GS3W 7 0~~~~~~~~~~~~~~~~~~~~~~~~O-I

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 reactionsdirectly to your Distnct Chairperson, whose name and address is at the end of this list.

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

New York 2

Roberto Ayres, M.D.29 Village Hill Dr.Dix Hills, NY 11746-5514

Otolaryngology Specialty FellowNira Anda Goldstein, M.D.Dept. OtolaryngologySUNY-Health Center Brooklyn'Brooklyn, NY 11203-2098

Urology Specialty FellowMark Horowitz, M.D.Box 79445 Lenox Rd.Brooklyn, NY 11203

New Yorkc 3

Adam Aponte, M.D.57 E. 97thApt. 2New York, NY 10029

Juan Roure, M.D.157 E. 81st St.New York, NY 10028

V/lctoria Kisslinger, M.D.115 W. Hutchinson Ave.Pittsburgh, PA 15218

Otolaryngology Specialty FellowWasyl Szeremeta, M.D.867 Meadowbrok Dr.Huntington Valley, PA 19006

Uchenna Ufondu, M.D.436 Winona LakesE. Stroudsburg, PA 18301

West Virginia

Maha Abdalla, M.D.619 Robin St.Bluefield, VA 24605

Sherrie Miranda, M.D.17 Lakeview Dr.Huntington, WV 25704

Kentucky

Urology Specialty FellowBruce Slaughenhoupt, M.D.210 E. Gray St.Ste. 1000Louisville, KY 40202

EliotThompson, M.D.Ste.156400 Dutchman's Pkwy.Louisville, KY 40205-3341

North Carolina

Timothy Quinn Van Noy, M.D.2002 Fairview CircleWoodfieldWilkesboro, NC 28697

Puerto Rico

Denise Rivera-Lugo, M.D.Urb. Altamira592 Aldebaran St.San Juan, PR 00920-4220

Tennessee

Marcie Castleberry, M.D.1004 N. Highland Ave.Murfreesboro, TN 37130

Urology Specialty FellowD. Preston Smith, M.D.1924 Alcoa Hwy.Box U-1 1Knoxville, TN 37920

Virginia

Valerie Hicks, M.D.3213 Stratford Rd.Richmond, VA 23225

Krishna Madiraju, M.D.Apt. 1023909 Penshurst LaneWoodbridge, VA 22192

Kapil Saxena, M.D.6100 1-aurent Dr., #705Regency TowersParma, OH 44129

Sara Spinner-Block, M.D.2404 Dysart Rd.University Heights, OH 44118

Ontario

Urology Specialty FellowDarius J. Bagli, M.D.The Hospital for Sick Children555 University Ave.Ste. M 292Toronto, ON M5G-1X8Canada

Evelyn Boyle, M.D.10 Yonge St.Apt. 200Toronto, ON M5E 1 R4Canada

Osama Kentab, M.D.100-G Twyford St.Ottawa, ON KlV 0V5Canada

Ra-ghavendra Rao, M.D.1973 Sioux Blvd.New Brighton, MN 55455

Otolaryngology Specialty FellowFrank L. Rimell, M.D.Box 396420 Delaware St. SEMinneapolis, MN 55455

Wisconsin

Otolaryngology Specialty FellowDavid Beste, M.D.9000 W. Wisconsin Ave.P.O. Box 1997Milwaukee, WI 53201-1997

John Edwards, M.D.506 E. Lonview Dr.Appleton, WI 54911

Ernest Stremski, M.D.742 E. Sylvan Ave.Whitefish Bay, WI 53217

Alabama

Mohammad Alghamdi, M.D.ARAMCO DhahranDhahran Health Ctr., PediatricsDhahran, 31311Saudi Arabia

