MC~iO -or" @S iS *.Ophthalmology Specialty Fellow *Stephen Glaser, M.D. 101 Lakeforest Blvd., Ste. 380 Gaithersburg, MD 20877 Mitchell A. Goldstein, M.D. 41 0 Sanders St. Baltimore, MD 21230 *.Kathleen Hawkins, M.D. 970 N Potamac St. Arlington, VA 22205 *Pauline Hsu, M.D. *9706 Starling Rd. Ellicott City, MD 21042 *Allison Mc Carley, M.D., M.P.H. 3525 Sharonwood Rd., Apt. 2C Laurel, MD 20724 *Saadat Panni, M.D. 217 Phillip Morris Dr. Salisbury, MD 21804 Michelle Potter, M.D. 501 N Frederick Ave. Gaithersburg, MD 20877 *James Rice, M.D. *.20 Glen Ave. Annapolis, MD 21401 *.New Jersey Karen Alton, M.D. 1 0 Brass Castle Rd. Washington, NJ 07882 Sandra Dee, M.D. *.1200 Chambers Ave. *Cherry Hill, NJ 08002 Heba El Goweni, M.D. 25 Hickory Pi., Apt. D9 *Chatham, NJ 07928 *Patricia Gao, M.D. 1 0 Congress Ln. South River, NJ 08882 Deborah Hung, M.D. 120 8th Ave. *Haddon Heights, NJ 08035 Kelly Knowles, M.D. 31A Brittin St. Madison, NJ 07940 *Rupal Mehta, M.D. 1 1 Oak Hollow Ct. *Voorhees, NJ 08043 Gladibel Mercado, M.D. *.755 Hamilton St. *Somerset, NJ 08873 William Onwuka, M.D. *.650 Paramus Rd. *.Paramus, NJ 07652 Alexander Petron, D.O. .12 Woods Edge Dr. Succasunna, NJ 07876 .Pennsylvania Thomas Coyte, M.D. 159 Thunder Cir. Bensalem, PA 19020 *Debra Georgetti, M.D. *440 N. Main Ave. Scranton, PA 18504 Shreeti Kapoor, M.D. *1450Oak Dr. Saxonburg, PA 16056 Maria Mahoney, M.D. *314 Warren Rd. Hatboro, PA 19040 Loretta Rudloff, D.O. 1 00 N. Academy Ave. Danville, PA 17822 Kristen Shapren, M.D. 316 E. Baltimore Pike West Grove, PA 19390 Rachel Weinryb, D.O. 1607 Eldridge Dr. Westchester, PA 19380 Lyra Ratmeyer, M.D. 603 W Wheat Ave., Ste. 450 Bainbridge, GA 31717 Kentucky Thomas Hubbs, M.D. 3503 Dayton Ave. Louisville, KY 40207 Vahid Mehrpouyan, M.D. 56 Hale Dr. Whitesburg, KY 41858 Diane Thomas, M.D. P.O. Box 364 466 Linden Ave. Harrodsburg, KY 40330 North Carolina Ronald Crevecoeur, M.D. 3683 Laurel Bluff Cir. High Point, NC 27265 Paul Iacono, M.D. 610 Surrey Glen Cir. Hendersonville, NC 28739 Lori Kutka Porter, M.D. 351 Sawtooth Dr., #5 Fayetteville, NC 28314 Arlene Massaro, M.D. 106 Goldenthal Ct. Morrisville, NC 27560 Robert Pfister, M.D. 165 Williams Way Maggie Valley, NC 28751 John Rusher, M.D. 4905 Professional Ct. Raleigh, NC 27609 Robert Spies, M.D. 1340 Matthews-Township Pkwy., Ste. 1 00 Matthews, NC 28105 Puerto Rico Maria Curet-Salim, M.D. G-9 Genova St. Ext Villa Caparra Guaynabo, PR 00966 South Carolina Kyllan Hutchinson, M.D. 9 Richland Med Park, Ste. 11 0 Columbia, SC 29203 Ashwin Mallikarjun, M.D. 681 W. Flint Lake Ct., Apt. A Myrtle Beach, SC 29579 Catherine Miller, M.D. 1508 Quail Valley W. !Columbia, SC 29212 Tennessee Lana Fox, M.D. 414 Greenbelt Dr. Maryville, TN 37804 Brian Gannon, M.D. 301 N University St., Ste. 104 Murfreesboro, TN 37130 David Kalwinsky, M.D. 1907 Northwood Dr. *.Johnson City, TN 37601 *Maria Lee, M.D. *1 424A Eagle Loop Fort Campbell, KY 42223 *Virginia Hashim El-Dadah, M.D. 2504 Manor Dr., Apt. 2E Fredericksburg, VA 22401 Florida Lourdes Alamo, M.D. 