/---.1-3\1 .) A In submifting these names of board-certified pediatricians to you, it is understood that academic and pediatric credentials are not in question. Comments are requested concerning possible legal and/or ethical situations of which you might have personal knowledge. Send any comments on the following list of new applicants to your Dishid Chairperson by March 15. 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 reactions directly to your District Chairperson, whose name and address is at the end of this list. Floyd Ostrom, D.O. 2005 Chantilly Ct. Arlington, TX 76015 New Jersey Jocelyn Bautista, M.D. 3 Driftwood Dr. Howell, NJ 07731 Paul Kouyoumdji, M.D. Laura's Glen Apts. 542 S. Broadway, #F-21 Pennsville, NJ 08070 Emmanuel Siaw, M.D. 1 -R Reading Rd. Edison, NJ 08817 Charles Sperrazza, M.D. 3 Newberry Ct. Medford, NJ 08055 Nancy Harper, M.D. 129 Hillside Ave. Suffolk, VA 23434 Surgery Specialty Feliow Eugene McGahren, M.D. RO. Box 10005 Charlottesville, VA 22906 John Williams, M.D. 3102 Floyd Ave. Richmond, VA 23221 Michigan Zafer Soultan, M.D. P.O. Box 66548 Riyadh, 11 586 Saudi Arabia Missouri Stephanie Mai 3928 NE 60th Gladstone, M( Nebraska Francis Harrisc 1107 Norton Papillion, NE E North D'akol Mary McAdo( 921 15th Ave. Minot, ND 58 Wisconsin Rebecca Webl 2700 W. 9th Oshkosh, WI, Arkansas David Weed, 1618 N. Harri Liftle Rock, Al Mississippi Nandini Bharl 1740 James 8 Biloxi, MS 391 Oklahoma 1- A r% -i :Florida 0 0 0 0 xx, M.D. St. 0 64119 on, M.D. Dr. 68046 ita o, M.D. .. SE 3701 Arizona Mark Hemphill, 1841 E. Northv Phoenix, AZ 85 Colorado Sorenna Kirkeg 352 S. High St. Denver, CO 80 New Mexico Grace Nadell, A 104 5 Eldorado Cir. Santa Fe, NM E Utah Neurological & Specialty Fello, Douglas Brocki 100 N Medical Suite 2400 Salt Lake City, Washington Dr. Loris Hwang, t 10711 Meridia #409B Seaftle, WA 9E Califomia I Lawrence Coo 1860 Pennsylv Fairfield, CA 9, Nathan Hirsch -ery 1233 Shafter) Pacific Grove, Califomia 2 285 Bobbi Underhi c/o Tom Milto 1 rn cn;n+ lr%rn AAada Hoffi 15200 S\A Miami, FL .-,% -.L I .nan-Guardia, M.D. V 81 Ave. 33157 ifante, M.D. .ale Ave. L 33614 1, M.D. /iew Ave. 5020 )-aard, M.D. )209 M.D. 87505 )urgery M meyer, M.D. .1 Dr. UT 84113 M.D. an Ave. N, 8133 : Orestes In : 6902 N. F : Tampa, FL : Heather Li : 4951 G rai : Pensacola : Tobias No : 7001 SW : Miami, FL : Georgia : Santanu I : 1049 N. 1- : Warner Ri Connecticut Robert Macauley, M.D. 33 Gerrish Ln. New Canaan, CT 06840 Massachusetts Jacqueline Gibbes, M.D. 1000 Broadway Chelsea, MA 02150 Rhode Island Surgery Specialty Fellow Arlet Kurkchubasche, M.D. Two Dudley St., Ste. 180 Providence, RI 02905 -enga, M.D. Me Dr. i, FL 32504 )bigrot, M.D. 187th Ave. L 33173 0 Shohreh Moazami, M.D. 265 Fremont St. Battle