Heather Zar, M.D.9 Watson Rd.MuizenbergCapeTown, 7945South Af-rica

Massachusetts

Sanjeev Kothare, M.D.Apt. 602295 Tumpike Rd.Westborough, MA 01581 -2820

Deborah Esrig Simon, M.D.24-6 Deer PathMaynard, MA 01754

Sara Schutzman, M.D.133 Park St., #1201Brookline, MA 02146

New Hampshire

Cara Nelson, M.D.Apt. B40 Bay Ridge DriveNashua, NH 03062-4731

Linda Williams, M.D.19 Merrimack St.Concord, NH 03301-3807

Uniformed Services-East

Ann Macke, M.D.Naval Medical Ctr.Dept. of PediatricsPortsmouth, VA 23708

Michael Serwacki, M.D.CMR 442 Box 271APO, 09042Germany

Mark Thompson, M.D.20402 Heritage Farm TerraceMontgomery Village, MD 20886

New York 1

Holly Swanson, M.D.785 DelawareDelmar, NY 12054

Tariq Khan, M.D.P.O. Box 41Lakewood, NY 14750

Laura Kopp, M.D.2215 Five Mile Line Rd.Penfield, NY 14526

Kathleen Tigue, M.D.2900 Elmwood Ave.Rochester, NY 14618-2023

Wayne Waz, M.D.34 Lucy LaneBuffalo, NY 14225-4438

Margot Hilary Weinberg, M.D.23 Sandy LanePittsford, NY 14534

IFlorida

Salman Ahmed, M.D.Ste. 2B1688 W. Granada Blvd.Ormond Beach, FL 32174

Vasanth Bantwal Baliga, M.D.Heartland Peds. of Lake Wales1105 Druid CircleLake Wales, FL 33853

Jose H. Bolanos, M.D.5060 SW 154th Ave.Miami, FL33185

Amy Winterbotham Hardman, M.D.2121 Park St.Jacksonville, FL 32204

Otolaryngology Specialty FellowBeverly Denise McMillin, M.D.Nemours Children's Clinic807 Nira St.Jacksonville, FL 32207

Victoria Mosteller, M.D.3945 San Jose Park Dr.Jacksonville, FL 32217

Aarti Raina, M.D.10256 NW 52nd TerraceMiami, FL 33178-6617

Athena Richardson, M.D.1125 Seville Lane NESt. Petersburg, FL 33704-2422

Christine Wessels, M.D.2855 5th Ave. NSt. Petersburg, FL 33713

Georgia

Michael Hinkes, M.D.Ste. 3495555 Peachtree Dunwoody Rd.Atlanta, GA 30342

Jose Alvaro Rios, M.D.2135 Waters Ferry Dr.Lawrenceville, GA 30043

Radiology Specialty FellowJohn Grattan-Smith, M.D.Saottish Pite Children's AAedical Center1001 Johnson Ferry Road NEAtlanta, GA 30342-1600

Sheridyn Breedlove, M.D.1245 Vista LaneBirmingham, AL 35216-2359

Arkansas

Charles Hanson, M.D.228 W. Tyler, #105W. Memphis, AR 72301-4257

Mississippi

Deborah Shirley, M.D.102 Doctors' ParkStarkville, MS 39759

Maria Rosario Soriano, M.D.29 Treasure PointHattiesburg, MS 39402

Oklahoma

Todd Anthony Krehbiel, M.D.Ste. D205 S. AcademyGuthrie, OK 73044

Urology Specialty FellowBradley Kropp, M.D.Assislant Professo/Urodo& - WP3150Univ. of OK Health Sciences Center920 Stanton L. Young Blvd.,WP 3150Oklahoma City, OK 73104

Texas

Urology Specialty FellowDavid Harris Ewalt, M.D.3600 Gaston Ave.Ste. 1 2Dallas, TX 75246

Michele James, M.D.114 River KnollCastroville, TX 78009

Elizabeth Helen Lee, M.D.Shannon Clinic120 E. Beauregard Ave.P.O. Box 22000San Angelo, TX 76902

Pamela Mc Graw, M.D.909 FrostwoodSte.1 26Houston, TX 77041

Holly Monroe, M.D.2926 Camille Dr.College Station, TX 77845

__

_enz:l ___

DelawareIllinois

Ophthalmology Specialty FellowDorothy Moore, M.D.2055 Limestone Rd., #103Wilmington, DE 19808