820 NW 1 11 th Ave. Plantation, FL 33324 Manuel Galguera, M.D. 220 Hialeah Dr. Hialeah, FL 33010 Kevin Niebaum, D.O. 4736 E. Michigan St., #1 Orlando, FL 32812 Manuel Pedroso, M.D. 1800 Sunset Harbor Dr., Apt. 2012 Miami Beach, FL 33139 Ayleen Pinera-Llano, M.D. 1419 Dorado Ave. Coral Gables, FL 33146 Susan Sandoval, M.D. 461 0 Alcantara Ave. Sebring, FL 33872 Jennifer Sawka, M.D. 12000 4th St. N, Apt. 162 St. Petersburg, FL 33716 Maria Soto, M.D. 1780 Lake Terrace Dr. Eustis, FL 32726 Antoinette Spoto-Cannons, M.D. 804 Belle Chase Cir. Tampa, FL 33634 Jill Steigelfest, M.D. 1 161 South Park Rd., Apt. 202 Hollywood, FL 33021 Sanjeev Tuli, M.D. 381 12 Townview Ave., Apt. 203 Zephyrhills, FL 33540 Tara Van Bennekom, D.O. 1708 Bridled Tern Ct. Orange Park, FL 32073 Georgia Carmina Babao, M.D. 2324 Bradford Pi. Dawsonville, GA 30534 Caroline Charles-May, M.D. 285 Boulevard NE, Ste. 235 Atlanta, GA 30312 Jamie Flanders, M.D. 123 Kathi Ave. Fayetteville, GA 30214 Mikyung Han, M.D. 2663 Sandpiper Dr. Tucker, GA 30084 Craig Lebish, M.D. 3911 Mulkey Way Austell, GA 30106 Vivian Lennon, M.D. 1847 Georgiana Dr. Atlanta, GA 30329 Leslie Meyers-Joseph, M.D. 2600 Martin Luther King Jr. Dr., Ste. 300 Atlanta, GA 30311 Ann Kellams, M.D. 1002 Amherst St., Bldg. C Winchester, VA 22601 Deena Obrokta, D.O. 716 Denbigh Blvd., Ste. A3 Newport News, VA 23608 Sue Park, M.D. 6820 Old Chesterbrook Rd. Mc Lean, VA 221 01 Julie Poole, M.D. 2820 Hydraulic Rd., #301 Charlottesville, VA 22901 Jocelyn Realubit, M.D. 7000 Patterson Ave. Richmond, VA 23226 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. In submitting 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 District Chairperson by Sept 15. Sunthorn Muangmingsuk, M.D. Dept. of Peds. 1873 Rama 4 Rd. Patumwan Bangkok, 10330- Thailand Connecticut John Lavalette, M.D. 412 Cromwell Ave. Rocky Hill, CT 06067 Melanie Mier, M.D. 67 Old Kings Hwy. Wilton, CT 06897 Erin Rice, M.D. 329 Wilburs Ln. Guilford, CT 06437 Maine Serena Rosen, M.D. 42 Tailwind Ct., #81 D Auburn, ME 04210 Massachusetts Jasmin Bhathena, M.D., M.B.B.S. 44 Royal Crest Dr., Apt. #7 North Andover, MA 01 845 Isha Clark, M.D. 19 Muzzey St. Lexington, MA 02173 Imelda Garcia, M.D. 881 South St. Fitchburg, MA 01420 Michael Lyons, M.D. 100 Hospital Rd., Ste. 2A Leominster, MA 01453 Eric Meikle, M.D. 16 Seventh Ave. North Chelmsford, MA 01 863 Brigitta Mueller, M.D. 1060 Beacon St., #10 Brookline, MA 02446 Donna Wren, M.D. 6 Beacon PI. Somerville, MA 02143 Rhode Island Janis Baccari, M.D. 21 Longwood Ave. North Providence, RI 02911 Barkat Hooda, M.D. 593 Eddy St. - MPS 11 5 Providence, RI 02903 William Morocco, M.D. 160 Emeline St. Providence, RI 02906 Verrnont Indra Lovko, M.D. 252 Grand Ledge Estates Center Rutland, \/T 05736 Quebec Gary Pekeles, M.D. 2300 Tupper St., Rm. C416 Montreal, PQ H3H 1 P3 Canada New Yorkc I Lisa Adeson, M.D. 141 Hudson Pointe Blvd. Queensbury, NY 12804 Shawn Ferguson, M.D. 414 Hawthorne PI. Youngstown, NY 14174 Sheela Graney, M.D. 10 Centruy Hill Dr. Latham, NY 1 211 0 