research in Pediatrics

Call for Nominations

Nominations are invited for the 2001 E. Mead Johnson Award for Researchin Pediatrics. Each of two recipients will receive an honorarium of $10,000plus travel expenses to attend the 2001 annual meeti'ng of the PediatricAcademic Societies (APS/SPR/APA) in Baltimore, Maryland where recipientswill present their research.

Eligibility for the 2001 award:. Nominees must have received their first doctoral degree in 1981 or later.Exceptions to the stipulation may be made by the committee for individ-uals who have interrupted their research career for 2 or more years but whoare otherwise eligible.

. Limited to investigators in the Americas.* Research must be related to pediatrics and published recently, perhaps com-ing to fruition or attaining recognition during the past few years.*Candidates are nominated by their Department Chair, past E. MeadJohnson Award recipients, any scientific colleague or members of thePediatric Academic Societies.

The deadline for receipt of nominations is December 1, 2000.For further information/nomination forms, contact:

The Society for Pediatric Research3400 Research Forest Dr., Ste. B7

The Woodlands, TX 77381(281) 419-0052 Fax (281) 419-0082

E-Mail: infoEaps-spr.org URL: www.aps-spr.org

Although the Academy believes these classified ads are from reputablesources, theAcademy 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 classified sectionthat is professionally responsible, lawful, scientific and free of discrimi-nation.

Publication of an advertisement in AAP News 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.

Classtfacatlon: 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 Avaflable and Residencies/ Fellowships Available.Contact Roland Keve, The Walchli TauberGroup for display classified adsizes and rates.

For more Information, contact. Roland Keve, The Walchli Tauber Group,(410) 420-0311, or fax (410) 420-071 1. Ad copy is to be sent to: TheWalchli Tauber Group, 112 W. Pennsylvania Ave., Ste. 201, Bel Air, MD21014. Payments are to be mailed and made payable to The AmericanAcademy of Pediatrics, Dept. 77-5194, Chicago, IL 60678-5194.

AAP NEWSPublished Monthly

Amrerican Academy of PediatricsP.O. Box 927Elk Grove Village, IL 60009-0927

236 AAPNews November2000

0 W, available ow]tfww.aapnews.or

<3eg0:C',i,;3-tS--(W o

vir.2191WWV~~ ~

Refefences: 1. Greenberg RN. Overview of patient compliance with medication dosing: a literature review.Clin Ther. 1984;6:592-599. LPriceAlert'r'. San Bruno, Calif: First DataBank; June 15, 2000;12:10,12,15,77.

ZITHROMAX*(azithromycin for oral suspension)

BRIEF SUMMARY

INDICATIONSAND 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 pggulations vary among theseinfections,please see DOSAGE AND ADMINISTRATION for sgecific dosing recommendations,Acute otitis media caused by Haemophilus influenzae, Moraxella catarrhalis, or Streptococcuspneumoniae. (Forspecific dosage recommendation, see DOSAGE AND ADMINISTRATION.)Community-acquired pneumonia due to Chlamydia pneumoniae, Haemophilus influenzae, Mycoplasmapneumoniae, or Streptococcus pneumoniae in patients appropriate for oral therapy. (For specific dosagerecommendation, see DOSAGE AND ADMINISTRATION.)NOTE: Azithromycin should not be used in pediatric patients with pneumonia who are judged to be

inappropriate for oral therapy because ofmoderate to severe illness or risk factorssuch as anyofthe following: patients with cystic fibrosis,patients with nosocomially acquiredinfections, patients with known or suspected becteremia, patients requiring hospitalization, orpatients with siginifiicant underlyinghealth problems that may compromiseatheir ability torespond to their illness (including immunodeficiency or function.al asplenia).Pharyngitisitonsillitis caused by Streptococcuspyogenesas an alternative to first-line therapy in individuals

who 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 Streptococcus

pyogenes infection and the prophylaxis of rheumatic fever. ZITHROMAX"is often effective in the eradication ofsusceptible strains of Streptococcuspyogenesfrom the nasopharynx. Because some strains are resistant toZITHROMAX",susceptibility tests should be performed when patients are treated with ZITHROMAX". Dataestablishing effficacy 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.

CONTRAINDICATIONSZlTHROMAXIis contraindicated in patients with known hypersensitivity to azithromycin, erythromycin, or anymacrolide antibiotic.