District of Columbia

Abdool Rohoman Hamid, M.D.8508 16th St., #114Silver Spring, MD 20910

MarylandZenaidaAlidon, M.D.9461 Hickory LimbColumbia, MD 21045

Chinyere Rose Amazu, M.D.6914 Cipriano Woods Ct.Lanham, MD 20706

Madhu Nigam, M.D.11500 Broad Green Dr.Potomac, MD 20854-2097

New Jersey

Sheena Apun, M.D.1 1 Shainy LaneMatawan, NJ 07747

Jacqueline Marie Gerardi, M.D.385 Ocean Blvd.Apt. 1MLong Beach, NJ 07740-5735

Edna Sayat, M.D.206 Main St.Unit8Millburn, NJ 07041-1158

Pennsylvania

Patricia Gist-Watson, M.D.144 Westgate Dr.North Wales, PA 19454

Patricia Harkins, M.D.148 Marshall Dr.Mount Lebanon, PA 15228

Saw Htun, M.D.36 William Penn Dr.Chambersburg, PA 17201

Terence Beissel, M.D.15300 W. Ave.Ste. 304Orland Park, IL 60462

Maureen Bohnsak, M.D.500 Davis, 9th Fl.Evanston, IL 60201

William Cannon, M.D.708 WenonahOak Park, IL 60304

Marlito Favila, M.D.602 E. Chestnut St.Apt. 1Bloomington, IL 61701-3271

Saba Khalid, M.D.8248 Springfield Ave.Skokie, IL 60076-2724

Denise Messing, M.D.Ste. 1 502050 PfingstenGlenview, IL 60025

Dalila Nasser, M.D.413 Beech Dr.Glenview, IL 60025

Sai Nimmagadda, M.D.Children's Memorial Hospital2300 Children's PlazaBox 60Chicago, IL 60614

Aurelia Peera, M.D.9446 N. Dee Rd. 2GDes Plaines, IL 60016-3828

Margaret Scotellaro, M.D.2530 RidgeEvanston, IL 60201

Iowa

Angela Nystrom Riley, M.D.5409 Ave. OFt. Madison, IA 52627

Minnesota

Nina Jorgensen, M.D.479 44th Ct. NWRochester, MN 55901-6666

Ziad King, M.D.28100 Grand River Ave.Ste. 314 SFarmington Hills, MI 48336-5967

Eileen Marie Pokriefka, D.O.37855 Union Lake Rd.Clinton Township, Ml 48036-2885

Ohio

Valerie Edwards, M.D.1000 Halesworth DriveCincinnati, OH 45240-1713

Jacqueline Grupp-Phelan, M.D.6323 Grand Vista Ave.Cincinnati, OH 45213-1115

Karla Hauersperger, M.D.6505 Winchester Highlands Dr.Canal Winchester, OH 43110-9475

David Allan Katz, D.O.3825 Lincoln Way EastMassillon, OH 44646

Robert Krzeski, M.D.730 Red Bud Ave.Cincinnati, OH 45229

Julie Owens Politi, M.D.550 Robinson Ave.Ste. 8Barberton, OH 44203

34 AAPNews January1999

Michigan

15|t_§ t / /, \1T4Tf Ltl | i X| s t 1_F g/ A \

I

_

'l N~:l tervices-West

ity FellowM.D.

X 78216

M.D.iood Ave.UT 84108

,M.D.

trics31 95-6320

M.D./e., NE98028

Sari Nabulsi, M.D.Ste. 4064400 N. Midland Dr.Midland, TX 79707

David Riojas, M.D.3016 22ndLubbock, TX 79410

Urology Specialty FellowGeorge Michael Seremetis, M.D.1313 Red RiverSte. 316Austin, TX 78701

Paul Sharkey, M.D.3618 Oak Leaf CircleTyler, TX 75707

Maryam Taghadosi, M.D.4623 Jamaica DriveSugar Land, TX 77479

Marsha Turner, M.D.17402 Aspen Oak Ct.Spring, TX 77379

Michael Willcutts, M.D., Ph.D.Columbia Las Colinas Med. Ctr.Ste. 206Irving, TX 75039