Susan Moore, M.D. 154 Warren St. Glens Falls, NY 12801 Valerie Sprenz, M.D. 708 Neighborhood Rd., Apt. 7H Lake Katrine, NY 12449 New York 2 Martha Anthony, M.D. 426 45th St. Brooklyn, NY 1 1220 Nejatollah Bentyaghoub, M.D. 1731 E. 17th St. Brooklyn, NY 11229 Yoojin Kim, M.D. 70 Birchwood Pk. Dr. Jericho, NY 1 1753 Joan-Lisanne Lange, M.D. 81-50 Langdale St. New Hyde Park, NY 11040 Brian Rabinowitz, M.D. 664 Broadway Massapequa, NY 11758 Boris Ripa, M.D. 2019 Voorhies Ave. Brooklyn, NY 1 1235 Deborah Tsotsos, D.O. 222 Station Plaza N., Ste. 611 Mineola, NY 11501 New Yorkc 3 Suzanne Kaseta, M.D. 4602 Whispering Hills Chester, NY 10918 Robert Lawrence, M.D. 433 Lane Gate Rd. Cold Spring, NY 10516 Julia Lee, M.D. 10 Ronald Reagan Blvd. Warwick, NY 10990 Yick Lee, M.D. 635 W 141 st St., Apt. 9A New York, NY 10031 Sariya Pacheco, M.D. 74 Mc Kay Ave. East Orange, NJ 07018 Ji Sook Yoon, M.D. 147-43 Elm Ave. Flushing, NY 1 1355 . _ _ ...~~~~--- d - FmnA IMIgUm Indiana Chriistine Bender, M.D. 8244 E. Highway 36, Ste. 100 Avon, IN 46168 Melanie Heniff, M.D. 6827 Antelope Dr. Indianapolis, IN 46278 Anne Kelly, M.D. 3831 Arbor Green Way, Apt #923 Indianapolis, IN 46220 Abigail Klemsz, M.D., Ph.D. 6524 Bergeson Way Indianapolis, IN 46278 William Parsons, M.D. 7892 Landings Dr. Indianapolis, IN 46240 Michael Sauer, M.D. 8303 Maple Valley Dr. Fort Wayne, IN 46835 Timothy Snyder, M.D. 1458 Oak St., #A Frankfort, IN 46041 Michigan Cem Demirci, M.D. 1 1 438 Bancroft Ct. Fenton, MI 48430 Emergency Medicine Specialty Fellow Sandra Kay Cr-ady Dettmann, M.D. 4191 Peshtigo Ct. Grandville, MI 49418 Andrea Hornbuckle, M.D. 2024 Bancroft Dr. Ann Arbor,, Ml 48108 Janelle Stutzman, M.D. 3922 W. DeBlaay Ct., SE Grand Rapids, Ml 49512 Ohio William Border, M.D. 2125 Forestlake Dr. Cincinnati, OH 45244 Mary Dearmin, M.D. Dept. of Pediatrics 9000 Mentor Ave. Mentor, OH 44060 Radiology Specialty Fellow Neil Johnson, M.D. Cincinnati Childrens Hosp. 3333 Burnet Ave. Cincinnati, OH 45229 Tracy Karolyi, D.O. 1090 W South Boundary, Ste. 500 Perrysburg, OH 43551 ...." , Lews, E 1995 Marlandr Atchuthanand Budi, M.D. 63 Byron Dr. Smithsburg, MD 21783 August 1999 AAP News 27
Tara Van Bennekom, D.O.1708 Bridled Tern Ct.Orange Park, FL 32073
Georgia
Carmina Babao, M.D.2324 Bradford Pi.Dawsonville, GA 30534
Caroline Charles-May, M.D.285 Boulevard NE, Ste. 235Atlanta, GA 30312
Jamie Flanders, M.D.123 Kathi Ave.Fayetteville, GA 30214
Mikyung Han, M.D.2663 Sandpiper Dr.Tucker, GA 30084
Craig Lebish, M.D.3911 Mulkey WayAustell, GA 30106
Vivian Lennon, M.D.1847 Georgiana Dr.Atlanta, GA 30329
Leslie Meyers-Joseph, M.D.2600 Martin Luther King Jr. Dr.,Ste. 300Atlanta, GA 30311
Ann Kellams, M.D.1002 Amherst St., Bldg. CWinchester, VA 22601
Deena Obrokta, D.O.716 Denbigh Blvd., Ste. A3Newport News, VA 23608
Sue Park, M.D.6820 Old Chesterbrook Rd.Mc Lean, VA 22101
Julie Poole, M.D.2820 Hydraulic Rd., #301Charlottesville, VA 22901
Jocelyn Realubit, M.D.7000 Patterson Ave.Richmond, VA 23226
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.