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. Althoughrare, fatalities have been reported. (See CONTRAINDICATIONS.} Despite initially successfulsymptomatic treatment of the allergic symptoms, when symptomatic therapy was discontinued, the allergicsymptoms recuffed soon thereafter in some paltients without further azithromycin exposure. These patientsrequired prolonged periods of observation and symptomatic treatment. The relationship of these episodes to the longtissue 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 trea_entof pneumonia, azithromycin has only been shown to be safe and effecrtive in the treat-ment of community-acquired pneumonia due to Chismydiapnoumonise,Haemophilus influenzse,AMycoplam pneumoniaa,or Sbptococcuspneumoniao in patients appropriate for ofal therapy.Azithromycin should not be used in patiients wihbpneumonia who are judgled to be inappropriate for oraltherapy because of modefate to severeillness or risk factors such as any of the following: patients wihhcystic fibrosis, patients with nosocomially acquired infections, patients with known or suspectedbactwremia, patients requiring hospitalization, elderly or debilitated patients or peatints with significantunderlying health problems that may compromise their ability to respond to their illness(includingimmunodeficiencyor functional asplenia).Pseudomembranous colitis has been reported with nearly all antibacterial agents and may range inseverityfrom mild to life-threateningl.Therefore, it is important to consider this diagnosis in patients whopresent with diarrhea subsequent to the administration of antibacterial agents.

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

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

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

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

The following adverse events have not been reported in clinicaltrials with azithromycin, an azalide; however, theyhave been reported with macrolide products: ventricular arrhythmias, including ventricular tachycardia andtorsades depointes, in individuals with prolonged QT intervals.

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

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

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

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

intravenous dose. The effect of azithromycin on the plasma levels or pharmacokinetics of theophylline administered inmultiple doses resulting in therapeutic steady-state levels of theophylline is not known. However, concurrent use ofmacrolides 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 increased anti-coagulant 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 cytochromeP450 system-elevations of serum carbamazepine, terfenadine, cyclosporine,hexobarbital, and phenytoin levels.Labotatory 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: mouselymphomaassy, human lymphocyte clastogenic assay, and mouse bone marrow clastogenic assay.No evidence of impaired fertility due to azithromycin was found.Pregnancy-Teratogenic Effects. Pregnancy Category B: Reproduction studies have been performed in rats and miceat doses up to moderately maternally toxic dose levels (i.e., 200 mg/kg/day). These doses, based on a mg/m2 basis,are estimated to be 4 and 2 times, respectively, the human daily dose of 500 mg. In the animal studies, no evidence

adults with complex chronic disease. Theypractice aggressive, evidence-based medicinewith excellent case management; patientsreferred for UJNM or University of Colorado-Denver consults are treated in Taos. The physi-cians are supported by two nurse practitioners,3RNs. Compensation package is competitive.Historic Taos, home to artists/writers, hastremendous culture, great restaurants, world-class recreation. Details: Carole Gregory atMedQuest; phone: (800) 220-6331; fax:(505) 758.5325; e-mail: medquestOtaos-net.com.

Northwest

preceded by an optional NRP workshop onThursday, Feb. 1 5th. For registration informa-tion or to request a brochure, please call (800)588-5300 or e-mail your request tocmeX?tulane.edu.

Pediatrics Seminar '*Advances & ChangingTrends" (Twelfth Annual Lloyd Noland), at theWyndham Palace, Wait Disney World, Florida,March 14-17, 2001. Faculty: Drs. Duffner,Kokotailo, Lavelle, Ruley & Weston.Call/fax/write: George M. Converse 111, M.D.,FAAP, Department/Medical Education, LloydNoland Foundation, P.O. Box 925, Fairfield, AL

35061-0925; (205) 783-8181 (voice &fax), Visit the Lloyd Noland CME Website: CME4you.com, shortcut toLloydNolandCME.org.

Pediatrics Update (Eighth Annual LloydNoland, Hilton Head Island, SC, April 18-21,2001. Faculty: Drs Garrick, Honig, Howard,Lieberman & Shaw. Call/fax/write: George M.Converse 111, M .D., FAAP, Depart-ment/Medical Education, Lloyd NolandFoundation, P.O. Box 925, Fairfield, AL 35064-0925; (205) 783-8181 (voice & fax) Visit the

Lloyd Noland CME Web site: CME4you.com,shortcut to LloydNolandCME.org.

2001 Pediatric Update for the Primary CarePhysician, sponsored by Tulane UniversityHealth Sciences Center and Ochsner MedicalInstitutions, will be held April 27-29, 2001(New Orleans Jazz and Heritage Festival) atthe Wyndham Canal Place Hotel in NewOrleans, Louisiana. For registration informa-equest a brochure, please call (800)588-5300 or e-mail your request tocmeX?tulane.edu .