Creek, MI 49017 Ohio Alexander Harrison, M.D. 9500 Euclid Ave., M-39 Cleveland, OH 44195 Elizabeth Jacob, M.D. 1298 Inglis Ave. Columbus, OH 43212 Surgery Specialty Fellow Brian Kenney, M.D. 2121 Hughes Dr., Ste. 620 Toledo, OH 43606 Jill Sohayda, M.D. 6773 Old Royalton Rd. Brecksville, OH 44141 Pennsylvania Joseph Paolillo, M.D. 6236 Fifth Ave., Apt. 2( Pittsburgh, PA 15232 North Carolina Mark Baker, M.D. 604 W 27th St. Lumberton, NC 28358 Michelle Chiu, M.D. Div. of Neonatology P.O. Box 32861 )b, M.D. Ave., Ste. 54904 Al ki, I 9 01A Das, M.D. Houston Rd. kobins, GA 31093 Kathleen EmpE 11 37 Windy R Atlanta, GA 3C Zerah Gorham- 5244 FieldgreE Stone Mounta 30088 Leila Stallwortl 3134 EdinburE Augusta, GA 3 Anna Tanner, J 601 A Professi( Suite 160 Lawrenceville, DISTRICT I Eileen M. Ouell( Pediatric Neur North Shore C Hospital 57 Highland A Salem, MA 01 e-mail: eouell( DISTRICT 11 Robert M. Co Medical Direc MedBest Presidential PI Suite 106 Madison Tow, Syracuse, NY e-mail: rcorwi I* 4 en, M.D. tidge Ln. D339 -Cherry, M.D. en Crossing tin, GA .h, M.D. gh Dr. 30909 M.D. .onal Dr. , GA 30045 M.D. ison St. A 72207 New York I Muhammad ldrees, M.D. 71 Walden Creek Dr. Batavia, NY 14020 Herbert Schneiderman, M.D. 1 00 Circle Rd. Syracuse, NY 13210 New York 2 Agnes Banquet, M.D. 357 Knollwood Extension Elmsford, NY 10523 Carlos Rivera, M.D. 29 Port Ln. Staten Island, NY 10302 New York 3 Dov Rosen, M.D. 436 Chestnut St. West Hempstead, NY 11 552 a ON 7th Flr. Surgery Twr. Charlotte, NC 28232 Joy Lowry, M.D. 516 W. Wilson Creek Dr. New Bern, NC 28562 Shannon McQueen, M.D. 613 Fountain PI. Burlington, NC 27215 Cesar Santos, M.D. Medical Ctr. Blvd. Winston-Salem, NC 27157 South Carolina Surgery Spec.alty Fellow William Adamson, M.D. Dept. of Surgery 96 Jonathan Lucas, Ste. 418 CSB Charleston, SC 29425 Kent Stock, D.O. 2093 Henry Tecklenburg Dr. Suite 308 Charleston, SC 29414 Virginia Maria Asi-Bautista, M.D. 7101 Jahnke Rd., Ste. 720 Richmond, VA 23225 -gav, M.D. Buchananl )531 Scott Steinbei 2475 W. Galt Suite. A Cincinnati, 01 Illinois Rashed Durgl 5418 Regent Rockford, IL Jerilyn Morris 2707 E. Hick( Marion, IL 62 Minnesota Congenital h Specialty Feh David Overry 2545 Chicagi Suite 106 Minneapolis, Neurological Specialty Fel, Joseph Petro 280 N. Smiff Suite 234 St Paul, MN, rg, M.D. braith Rd. fl 45239 ; Cheryl : 14600, : Edmoni 0 : Tonya 1. : 701 E. : Jenks, ( : Texas 0 Bryant, M.D. Coles Rd. id, OK 73013 1- a a m Suffridge, D.O. Main OK 74037 )ney, M.D. vania Ave. )4533 1, M.D. Ave. CA 93950 'ham, M.D. s Park Rd. 61107 ssey, M.D. ory Ln. 2959 lette, M.D., J.D. rology "'.'h i I d re n's Ave. 1970 lette.aap.org 0. DW rwr. Congenital Heart Surgo Specialty Fellow Charles Fraser, M.D. 6621 Fannin, MC 1-2. Houston, TX 77030 Frantz Jean-Louis, M.