Arizona

Deborah A. Gonzales, M.D.500 W. ThomasSte. 620Phoenix, AZ 85013

Anthony Na*6987 W. Au*.Glendale, A"

*Colorado

*.Susan Tiegs,11402 King

.Westminste

*Hawaii

*Urology Spz*.Ronald S. St149 KailuanKailua, HI 9

Kara Yamar*.45-644 Hin*.Kaneohe,HF

.Idaho

Carolyn RuiP.O. Box 1ECaldwell, 11

*Oregon

*.Nancy JohrThe Portlan1 5950 SW

*Beaverton,

Kenneth Le1 5558 NV\Beaverton,

agorka, M.D.urora Dr.kZ 85308

s, M.D.:3Wayer, CO 80030

lecialty FellowWutherland, M.D.na Place)3734-1 671

,moto, M.D.iamoe LoopdlI 96744

Uniformed Se

Urology Special*M. Bomalaski, P11627 IntrigueSan Antonio, T,

.Utah

Susan Morelli,I*.1851 E. Hollywi

Salt Lake City, L

*Washington

Sherilyn Smith,*.Box 356320*.Dept. of Pediati

Seattle, WA 98

*Odette Sueda,*19306 63rd Av,Kenmore, WA

*.California 1

*.Concepcion Ba1255 MartiniqLFoster City, CA

*Diane R. Dow,John Muri Mec1601 Ygnacio'

*Walnut Creek,

*.David Honeycl~2715 EmeraldIDavis, CA 956'

DISTRICT I

Eileen M. Ou(Pediatric NeuiNorth Shore (

* 57 Highland)v::Salem, MA 0'

DISTRIC'T 11I

.*DISTRICT VI

Ordean L. TorsteDean Medical CE1313 Fish Hatch(

*Madison, WI 53-

DISTRICT Vll

*L. Leighton Hill,Office of AdmissBaylor College ol

*One Baylor PlazzHouston, TX 77(

DISTRICT Vlill

*Jon R. Almquist,Virginia Mason tDept. of Pediatri,

.33501 FirstWayFederal Way, W,

DISTRICT IX

Lucy S. Crain, IV*.UCSF Box 0374400 Parnassus ASan Francisco, C

*.AmericAcader..Pediatr

Anita Keswani, M.D.125 Elliott Ct.Alamo, CA 94507

Kelly A. Look, M.D.300 Homer Ave.Dept. of PediatricsPalo Alto, CA 94301

California 2

Lori Openshaw, M.D.2960 Champion Way, #2209Tustin, CA 92782

Otolaryngology Specialty FellowNina Lisbeth Shapiro, M.D.Division Of Head & Neck Surgery62-158 CHSUCLA School of Medicine10833 Le Conte Ave.Los Angeles, CA 90095-1624

Harjinder Singh, M.D.226 Calle ConcordiaSan Dimas, CA 91773

California 4

Mohini Dayal Sinha, M.D.29162 Murre LaneLaguan Niguel, CA 92677

znson, M.D.,enter, SCiery Rd.,71 5-191 1

M.D.sions)f Medicine'a030

,M.D.Medical Ctr.'ICSy South(A 98003-6208

iellette, M.D., J.D.irologyChildren's HospitalAve.)1 970

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 19072-161 8

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

indquist, M.D.599D 83605-9998 A.D., MPH

Nve.:A 94143-0374intug, M.D.

lue Lanek 94404

,M.D.dical Center-3 EValley Rd.,CA 94598

:hurch, M.D.Bay Dr.16

nson, M.D.nd ClinicMilliken Way,OR 97006

ee, M.D.V Overton Dr.,OR 97446

21an-nyof-ics

IDEAS FOR LIVING, INC. BOULDER, COLORADO 80304

January 1999 -,AP Ne-ws 35

"I'd thoughit nothing coul uwake our sixyear ol son. But uwhen a urologist rec-ommiencded thie PottyPgr, wve clecicledto give i"t a try, Thlree uweeks later ourson's bedwetttingproblenms wvere over!"