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 the following list of new applicants to your District Chairperson by Sept 15.
Sunthorn Muangmingsuk, M.D.Dept. of Peds.1873 Rama 4 Rd.PatumwanBangkok, 10330-Thailand
Connecticut
John Lavalette, M.D.412 Cromwell Ave.Rocky Hill, CT 06067
Melanie Mier, M.D.67 Old Kings Hwy.Wilton, CT 06897
Erin Rice, M.D.329 Wilburs Ln.Guilford, CT 06437
Maine
Serena Rosen, M.D.42 Tailwind Ct., #81 DAuburn, ME 04210
Massachusetts
Jasmin Bhathena, M.D., M.B.B.S.44 Royal Crest Dr., Apt. #7North Andover, MA 01845
Isha Clark, M.D.19 Muzzey St.Lexington, MA 02173
Imelda Garcia, M.D.881 South St.Fitchburg, MA 01420
Michael Lyons, M.D.100 Hospital Rd., Ste. 2ALeominster, MA 01453
Eric Meikle, M.D.16 Seventh Ave.North Chelmsford, MA 01863
Brigitta Mueller, M.D.1060 Beacon St., #10Brookline, MA 02446
Donna Wren, M.D.6 Beacon PI.Somerville, MA 02143
Rhode Island
Janis Baccari, M.D.21 Longwood Ave.North Providence, RI 02911
Barkat Hooda, M.D.593 Eddy St. - MPS 115Providence, RI 02903
William Morocco, M.D.160 Emeline St.Providence, RI 02906
Verrnont
Indra Lovko, M.D.252 Grand Ledge EstatesCenter Rutland, \/T 05736
Shaun Berger, M.D.520 W. El Paso Ave.Clovis, CA 93611
Cindy Chung, M.D.99 Monticello Rd.San Rafael, CA 94903
Quang Dao, M.D.770 E. Calaveras Blvd.Milpitas, CA 95035
Marietta Frey, M.D.352 Waverley St., #2Menlo Park, CA 94025
Jeffrey Harris, M.D., Ph.D.Box 1234UCSF/GIVISan Francisco, CA 94143
Mike Huang, M.D., Ph.D.4738 Grouse Run Dr., #7Stockton, CA 95207
Gena Lewis, M.D.2562 Hilgard St.Berkeley, CA 94709
Padmaja Padalkar, M.D.5380 Hammerton Ct.San Jose, CA 95118
DISTRICT I
Eileen M. Ouellette, M.D., J.D.Pediatric NeurologyNorth Shore Children's Hospital57 Highland Ave.Salem, MA 01970e-mail: eouelletteOaap.org
DISTRICT II
Louis Z. Cooper, M.D.Department of PediatricsColumbia UniversityRoom BHS 1 14630 W. 168th St.NewYork,NY 10032e-mail: IcooperQaap.org
DISTRICT III
Susan S. Aronson, M.D.605 Moreno Rd.Narbeth, PA 19072e-mail: saronsonOaap.org
DISTRICT IV
E. Stephen Edwards, M.D.2800 Blue Ridge Blvd.Suite 501Raleigh, NC 27607e-mail: sewardsOaap.org
DISTRICT V
Stanford A. Singer, M.D.n6700 Woodward Ave.Suite 300Bloomfield Hills, MI 48304e-mail: ssingerOaap.org
Colorado
Jeremy Erdley, M.D.114 Bristlecone Dr.Fort Collins, CO 80524
Kathleen Nitcher, M.D.209 South NevadaColorado Springs, CO 80903
Hawaii
Matthew Ho, M.D.2180Main St.Wailuku, Hi 96793
Nevada
Ravi Krishnan, M.D.10805 Barkwood Ave.Las Vegas, NV 89134
New Mexico
Mark Beatty, M.D.P.O. Box 157Crownpoint, NM 87313
October 21-24, 1999SHERATON BUCKHEAD ATLANTAA. Gerald Reisman, MD, Program Chair
Sponsored byGeorgia Chapter/American Academy of Pediatrics
For information contact Meg Evans (404) 881-5067 * Fax (404) 249-9503 * rnevansXmag.org
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Contact: Sylvia Mayes, Department of Education, 100 S. Los Robles,Suite 550, Pasadena, CA 91188; (626) 564-5338 or fax (626) 564-5387.E-mail: [email protected]
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because life's challengingenough without a bed-
wetting problem!