[ 1914 Leatherstem Kingwood, TX 77345 Kathleen McCrory, D.( 701 N. Sixth St. Longview, TX 75601 Surgery Specialty Fe//c Donald Meier, M.D. 1935 Motor St. 3 rd Fl. (H -31 0) West 1 Dallas, TX 75235 ; -i Du --)ain-E josepn .a- : Arcadia, CA 91006 : Califomia 3 : Deborah Mishek, Ml : 11251 Alejo Ln. : San Diego, CA 92124 iillr D.O. )n mr%k C+ leart Surgery low nan, M.D. -o Ave. MN 55404 Surgery I/ow inio, M.D. i Ave. 55102 )rwin, M.D. Aor - Ilaza ters I 3202 rin.aap.org Maryland Reynaldo Ebreo, M.D. 101 Rolling Rd., Unit B Elkton, MD 21921 Mary Leppert, M.D. 1403 Quick Fox Ct. Eldersburg, MD 21784 D. 4 44 AAP News February 2000
Transcript
/---.1-3\1 .) A
In submifting 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 the following list of new applicants to your Dishid Chairperson by March 15.
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 yourreactions directly to your District Chairperson, whose name and address is at the end of this list.
Susan S. Aronson, M.D.605 Moreno Rd.Narbeth, PA 19072e-mail: saronsontaap.org
DISTRICT IV
E. Stephen Edwards, M.D.2800 Blue Ridge Blvd.Suite 501Raleigh, NC 27607e-mail: sewardsQ?aap.org
DISTRICT V
Stanford A. Singer, M.D.36700 Woodward Ave.Suite 300Bloomfield Hills, MI 48304e-mail: ssingerEaap.org
DISTRICT VI
Ordean L. Torstenson, M.D.Dean Medical Center, SC1313 Fish Hatchery Rd.Madison, WI 53715e-mail: otorstensontaap.org
DISTRICT Vll
L. Leighton Hill, M.D.Office of AdmissionsBaylor College of MedicineOne Baylor Plaza,Room N104Houston, TX 77030e-mail: lhill?aap.org
DISTRICT Vlill
Jon R. Almquist, M.D.Virginia Mason MedicalCenterDepartment of Pediatrics33501 First Way SouthFederal Way, WA 98003e-mail: jalmquist@?aap.org
DISTRICT IX
Lucy S. Crain, M.D., M.P.H.UCSF Box 0374400 Parnassus Ave.San Francisco, CA 94143e-mail: Icraintaap.org
~r, M.D.Lge of Georgia
30912XrEaap.org
'*anny ofliCS
A CME Meeting in Practical Pediatric Topicsand a Practice Management Seminar
C at*) S THE ~~~CLOISTERW
June 15-17, 2000 *The Cloister *Sea Island, GeorgiaFrank P. Bowyer, MD, Program Chair
Sponsored byGeorgia Chapter/American Academy of Pediatrics
For information contact Meg Evans * (404) 881-5067 * Fax (404) 249-9503 * mevansinag.orgor visit our Web site at w-ww.gaaap.org
r'A
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NORTHEASTWESTCHESTER COUNTY NEW YORKBusy well-established practice seeks BC1BEpediatrician with potential partnership.Mail CV to: AAP1, P.O. Box 149, Bel Air,MD 21014.
MID-ATLANTICPENNSYLVANIA:. Premier pediatric groupseeking ninth pediatrician, BC/BE. -Excellentsalary/benefits package. Partnership optionin three years. Contact: Reading PediatricsInc., Mark Reuben, M.D.,.40 Berkshire Ct.,Wyomissing, PA 19610. Phone: (610)374-7400.