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BEDWETTING! WHY JUST "CONTROL" IT WHEN YOU CAN CURE IT!

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]Ken-Cirest Sex-vicesAnnounces 3rd N'ational Conference4CIildEret WI&, Are Aleaicg)zly oCarsplex7

or TechnPolo,gy Dependfent:"Safe5_ Stfome, Safe in thse 4Coamserity"

M>arch 3, 4 Jk 5, 1999]DoubleYree MotelPhiladelphia, PA&

For more information, contact:.Andrea ]Imperatore]Ken-Cresit Services3132 Midvale.Av-e.

Philadelphia, PA& 19129(215) 844-4620, ext. 122

Ordyerizng ReprintsTo orcder reprints of specific articles, please contact.

::0Dnna Hoffman

141 Northwest Point Blvd. PO Box 927El Grove Village, IL 60007-0927

Phone: 847/981-7904 Fax: 847/228-L5088E-mnai. dhoffmanaap:)org

17'T qand Ochsner Medical Institutions. Contact: TUMC's Center for ContinuingEducation, (504) 588-5466 or (800) 588-5300; fax (504) 584-1779, e-mail:cmeX?mailhost.tcs.tulane.edu.

May

"Management of Common Pediatric Problems" -May 20 - 22, 1999, Innat Loretto, Santa Fe, New Mexico. Featured speakers: Ronald Hansen,M.D., Dermatology; David Skaggs, M.D., Pediatric Orthopaedics, GaryOverturf, M.D., Infectious Disease; Victor Strasburger, M..D, Children andthe Media. Contact UNM Office of Continuing Medical Education, CampusBox 713, Albuquerque, NM 87131-5126, Phone (505) 272-3942, Fax (505)272-8604.

June

Pediatric Infectious Disease Seminar -(Seventeenth Annual LloydNoland), Hilton Head Island, SC, June 22-26, 1999. Faculty: Drs. Balfour,Chartrand, Fisher, Marcy and Overturf. Call, fax or write: George M.Converse 111, M.D., FAAP, Department of Medical Education, Lloyd NolandFoundation, PO Box 925, Fairfield, AL 35064-0925 (205) 783-5276 (voice& fax). Visit the Lloyd Noland CME Web site: www.Iloydnolandcme.org

2nd Annual

Advances in Pediatrics -Acute CareSymposium

"Follow the Rainbow"to

Las Vegas, Nevada, March 19 - 21,r 1999

Program DirectorsJames D. Swift, M.D.

Ronald M. Pe'rkin, M.D.

Topics to Include* Blunt Abdominal Trauma in Children* Oncologic Emergencies* Pediatric Pain Management* Sepsis in the Newborn* Hypertensive Emergencies in Children

Presented bySunrise Children's Hosptial Foundaiton

And Sunrise Children's Hospital(702) 731-8373 Fax (702) 731-8372

FebruaryDepartment of Pediatrics, University of South Florida College of Medicine-"Second Annual Gulf Coast Pediatric Conference", Diamondhead All

Suite Beach Resort, Ft. Myers Beach, Florida, Feb. 26 and 27, 1999. Credit:10 hours AMA-1. For further information, contact Rebecca Scott, (813)272-2744, fax: (813) (272) 2749.

Mamh

Pediatrics Seminar "Advances & Changing Trends"-(Tenth Annual LloydNoland), at the Buena Vilsta Palace, Wait Disney World, Fla., March 17-20,1999. Faculty: Drs. Balistreri, Hansen, Rosman, Rupp and Shaw. Call, fax orwrite: George M. Converse III, M.D., FAAP, Department of MedicalEducation, Lloyd Noland Foundation, P.O. Box 925, Fairfield, AL 35064-0925; (205) 783-5276 (voice and fax). Visit the Lloyd Noland CME Website: www.Iloydnolandcme.org

April19th Annual National Pediatric Infectious Disease Seminar -April 7-10,1999, Hyatt Regency Hotel, San Diego, Calif. The seminar is jointly spon-sored by the University of Texas Southwestern Medical Center at Dallas,Texas, the accrediting institution, and the National Pediatric InfectiousDiseases Foundation. CME/AAP credit offered. For information, you mayconsult the Web site: www.cwiweb.com/npids or call (214) 648-2166; fax(214) 648-2317.