Pediatrics - Salem, Oregon - Experience thebest of the Northwest! Practice in a stimulat-ing professional environment in one of themost successful managed care systems in thecountry and enjoy a qualit,v lifestyle inherentto the beautiful Pacific Northwest! NorthwestPermanente, P.C., a stable, physician-man-aged multispecialty group serving over440,000 members of Kaiser Permanente inOregon and Southwest Washington, has afull-time position available for a BC/BEGeneral Pediatrician in Salem, Oregon. Our50-physician multispecialty group in Salem, amid-sized city of 120,000 people located inthe lush Willamette Valley, includes threepediatricians and provides a full range of pro-fessional services-to 48,000 plan members inthe area. We offer a competitive salary andbenefits package including a generous retire-ment program, professional liability coverage,sabbatical leave and more. To receive addi-tional i'nformation, forward inquiry and CV to:A.P. Clark, Director of Professional Resources,Northwest Permanente, P.C., 500 NEMultnomah, Ste. 100, Portland, OR 97232-2099. EOE.

of harm to the fetus due to azithromycin was found. There are, however, no adequate and well-controlled studies inpregnant women. Because animal reproduction studies are not always predictive of human response, azithromycinshould be used during pregnancy only if clearly needed.Nursing Mothers: It is not known whether azithromycin is excreted in human milk. Because many drugs are excretedin human milk, caution should be exercised when azithromycin is administered to a nursing woman.Pediatric Use: (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 I followed by 5 mg/kg on Days 2-5): Safetyand effectiveness in the treatment of children with community-acquired pneumonia under 6 months of age have notbeen established. Safety and effectiveness for pneumonia due to Chlamydia pneumoniaeand Mycoplasma pneumoniaewere documented in pediatric clinical trials. Safety and effectiveness for pneumonia due to Haemophilus influenzaeand Streptocouccuspneumoniaewere not documented bacteriologically in the pediatric clinical trial due to difficulty inobtaining specimens. Use of azithromycin for these two microorganisms is supported, however, by evidence from ade-quate and well-controlled studies in adults.

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

Studies evaluating the useof 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 vol-unteers (18-40 years old) for the 5-day therapeutic regimen. Dosage adjustment does not appear to be necessary forolder 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)('lazithromycin) therapy because of treatment-related side effects. Most of the sideeffects leading to discontinuation were related to the gastrointestinal tract, e.g., nausea, vomiting, diarrhea, orabdominal pain. Potentially serious side effects of angioedema and cholestatic jaundice were reported rarely.Clinical: Adults: Multiple-dose regimen: Overall, the most common side effects in adult patients receiving amultiple-dose regimen of ZITHROMAXOwere related to the gastrointestinal system with diarrhea/loose stools (5%),nausea (3%), and abdominal pain (3%) 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 ofI1% or less included the following:Cardiovascular Palpitations, chest pain.Gastointwsinal: Dyspepsia, flatulence, vomiting, melena, and cholestatic jaundice.Genitourinary: Monilia, vaginitis, and nephritis.Nervous System: Dizziness, headache, vertigo, and somnolence.General: Fatigue.Allergic: Rash, photosensitivity, and angioedema.Single 1-gram dose regimerr.Overall, the most common side effects in patients receiving a single-dose regimen of1 gram of ZITHROMAX(a were related to the gastrointestinal system and were more frequently reported than inpatients receiving the multiple-dose regimen.

Side effects that occurred in patients on the single one-gram dosing regimen of ZITHROMAX( with a frequency of1% or greater included diarrhea/loose stools (7%), nausea (5%), abdominal pain (5%), vomiting (2%), dyspepsia (1%),and vaginitis (1 %).Single 2-gram dose regimen: Overall, the most common side effects in patients receiving a single 2-gram dose ofZITHROMAXOwere related to the gastrointestinal system. Side effects that occurred in patients in this study with afrequency of 1% or greater included nausea (18%), diarrhea/loose 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%), abdominal pain (2%),vomiting (1%), and nausea (1%).

Community-Acquired Pneumonia: For the recommended dosage regimen of 10 mg/kg on Day 1 followed by5 mg/kg on Days 2-5, the most frequent side effects attributed to treatment were diarrhea/loose stools (5.8%),abdominal pain, vomiting, and nausea (1.9% each), and rash (1.6%).