SOUTHWESTCALIFORNIA -Neonatologist's (BC/BE)positions available throughout the LosAngeles area with large physician owned pri-
vate/academic multihospital-based privatepractice group specializing in Neonatologyand Pediatric Intensive Care. Competitivestarting salary with profit-sharing bonus andlong-term employment options, clinical posi-tions needed with academic association avail-able. Positions available immediately.Contact: Pediatric Critical Care MedicalGroup, -5400 Balboa Blvd., Suite 331, Encino,CA 91316 - (818) 461-8888.
SOUTH TEXAS - A group of five pediatri-cians is searching for a sixth. Loan repay-ment of up to 20K per year. Complete ben-efits package to include paid malpractice anda first-year guarantee of 130K. Keep whatyou collect after first year. Bilingual a plus. NoJ-1 visas. Fax CV to (210) 651-4338 or con-tact David Beck at (800) 304-3095 or e-maildbeckObeck-field .com.
TEXAS -An 88 member multispecialtyDirector,Pediatric InpatientProgram
Children's Memorial Hospital, ranked one of the nation'stop 10 pediatric hospitals for the seventh consecutive year,seeks a Director for the Pediatric Inpatient Prograii at LakeForest Hospital, a Children's Memorial Hospital relatedaffiliate. In this role, you will provide neonatology coveragefor Lake Forest Hospital, a Level II community hospitallocated in the picturesque and prestigious North Shore areaof Chicagoland with an approximate 2400 defiveries and300 nursery admissions annually.Opportunities are also availale to participate in activitieswith Chhidren's Memnorial Hospital and NorthwesternUniversity Medical School's Division of Neonatology in theDepartnient of Pediatrics. This position requires a balanceof in-house and back up coverage. Qualified applicantsmust have previous community neonatology experience andbe comfortable mentoring pediatric general practitioners.It is proposed that the successful incumbent wouldcommence May 1, 2000.- We offer a competitive salarycommensurate with experience and a comprehensivebenefits package in a rewarding work environment. Forconsideration, please forward CVs to:
Dr. Daniel Polk, Associate Head,Division of Neonatology, Professor of Pediatrics,Northwestern University Medical SchoolC/0 Children's Memorial Hospital2300 Children's Plaza, no. 45Chicago, IL 60614FAX 773.880.3061e-mail [email protected]'s Memorial Hospital is an Equal Opportunity Employer.Eiring is contingent upon eligibility to worlc in the United States.
Children's Memorial Hospital is a teaching hospitalwdliged with Northwestern Unnersity Medical SchooL
StaffNeonatologist
Memorial Hospital
CLASSIFIERD ADVERTISING POLICYWhenyou need to contact pediatricians, contactAAPNews. Each month more than 55,000 pediatricians,pediatricspecialists, third-year pediatric residents and othersubscribers turn toAAPNewsforchild hlealthinforrnation theycannotgetelsewhere. With a classified ad, you can speakdirectlyto those readers.
Although the Academy believes these classified ads are fromreputable sources, theAcademy does not investigate the offersmade anld assumes no responsibility conceming them.
OccasionaUy, it is necessary to modify the wording ofclassifiedads. These changes are generaDy made in compliance with theregulations ofvarious federal and/or state conunissions againstdiscrinmination or because they might be interpreted as beingurlawful or in conflict with accepted professional standards ofmedicl practice.These advertising modifications are made to maintain a clas-sified section that is professionally responsible, lawful, scientificanid free of discrimination.
Publication of an advertisement in AAP News neither consti-tutes nor implies a guarantee or endorsement byAAP News or
AAP NEWS
Axmerican AcademyofPeitrc
ELk Grove V-dlage, IL 60009-09 277
the American Academy of Pediatrics ofthe product or serviceadvertised or ofthe claimns made for the product or service bythe advertiser.