Pediatrics Update -(Sixth Annual Lloyd Noland) Hilton Head Island, S.C.,April 21-24, 1999. Faculty: Drs. Busch, Cotton, Gartner, Stein andTunnessen. Call, fax or write: George M. Converse 111, M.D., FAAP,Department of Medical Education, Lloyd Noland Foundation, P.O. Box 925,Fairfield, AL 35064-0925, (205) 783-5276 (voice & fax). Visit the LloydNoland CME Web site: www.lloydnolandcme.org.

1999 Pediatric Update For The Primary Care Physician -April 30 - May1 (the last weekend of the internationally acclaimed ";Jazz & HeritageFestival"), New Orleans, La. Presented by Tulane University Medical Center

mobbi.,

MMUT-yl Mmm _ll

GeorffaBC/BE Pediatrician For A Busy Practice North Of Atlanta -Competitivesalary/bonus/benefit package. Send CV to: Jonathan Cheek, M.D., 205Waleska Road 1A, Canton, GA 301 14.

MarylandRockville -Seeking 13C/BE infectious diseases (peds or IM) physician forposition at the Food and Drug Administration for the review of investiga-tional vaccine applications. Opportunities for professional development toinclude patient care. If interested, send CV to Kerin Denault, 1401 RockvillePike, Suite 200N, HFM-475, Rockville, MD 20852-1448. FDA is an EqualOpportunity Employer.

New HampshirBC/BE PEDIATRICIAN BY JULY 1999 -FT/3/4 time pediatrician for five-physician group. Call 1:4 Nurse Practitioner backup. 200 bed hospital, level2 nursery. PRACTICE PHYSICIAN OWNED! Excellent Lifestyle. (603) 224-1929, Fax (603) 228-7114.

PennrfvaniaState College: Penn State Geisinger Health System is currently seeking13C/BE pediatrician to join its multispecialty group practice in State College,Pa. Call is shared with its sister clinic in Philipsburg and is 1:5. The area offersa tremendous amount of educational, cultural and recreational activities toenjoy as well as an excellent business climate and a superior quality of life.State College is the home of Penn State University. We offer a competitivesalary and excellent benefit package. For additional information, please con-tact: Penn State Geisinger Professional Staffing (PP-AB), 100 NorthAcademy Ave., Danville, PA 17822-152a--. phone (800) 845-7112; fax (800)622-2515. E.O.E. M/F/H/V. Sorry, noJl visa opportunities available.

The Sisters of the Third Order of St. Francis (OSF)have been providing medical care for residents of MEDICAL GROUPIllinois, Iowa and Michigan for more than 120 years.Their corporation, now known as OSF HealthCare, includes seven hospitals, two extended care facilities, aninsurance company with its own managed care products, more than one dozen affiliated companies pro-viding medical products and services, and OSF Medical Group, a multi-specialty physician group with morethan 220 providers in its multi-state service area. We now have general pediatrics opportunities in:

Peoria, IllinoisFor more information, please contact:

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

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 modify the wording of classi-fied ads. These changes are generally made in compliancewith the regulations ofvarious federal and/or state commis-sions against discrimination or because they might beinterpreted as being unlawful or in conflictwith accepted pro-fessional standards ofmedical practice.These advertising modifications are made to maintain a clas-sified section that is professionally responsible, lawful,scientific and free ofdiscrimination.

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

Classification: Classified ads are accepted under BusinessServices, GeneralAnnouncements, Medical Meetings, Physi-ciansWanted, PositionsWanted, Practices Available, Publica-tions, Real Estate and Residencies/FellowshipsAvailable.