BOULDER, COLORADO 80304IDEAS FOR LIVING, INC.
August 1999 AAP News 29
A CME meeting in practicol pediatric topics onda proctice monogement seminor
44After ten years of agonizilng, diapers,and two 'ineffective drugs, our sonfinally has the confidence for a sleep-over, thanks to the Potty Pager.
Daniel E. Turnb-ull
It's wireless. It's private. It inspires letters like this.And now it's CLINICALLY PROVEN EFFECTIVE.
In a two year clinical study at the University ofAlabama medical school, thePotty Pager has been proven 71%X effective on hard-to-reach TEEN bedwet-ters. (Lo, Perez, Hanchrow and Joseph)
So whyjust "control" bedwetting with drugs when youcan CURE it! With the WIRELESS alarm that wakesthe BEDWETTER... not the whole house!
The Potty Pager teaches bedwetters to respond normally to bladder fullness.It uses a tactile alarm, much like a silent business pager. It is 100%o safe, andcosts just $51.00 + S&H. It comes with a 30 day no-questions guarantee.
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University of Connecticut School of Medicine at the appro-priate rank. Candidates interested in applying for this posi-tion should submit letter of interest and CV to: Paul H.Dworkin, M.D., Professor and Chair, University ofConnecticut School of Medicine, Departments ofPediatrics, Connecticut Children's Medical Center, 282Washington St., Hartford, CT 06106. An AffirmativeAction/Equal Opportunity Employer, M/F/PwD/V.
NORTHERN VIRGINIA -Growing pediatric practicein Sterling, Va., with a reputation for excellence,looking for BC/BE pediatrician to add to our team.Approximately 30 minutes west of Washington,D.C., just minutes from the scenic, rural countrysideof the Blue Ridge Mountains. Many cultural andrecreational opportunities; excellent neighborhoodsand schools. Position is available now with a flexi-ble starting date. Competitive salary with good ben-efits package. Please contact Shara Mess'ick (703)444-2675 or 444-3245 or send CV to PediatricHealthCare, PC; 46440 Benedict Dr., Ste. 207,Sterling VA 20164; fax: (703) 444-0386; e-mail:misty.mountainEcwi.com.
TEXAS
JCAHO accredited comnmunity health centerin beaufiful South Texas; South Padre Islandand recreational facilities nearby.Multi-specialty pnimary care practice, sharedhospital call with 6 other pediatricians. Fourto five weeks paid vacation, paid CME,competitive salary with incenfive plan,retirement plan and other benefits.
Dr Elena Marin, Executive DirectorSU Clinica Famffiar4501 S. Expressway 83Harlingen, TX 78550956428 4345
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PEDIATRIC RECRUITMENT SPECIALIST -Locatingand evaluating practice opportunities availablenationwide for general pediatrics/subspecialties. Todiscuss your interests, contact: Julie Stoehr, MedicalStaffing Associates, 6731 Whittier Ave., 3rd Fl.,McLean, VA 22101. (800) 235-5105. Fax: (703)893-7358. e-mail: dconway?serviceusa.com.I nternet: http://www. medstaffer.com .
NORTHEAST
PEDIATRICIAN -Academically-oriented Primary CarePediatrician to provide ambulatory and newborn nurserycare and teach students and residents in a busy clinical set-ting. Responsibilities include direct patient care, clinical anddidactic teaching of medical students and residents, andshared call. Opportunities for community involvementand clinical research. BC/BE, faculty appointment at the
__~~~~~~~~~~~~~~~~~~~~~~~Growing, four-physician, system-owned practice seeks BC/BE Pediatricianl.Office just two blocks from 226-bed Chambersburg Hospital, including afull-time Pediatric Nurse Practitioner.