Classlflcation: Classified ads are accepted under BusinessServices, General Announcements, Medical Meetings, Physi-cians Wanted, Positions Wanlted, Practices Available, Publica-tions, Real Estate and Residencies/lFellowshipsAvailable.
Display Classified Ads: Camera-ready, 4-color, 3-color and2-color display classified ads are accepted under GeneralAnnouncements, Medical Meetings, Physicians Wanted,Positions Wanted, Practices Available and Residencies/Fellowships Available. Contact Roland Keve, The WalchliTauber Group for display classified ad sizes and rates.
For more information, contact: Roland Keve, The WalchliTauberGroup, (410) 420-0311,orfax(410) 420-0711.Adcopyis to be sent to: TheWaldoauber Group, 112 W. PennsylvaiAve., Ste. 201, Bel Air, MD 21014. Payments aretobemailedandmadepayable toTheAmericanAcademyofPediatrics, Dept. 77-5194, Chicago, IL 60678-5194.
,.lh
46 AAP News February 2000
Mants InInd, once stretched by anew idea,never regan fts original dfnnsion.
Oliver Wendell Holmes -
Our mnshave been stretched by lthe World Wilde Web. ]1If you are a pediatfiaan on matemity leave, retired, or lookingfor a way to work from horne, consider a rewarding opportunityunth drpaula.com the prerniere website for pediatric andparenbng advice. Our success has been overwhelming. However,_Wts becoming mnore difficuH to handle the increasing volurme of_questions coming in. If you enjoy g'mng advice, join ourteam and help makea difference in the lives of parents and their kids.-Dr. Paula
If you cue interested go to: dr au a 'X<Aiwwwv.dpala.c*m/0Wew8ach dpuaso
I D --:. 1. T) . 1,
References: 1. Greenberg RN. Overview of patient compliance with medication dosing: a literature review. Clin Ther.1984;6:592-599. L RedBookO Update. Montvale, NJ: Medical Economics Co Inc; July 1998:22,24,26,27,71.
ZITHROMAX"(azithromycin for oral suspension)
BRIEF SUMMARY
INDICATIONS AND USAGEZITHROMAX' (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 Streptocouccus pneumoniae.(For specific 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 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 requiring hospitalization.or patients with significant underlying health problems that may compromise their ability torespond to their illness (including immunodeficiency or funcitional asplenia).
Pharynglitis/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 Streptococcus pyogenes from the nasopharynx. Because some strains are resistant toZITHROMAXt', susceptibility tests should be performed when patients are treated with ZITHROMAX(*. 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 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 recuffed 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 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 treatment of pneumonia, azithromycin has only been shown to be safe and effective in thetreatmnent of community-acquired pneumonia due to Chlamy/dia pneumoniae, Hasmophilus influenzae,Mycopisama pnsumonise, or Streptococcus pneumnwise 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 moderste to severe illness or risk factors such as any of the following: patients withcystic fibrosis, patients with nosocomially acquired infections, patients with known or suspectedbacteremia, patients requiring hospitalization, elderly or debilitated patients, or patients with significantunderlying health problemis that may compromise their ability to respond to their illness (includingimmunodeficiency or functional asplenia).
Pseudomembranous colitis has been reported with nearly all antibacterial agents and may range inseverity from mild to life-threatening. Therefore, it is important to consider this diaginosis in paitientswvho presenit 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 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 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 Patients: Patients should be cautioned to take ZITHROMAXZ 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 azithromyci'nsimultaneously.