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36 AAP News January 1999

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CLASSIFIEDADVERTISING POLICYWhenyou need to contactpediatricians, contactAAPNews. Each month more than 55,000pediatricians,pediatricspecialists, third-yearpediatric residents and othersubscribers turn toAAPNewsforchild healthinformation they cannotget elsewhere. With a ckassified ad, you can speak directly to those readers.

aec(miC D*-.~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ n,

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

ZffHROMAX"(uzithromycis for oral suspension)

BRIEF SUMMARY

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 gatient populations vary among these,infections. please see DOSAGE AND ADMIINISTRATION for speific dosing recommendations,Acute oddis medi caused by Haemophilus influenzae, Moraxella catarrhalis, or Streptococcus pneumoniae.

(For specific dosage recommendation, see DOSAGE AND ADMINISTRATION.)Commnunity-acquired pnoumonis due to Chlamydia pneumoniae, Haemophilus influenzae, Mycoplasma

pneumoniae, or Streptococcus pneumoniae in patients appropriate for oral therapy. (For specific dosagerecommendation, see DOSAGE AND ADMINISTRATION.)

NOTE. Azithmcyin shwould not be used in pedodiarc p tiont with pnotunois who amo judged to beinappropriate for oral therapy because of moderate to severe illness or risk factors such asany of the following: patients with cystic fibrosis, pationts wilb nosmomoially acquiredinfections, patients with known or suspected bacteremia, patients requiring hospitalization,or patients with significant underlying health problemns that may compromnise their ability torespond to their illnoss (including immunodeficiency or functional asplania).

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

NOTE: Penicillin by the intramuscular route is the usual drug of choice in the treatment of Streptococcuspyogenes infection and the prophylaxis of rheumatic fever. ZITHROMAXI is often effective in the eradication ofsusceptible strains of Streptrococcus pyogenes from the nasopharynx. Because some strains are resistant toZITHROMAX5, susceptibility tests should be performed when patients are treated with ZITHROMAX Dataestablishing efficacy of azithromycin in subseqzuent 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 ZITHROMAXO may be initiated before results of thesetests are known; once the resufts become available, antimicrobial therapy should be adjusted accordingly.

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

WARNINGSSerious allergic reactions, including angioedema, anaphylaxis, and dermatologic reactions including StevensJohnson Syndrome and toxic epidermal necrolysis have been reported rarely in patients on azithromycin therapy.Although rare, fatalities have been reported. (See CONTRAINDICATIONS.) Despite initially successfulsymptomatic treatment of the allergic symptoms, when symptomatic therapy was discontinued, the allergicsymptoms recurred soon thereafter in some patients without further azithromycin exposure. These patientsrequired prolonged periods of observation and symptomatic treatment. The relationship of these episodes to thelong tissue half-life of azithromycin and subsequent prolonged exposure to antigen is unknowen 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 treatinent of pneumonia, azithromycin has only been shown to be safe and effectiive in thetreatmenit of commnunity-acquired pneumonia due to Chlavmydis pneumoniso, Hamnophilus inflvenzaa,Mycoplasina pneumoniss, or Straptococcus pnoumonine in patients appropriate for oral therapy.Azithromycin should not be used in patients with pneumonia who are judged to be inappropriate for oraltherapy because of moderate to severe illness or risk factors such as any of the following: patients withcysfic fibrosis, patients with nosocomially acquired infections, patients with known or suspectedbacteremia, pFtients requiring hospitalization, elderly or debilitated patients, or patients with significantunderlying health problems that may compromise their ability to respond to their illness {includingimmunodeficiency o ur nctional asplenia).

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

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

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

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

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

The following adverse events have not been reported in clinical trials with azithromycin, an azalide; however,they have been reported with macrolide products: ventricular arrhythmias, including ventricular tachycardia andtorsades de pointes, in individuals with prolonged 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 for Patients: Patients should be cautioned to take ZITHROMAX(0 suspension at least one hour prior toa meal or at least two hours after a meal. This medication should not be taken with food.