~~~~Chambersburg is located in southcentral PA -whereNEWYORK 2 you Will find the splendor of the mountains, lakes,yrPENNSYLVANIA )\ farms, and countryside; coupled with theatre'.1Z~~~~music, skiing, fishing, hiking, andmuch more.
W.elatherby Locums is the placement specialist Pe-diatricians count on most!
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For more detailed informnafion on available assignments,visitourwebsite atww.whcfW.com, call
Frank Phillips, SeniorVice President, 800 586 5022, ext 140or e-mail to: [email protected].
Pmkxeda Provider for the American Academy of Pediatrics
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CLASSIFIEDADVERTISING POLICYWhenyou need to contactpediatricians, contactAAPNews. Each month more than 55,000 pediatricians,pediatricspecialists, third-yearpediatric residents and othersubscribers turn toAAPNewsforchild healthinformation they cannotget elsewhere. With a classified ad, you can speak directly to those readers.
Although the Academy believes these classified ads are fromreputable sources, theAcademy does not investigate the offersmade and assumes no responsibility concerning them.
Occassionally, it is necessary to modify the wording of classi-fied ads. These changes are generallymade in compliance withthe regulations of various federal and/or state commissionsagainst discrimination or because theymight be interpreted asbeing unlawful or in conflict with accepted professional stan-dards of medical practice.These advertising modifications are made to maintain a clas-sified section that is professionally responsible, lawful, scien-tific and free of discrimination.
:AAPNEWS l0Pulblished Monthly :0=tfi\AAmericanAcademyof Pediatrics ta<P.O. Box9927 \SX :Elk Grove Vilaget IL 600-0927
Publication of an advertisement in AAP News neither consti-tutes nor implies a guarantee or endorsement byAAP News orthe American Academy of Pediatrics ofthe product or serviceadvertised or ofthe claims made for the product or service bythe advertiser.
Classification: Classified ads are accepted under BusinessServices, General Announcements, Medical Meetings, Physi-ciansWanted, Positions Wanted, Practices Available, Publica-tions, Real Estate and Residencies/Fellowships Available.
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, TheWalchliTauberGroup for display classified ad sizes and rates.
For more information, contact: Roland Keve, The WalchliTauber Group, (410) 420-0311, or fax (410) 420-0711. Ad copyis to be sent to: TheWalchliTauber Group, 1 12W. PennsylvaniaAve., Ste. 201, BelAir, MD21014. Payments are to be mailed andmade payable to The Arnerican Academy of Pediatrics, Dept.77-5194, Chicago, IL 60678-5194.
The Sisters of the Third Order of St. Francis (OSF) havebeen providing medical care for residents of Illinois, Iowa andMichigan for more than 120 years. Their corporation, nowknown as OSF HealthCare, includes seven hospitals, twoextended care facilities, an insurance company with its ownmanaged care products, more than one dozen affiliatedcompanies providing medical products and services, andOSF Medical Group, a multi-specialty physician group withmore than 220 providers in its multi-state service area. Wenow have general pediatrics opportunities in:
Peoria, Illinois * Escanaba, MichiganFor more information, please contact:
Wendy Bass at (800) 462-3621; Fax (309) 685-2574;Email: [email protected]
30 AAP News August 1999
eoNES 5. m
M/EDICAL GROUP
"'WedotheRight Thing...
Well."
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References: 1. Greenberg RN. Overview of patient compliance with medication dosing: a literature review. Clin Ther:1984;6:592-599. LRedBook'Update, Montvale, NJ: Medical Economics Co Inc; July 1998:22,24,26,27,71.
ZITHROMAX-lazithromycin 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 patient populations vary among these,infections. please see DOSAGE AND ADMINISTRATION for specific dosing recommendations,Acuteotitis media caused by Haemophilus influenzae, Moraxella catarrhalis, or Streptococcus 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 be
inappropriatefor oral therapy because ofmoderate to severe illness or risk factors such asany of the following:patients with cystic fibrosis, patients with nosocomiallyacquiredinfections, patients with known or suspected bacteremia, patients requiring hospitalization,or patients with significant underlying health problemis that may compromise their ability torespond to their illness (includinglimmunodeficiency or functional asplenin).Pharynilitis/tonsillitis caused by Streptococcus pyogenes as an alternative to first-line therapyin 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 Streptococcuspyogenes 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 toZITHROMAXI,susceptibility tests should be performed when patients are treated with ZITHROMAXI.Dataestablishing efficacy of azithromycin in subsequent prevention of rheumatic fever are not available.