The patient should be directed to discontinue azithromycin immediately and contact a physician if any signs of anallergic reaction Dccur.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 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 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, Impairmenit of Fertility- Long-term studies in animals have not been performedto evaluate carcinogenic potential. Azithromycin has shown no mutagenic potential in standard laboratory tests:
20th ANNUAL NATIONAL PEDIATRICINFECTIOUS DISEASE SEMINAR, April 26-29, Hyatt Regency Hotel, New Orleans, La.The seminar is jointly sponsored by theUniversity of Texas Southwestern MedicalCenter at Dallas, Texas, the accrediting insti-tution, and the National Pediatric InfectiousDiseases Foundation. CME/AAP creditoffered. For information, consult the Web
site: http://www.cwiweb.com/npids or call cmeRmailhost.tcs.tulane.edu.(214) 648-2166; Telefax: (214) 648-2317.
group is searching for a neonatologist. Located'two hours south of San Antonio in the fastest-growing city in Texas. Brand new 326-bedmedical center, with more than 4,000 birthsper year, and a level III NICU. Complete ben-efits package to include paid malpractice, sixweeks' vacation and CME, and a first-yearguarantee of 190K. Keep what you collectafter first year. Bilingual a plus. No J-1 visas.Fax CV to (210) 651-4338 or contact DavidBeck at (800) 304-3095 or e-maildbeckfteck-field.com .
NORTHWESTPEDIATRICIANS-GROUP HEALTH PERMA-NENTE is currently seeking pediatricians. Weare a physician-managed organizationrecently affiliated with Kaiser Permanente,internationally known for research and clin-ical program development. Our facility islocated near Puget Sound with many recre-ational opportunities nearby. Visit our Website at www.ghc.org. Cover letter and CVcan be faxed to (206) 448-6191 or e-mailedto williams.kj?ghc.org. For further informa-tion, call (800) 543-9323. Equal opportu-nity employer.
Pediatric Infectious Disease Seminar (18thAnnual Lloyd Noland), Hilton Head Island,South Carolina, June 20-24. Faculty: Drs.Wald, Schutze,. Ross, Radetsky & English.Call/fax/write: George M. Converse III,M.D., FAAP, Department/ MedicalEducation, Lloyd Noland Foundation, P.O.Box 925, Fairfield, AL 35064-0925, (205)783-5276 (voice & fax). Visit the LloydNoland CME Web site: www.Iloydnoland-cme.org.
"2000 PEDIATRIC UPDATE FOR THE PRI-MARY CARE PHYSICIAN" -2000 PediatricUpdate for the Primary Care Physician, spon-sored by Tulane University Medical Centerand Ochsner Medical Institutions, will beheld April 28-30 (New Orleans Jazz andHeritage Festival) at the Westin Canal PlaceHotel in New Orleans, La. For registrationinformation or to request a brochure, pleasecall (800) 588-5300 or e-mail your request to
Adolescent Medicine Seminar (8th AnnualLloyd Noland), at the Wyndham Palace, WaitDisney World, Florida, Feb. 2-5. Faculty: Drs.Braverman, Coupey, Lift, Rosen & Rosenfeld.Call/fax/write: George M. Converse 111, M.D.,FAAP, Department/Medical Education, LloydNoland Foundation, P.O. Box 925, Fairfield,AL 35064-0925, (205) 783-5276 (voice &fax). Visit the Lloyd Noland CME Web site:www.lloydnolandcme.org.
3rd ANNUAL "CARE OF THE NEWBORN"FCONFERENCE - 3rd Care of the Newborn,sponsored by Tulane University MedicalCenter, will be held Feb. 24-27 (Mardi Grasseason) atthe Holiday Inn Superdome in NewOrleans, La. The three-day program is pre-ceded by an optional NRP workshop onThursday, Feb. 24. For registration informa-tion or to request a brochure, please call (800)588-5300 or e-mail your request tocmeRmai1host.tcs.tu1ane.edu .
Pediatrics Seminar "Advances & ChangingTrends" (11th Annual Lloyd Noland), at theWyndham Palace, Walt Disney World,Florida, March 15-18. Faculty: Drs. Buttross,Eichenfield, Rosenthal, Vanderhoof &Weinberger. Call/fax/write: George M.Converse III , M. D., FAAP, Depart-ment/Medical Education, Lloyd NolandFoundation, P.O. Box 925, Fairfield, AL35064-0925, (205) 783-5276 (voice & fax).Visit the Lloyd Noland CME Web site:www.Iloydnolandcme.org.