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

With either treatment regimen, no other side effects occurred in children treated with ZITHROMAXe' with afrequency greater than 1%. Side effects that occurred with a frequency of 1% or less included the following:Cardiovascular Chest pain.Gastrointestinal: Dyspepsia, constipation, anorexia, flatulence, and gastritis.Nervous System:Headache (otitis media dosage), hyperkinesia, dizziness, agitation, nervousness, insomnia.General: Fever, fatigue, malaise.Allergic: Rash.Skin and Appendages: Pruritus, urticaria.Special Senses: Conjunctivitis.Post-Marketing Experience: Adverse events reported with azithromycin during the post-marketing period in adultand/or pediatric patients for which a causal relationship may not be established include:Allergic: Arthralgia, edema, urticaria, angioedema.Cardiovascular Arrhythmias including ventricular tachycardia.Gastrointestinal: Anorexia, constipation, dyspepsia, flatulence, vomiting/diarrhea rarely resulting in dehydration,pseudomembranous colitis and rare reports of tongue discoloration.General: Asthenia, paresthesia and anaphylaxis (rarely fatal).Genitourinary: Interstitial nephritis and acute renal failure, moniliasis, vaginitis.Hematopoietic: Thrombocytopenia.Liver/Biliary.Abnormal liver function including hepatitis and cholestatic jaundice, as well as rare cases of hepaticnecrosis and hepatic failure,vwhich have rarely resulted in death.Nerv1ous System: Convulsions, dizziness/vertigo, headache, somnolence, hyperactivity, nervousness, and agitation.Psychiatic: Aggressive reaction and anxiety.Skin/Appendages: Pruritus, rarely serious skin reactions including erythema multiforme, Stevens JohnsonSyndrome, and toxic epidermal necrolysis.Special Senses Hearing disturbances including hearing loss, deafness, and/or tinnitus, rare reports of tasteperversion.LaboratoryAbnormalities: Adults.Significant abnormalities (irrespective of drug relationship)occurring during theclinical trials were reported as follows: with an incidence of 1-2%, elevated serum creatine phosphokinase, potas-sium, ALT (SGPT), GGT, and AST (SGOT); with an incidence of less than 1%, leukopenia, neutropenia, decreasedplatelet count, elevated serum alkaline 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 treat-

ment-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.

In multiple-dose clinical trials involving almost 3300 pediatric patients, no patients discontinued therapy becauseof treatment-related laboratory abnormalities.

DOSAGE AND ADMINISTRATION (See INDICATIONS AND USAGE.)Acute Otitis Media and Community-AcquiredPneumonia: The recommended dose of ZITHROMAX(for oral sus-pension for the treatment of children with acute atitis media and community-acquired pneumonia is 10 mg/kg as asingle dose on the first day (not to exceed 500 mg/day) followed by 5 mg/kg on days 2 through 5 (not to exceed 250mg/day).Pharyngitis/Tonsillitis: The recommended dose for children with pharyngitis/tonsillitis is 12 mg/kg once a day for 5days (not to exceed 500 mg/day).ZITHROMWX for oral susponsion should begliven atleast Ihour before or 2 hours after a meal.ZITHROMIUI for oral suspension shouldnot be taken with food.

Formore detailedprofessional infomiation please refer to the full prescribing information.Revised July 2000

Pediatric Health

CONFERENCES IN SAN DIEGO, sponsoredby Children's Hospital & Health Center,San Diego, California: Advances in thePractice of Pediatrics, San Diego 2001,March 2-4, 2001, Category 1 credit, 15hours; Pediatric Dermatology for thePractitioner, San Diego 2001, April 20-21,2001, Category 1 credit, 12 hours; CurrentConcepts in Pediatric Respiratory Diseases,San Diego 2001, June 29-July 1, 2001,Category 1 credit, 16 hours. For more infor-mation contact: Continuing MedicalEducati'on, Children Hospital-San Diego, Tel(888) 892-9249, (858) 576-4072; Fax:(858) 495-8587 or e-mail rwebbEchsd.org.Visit our Web page at cmeQchsd.org.SAN DIEGO CONFERENCE ON RE-SPONDING TO CHILD AND FAMILYMALTREATMENT, Jan. 22-26, 2001.Increase your professional skills in pre-vention, recognition, assessment andtreatment in responding to maltreatment.Fifteenth Annual Conference presented bythe Center for Child Protection, Children'sHospital-San Diego. Approximately 30CEUs available. Contact RegistrationCoordinator mholmesQchsd.org or fax yourname and address to (858) 974-8018.

4th Annual Care of the Newborn, sponsoredby Tulane University Health Sciences Center,will be held Feb. 15-18, 2001 (Mardi Grasseason) at the Holiday Inn Superdome in NewOrleans, Louisiana. The three-day program is (C)2000 Pfizer Inc. ZC225AOO,

November 2000 AAP News 237

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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 are diar-rhea/loose -stools (5.8%), abdomin'al pain, vomiting, and nausea (1.9% each), and rash (1.6%).Zithromaxe (azithromycin for oral suspension) is contraindicated- in patients with known hypersensitivityto azithromycin, erythromycin, or any macrolide antibiotic.

Zithrom-ax is indicated fot pediatric infections such as acute otitis meidia due to Hinfluenzae, Mcatarrhalis, or Spneumoniae, and community-acquired pneumonia due to Cpneumoniae, Hinfluenzae, Mpneumoniae, or Spneu-moniae.Oral azithromycin should not be used in pediatric, patients with pneumonia who are judged to be- inappropriate fororal therapy because of moderate to severe illness or risk factors such as any of the following: patients with cys-ic fibrosis, patients with nosocomially acquired infections, patients with known or suspected bacteremia, patients-requiring hospitalization, or patients with significant underlying he'alth problems that may compromise their abil-ity to respond to their illness (including immunodeficiency or functional asplenia).

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