Appropriate culture and susceptibility tests should be performed before treatment to determine the causativeorganism and its susceptibility to azithromycin. Therapy with ZITHROMAXImay be initiated before results of thesetests are known; once the results become available, antimicrobial therapy should be adjusted accordingly.CONTRAINDICATIONSZITHROMAXOis 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 initiall,v 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 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 safeand effective in thetreatm0nt of community-acquired pneumonia due to Chlamydispneumroniae, H omophilus influenzae,Mycoplasmn pneumoniao, or Streptococcus pneumonia&in patients appropristofororal therapy.Azithromycin should not be used in patients with pneumonia who are judged to be inappropriatefor oraltherapybecause of moderate to severe illness or risk facitomssuch as anyof the following:patients withcystic fibrosis, patients with nosocomially acquired infections, paltients with known or suspeebdbacte emis,patientsrequiring hospitalization, elderly or debilitated patients, or patients with siginiicantunderlyinghealth problems that may compromise their ability to respond to their illness (includingimmunodeficiency or funcitional aspleniaPseudomembranous colitis has been reported with nearly all antibacterial agents and may range inseverityftrom mild to life-threatening.Therefore, it is important to consider this diaginosis in patientswho present with diarrhea subsequent to the administraidon 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 difficileis 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 be
exercised 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 OTintervals.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.Informiation for Patients: Patients should be cautioned to take ZITHROMAXIsuspension 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 Dccur.Dnql hteractions:Aluminum- and magnesium-containing antacids reduce the peak serum levels (rate) but not theAUC (extent) of azithromycin absorption.
Administration of cimetidinel800 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 pharmracokinetics 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 medicalpractice 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 assDciated 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.
LaboratoryTest Interactions:There are no reported laboratory test interactions.Carcinogenesis, Mutagenesis, Impairment of Fertility:Long-term studies in animals have not been performedto evaluate carcinogenic potential. Azithromycin has shown no mutagenic potential in standard laboratory tests:
mouse lymphoma assay, 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 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 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 Chlamydiapneumoniaeand Mycoplasmapneumoniaewere documented in pediatric clinical trials. Safety and effectiveness for pneumonia due to Haemophilus inf/uenzaeand 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 courses of thierapyhave not been conducted.Geriatric Use: Pharmacokinetic parameters in older volunteers (65-85 years old)were similar to those in youngervolunteers118-40 years old) for the 5-day therapeutic regimen. Dosage adjustment does not appear to be necessaryfor older patients with normal renal and hepatic function receiving treatment with this dosage regimen.
ADVERSE REACTIONSIn clinical trials, most of the reported side effects were mild to moderate in severity and were reversible upondiscontinuation of the drug. Approximately 0.7% of the patients (adults and children) from the multiple-dose clinicaltrials discontinued ZITHROMAX"(azithromycin) therapy because of treatment-related side effects. Most of the sideeffects leading to discontinuation were related to the gastrointestinal tract, e.g., nausea, vomiting, diarrhea, orabdominal pain. Potentially serious side effects of angioedema and cholestatic jaundice were reported rarely.Clinical: Adults: Multiple-dose regimen: Overall, the most common side effects in adult patients receiving amultiple-dose regimen of ZITHROMAXIwere related to the gastrointestinal system with diarrhea/loose stools15%).nausea13%), and abdominal pain13%) being the most frequently reported.
No other side effects occurred in patients on the multiple-dose regimen of ZITHROMAXIwith a frequency greaterthan 1%. Side effects that occurred with a frequency of 1% or less included the following:Cardiovascular Palpitations, chest pain.Gastrointestinal: Dyspepsia, flatulence, vomiting, melena, and cholestatic jaundice.Genitourinary-Monilia, vaginitis, and nephritis.Nervous System: Dizziness, headache, vertigo, and somnolence.General: Fatigue.Allerglic: Rash, photosensitivity, and angioedema.Single 1-gram dose regimen: Overall, the most common side effects in patients receiving a single-dose regimen of1 gram of ZITHROMAXrD 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 ofI% or greater included diarrhea,(loose stools17%), nausea15%), abdominal pain15%), vomiting12%), dyspepsia (11%),and vaginitis (11%).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 nausea118%). diarrhea/loose stools114%), vomiting17%). abdominal pain17%).vaginitis12%), 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 stools12%), abdominal pain12%),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 nausea11.9% each), and rash (1.6%).