CME Breastfeeding, a course in human lacta-tion. Sponsored by The Nemours Foundation,April 13-16, Grosvenor Resort, Lake BuenaVista, Florida. Inquiries (800) 767-5437, ext.7464 or e-mail ttomanQ?nemours.org.
mouse lymphoma assay, human lymphocyte clastogenic assay, and mouse bone marrow clastogenic assay.No evidence of impaired fertility due to azithromycin was found.Pregnancy: Terato,qenic 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 evidenceof 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 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 pneumoniaeand 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 evaluating the use of repeated coumes of therapy have not been conducted.Geriatric Use: Pharmacokinetic parameters in older volunteers l65-85 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) fromn 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 angiGedema 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 ZITHROMAXI were related to the gastrointestinal system with diarrhea/loose stools (5%),nausea l3%), and abdominal pain l3%) being the most frequently reported.
No other side effects occurred in patients on the multiple-dose regimen of ZITHROMAXI with a frequency greaterthan 1%. Side effects that occurred with a frequency of 1% or less included the following:Cardiovascular. Palpitations, chest pain.Gasftrintestinal: Dyspepsia, flatulence, vomiting, melena, and cholestatic jaundice.Genitourinaryr: Monilia, vaginitis, and nephritis.Nervous System: Dizziness, headache, vertigo, and somnolence.General: Fatigue.Allergic: Rash, photosensitivity, and angioedema.Single 1-gram dose regimenf 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 occurred in patients on the single one-gram dosing regimen of ZITHROMAX" with a frequency of1% or greater included diarrhea/loose stools (7%), nausea l5%), abdominal pain l5%), vomiting 12%), dyspepsia 11%),and vaginitis ll%).Single 2-gram dose regimen: Overall, the most common side effects in patients receiving a single 2-gram dose ofZITHROMAXI were related to the gastrointestinal system. Side effects that occurred in patients in this study with afrequency of 1% or greater included nausea ll8%), diarrhea/loose stools 114%), vomiting l7%), abdominal pain (7%),vaginitis l2%), dyspepsia ll %), and dizziness ll %). 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 l2%),vomiting (11%), and nausea l1%).
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 15.8%),abdominal pain, vomiting, and nausea (1.9% each), and rash 11.6%).
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 l5%), abdominal pain (3%), nausea (2%),and headache (1%).
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 included the following:Cardiovascular. Chest pain.Gastrointestinal: Dyspepsia, constipation, anorexia, flatulence, and gastritis.Nervous Systemn: Headache (otitis 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.Uver/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 lSGPT), GGT, and AST lSGOT); 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 allreported at a frequency of less than 1%, but were similar in type to the adult pattern.
DOSAGE AND ADMINISTRATION (Sao INDICATIONS AND USAGE.)Acute Otitis Media and Cormmunity-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).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).ZfHROMAX" for oral suspension should be given at least I hour before or 2 houm after a meal.ZffHROMAX" for oral suspension should not be taken with food.More detailedprofessional inforuntion available on request.Revised January 1997
Pediatrics Update (7th Annual Lloyd Noland),Hilton Head Island, South Carolina, April 19-22. Faculty: Drs. Anderson, Eigen, Mauro,Polin & Sinatra. Call/fax/write: George M.Converse III , M. D., FAAP, Depart-ment/Medical EducaWjn, Lloyd NolandFoundation, P.O. Box 925, Fairfield, AL
i) 1998, Pfizer Inc ZC21 9A98
February 2000 AAP News 47
Pediatric Health D
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* 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%), abdominaJ pain (2%),vomiting (1 %), and nausea (1 %). In community-acquired pneumonia, the most common side effects arediarrhea/loose stoolis (5.8%), abdominal 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.
Zithromax is indicated for pediatric infections such as acute otitis media due to H influenzae, M catarrhalis, 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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