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

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

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

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

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

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

Digoxin-elevated digoxin levels.Ergotamine or dihydroergotamine-acute ergot toxicity characterized by severe peripheral vasospasmand dysesthesia.Triazolam-decrease the clearance of triazolam and thus may increase the pharmacologic effect of triazolam.Drugs metabolized by the cytochrome P450 system--elevations of serum carbamazepine, terfenadine, cyclosporine,hexobarbital, and phenytoin levels.

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

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mouse lymphoma assay, human lymphocyte clastogenic assay, and mouse bone marrow clastDgenic 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, howvever, no adequate and wvell-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 knowvn wvhether azithromycin is excreted in human milk. Because many drugs are excretedin human milk. caution should be exercised wvhen 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 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 Mycoplasma pneumoniaewere documented in pediatric clinical trials. Safety and effectiveness for pneumonia due to Haemophilus influenzaeand Streptococcus pneumoniae were not documented bacteriologically in the pediatric clinical trial due to difficultyin obtaining specimens. Use of azithromycin for these two microorganisms is supported, however, by evidence fromadequate and well-controlled studies in adults.

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

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

ADVERSE REACTIONSIn clinical trials. most of the reported side effects were mild to moderate in severity and were reversible upondiscontinuation of the drug. Approximately 0.7% of the patients (adults and children) from the multiple-dose clinicaltrials discontinued ZITHROMAXI( azithromycin) therapy because of treatment-related side effects. Most of the sideeffects leading to discontinuation were related to the gastrointestinal tract, e.g., nausea, vomiting, diarrhea, orabdominal pain. Potentially serious side effects of angioedema and cholestatic jaundice were reported rarely.Clinical: Adults: Multiple-dose regimen: Overall, the most common side effects in adult patients receiving amultiple-dose regimen of ZITHROMAX* were related to the gastrointestinal system with diarrhea/loose stools (5%),nausea (3%), and abdominal pain 13%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:Cardiovascular Palpitations, chest pain.Gastointesfinal: 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 regimenr. Overall, the most common side effects in patients receiving a single-dose regimen of1 gram of ZITHROMAX(^ 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 ZITHROMAXI with a frequency of1% or greater included diarrhea/loose stools (7%), nausea (5%), abdominal pain (5%), vomiting 12%), dyspepsia (11%),and vaginitis (1%).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/loose stools (14%), vomiting (7%), abdominal pain (7%),vaginitis l2%), dyspepsia (11%), and dizziness (11%). The majority of these complaints were mild in nature.Children: Multiple-dose regimens. The types of side effects in children were comparable to those seen in adults,with different incidence rates for the two dosage regimens recommended in children.

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

Community-Acquired Pneumonia: For the recommended dosage regimen of 10 mg/kg on Day 1 followed by5 mglkg on Days 2-5, the most frequent side effects attributed to treatment were diarrhea/loose stools 15.8%),abdominal pain, vomiting, and nausea (1.9% each), and rash (1.6%).

Pharyngitis/tonsillitis: For the recommended dosage regimen of 12 mg/kg on Days 1-5, the most frequent sideeffects attributed to treatment were diarrhea/loose stools 16%), vomiting 15%), abdominal pain 13%), nausea 12%),and headache (11%).

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

When 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 alireported at a frequency of less than 1%, but were similar in type to the adult pattern.

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

Pediatric HealthZC21 9A98

January 1999 AAP News 37

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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 arediarrhea/loose stools (5.8%), abdominal pain, vomiting, and nausea (1.9% each), and rash (1.6%).ZithromaxO (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 Hinfluenzae, Mcatarrhalis, orS pneumoniae, and community-acquired pneumonia due to C pneumoniae, H influenzae, M pneumoniae, orS pneumoniae.Oral azithromycin should not be used in pediatric patients with pneumonia who are judged to be inappropriatefor oral therapy because of moderate to severe illness or risk factors such as any of the following: patients withcystic fibrosis, patients with nosocomially acquired infections, patients with known or suspected bacteremia,patients requiring hospitalization, or patients with significant underlying health problems that may compromisetheir ability to respond to their illness (including immunodeficiency or functional asplenia).

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