Pharyngitis/tonsillitis: Fofthe recommended dosage regimen of 12 mg/kg on 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 Dccurred in children treated with ZITHROMAXIwith afrequency of greater than 1%. Side effects that occurred with a frequency of 1% or less included the following:CafdiovascularChest pain.Gastrointestinal: Dyspepsia, constipation, anorexia, flatulence, and gastritis.Nerves Systzn: Headachelotitis media dosage), hyperkinesia, dizziness, agitation, nervousness, insomnia.General: Fever, fatigue, malaise.Allergic: Rash.Skinand Appendaget Pruritus, urticaria.Special Sense: Conjunctivitis.Post-MiarketingExperience: 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:MUeric: Arthralgia, edema, urticaria.CardiovascularArrhythmias including ventricular tachycardia.Gashi__ s1m: Anorexia, constipation, dyspepsia, flatulence, vomiting/diarrhea rarely resulting in dehydration.General: Asthenia, paresthesia.Genitearinary: Interstitial nephritis and acute renal failure.Lnr/Bilify.Abnormal liver function including hepatitis and cholestatic jaundice.Nrv us Sysfto:Convulsions.Skin/Aplpendalles: Rarely serious skin reactions including erythema multiforme, Stevens Johnson Syndrome, andtoxic epidermal necrolysis.Special Seeme: Hearing disturbances including hearing loss, deafness, and/or tinnitus, rare reports of tastedisturbances.laborstory Abnonnalitier.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 allreported at a frequency of less than 1%, but were similar in type to the adult pattern.
DOSAGEAND ADMINISTRATION (See INDICATIONS AND USAGE.)Acute Otitis Media and Commnunity-Acquired Pneumonia: The recommended dose of ZITHROMAXIfor 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/[onsillitis: The recommended dose for children with pharyngitis/tonsillitis is 12 mg/kg once a day for5 days (not to exceed 500 mg/day).ZITHROMIAX*frorwal suspension should be given at least Ihour before or 2 bours after a meal.ZffHROMAX fororal suspension should not be taken w itfood.More detailedprofessional information available on requestRevised January 1997
Pediatric Health
L -i
Houston. Contact: Mary E. Greene, exec-utive director, 401 W. 15th St., Ste. 682,Austin TX 78701, Phone: (512) 370-1506, e-mail: tpsmgreeneEaol.com, Website: http://www.txpeds.org.
OCTOBER
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Sponsored by Saint Luke's Hospital andthe Children's Mercy Hospital of KansasCity. Call (816) 932-2220 or send e-mail
SOUTHEAST
PEDIATRIC PSYCHOLOGIST, FLORIDA-The Department of Pediatrics at the
University of Florida Health ScienceCenter - Jacksonville and the RainbowCenter for Women, Children & Adoles-cents housed at the University of Floridain the University Medical Center, i'srecruiting for a full-time Pediatric Psy-chologist to provide psychological serv-ices to an HIV/AIDS population in thePediatric I nfectious Diseases division .
This appointment will start at the level ofClinical Instructor/Clinical AssistantProfessor/Clinical Associate Professor.Major responsibilities will be coordinatingpsychological services to the clinic, pro-gram development, provision of cogni-tive and developmental testing, as well asindividual and group psychotherapy serv-ices. Applicants should possess a Ph.D. inclinical psychology with expertise inchild/pediatric psychology. Candidatesmust have completed an APA approvedinternship and must have experienceworking in a medical setting. A strongbackground in consultation liaison andworking with chronic illness is preferred.Experience working with high risk andunderserved populations is also pre-ferred . Recruiting deadline is Oct. 30,1999, with an anticipated start date ofNov. 30, 1999. Salary and rank com-mensurate with experience. Forward let-ter of intent, curriculum vitae, an'd thenames and addresses of three referencesto Mobeen Rathore, M.D., search com-mittee chairman, Department ofPediatrics, Division of InfectiousDiseases, University of Florida-Jacksonville, 653-1 W. 8th St., Jackson-ville, FL 32209, Telephone number:(904) 549-3051, Fax number: (904)549-5341 or e-mail to [email protected]. The Universityof Florida is an Affirmative Action/EqualOpportunity Employer.
MIDWEST
PEDIATRICIAN - Northeast PediatricClinic, an independent, well-establishedpediatric group located in a suburb of St.Paul, Minn., is seeking a full-time boardeligible/board certified pediatrician to joinour four-physician group. This greatopportunity for potential partnership in aprogressive, dynamic practice is availableJan. 1, 2000. Excellent salary and benefits.For more information, contact Dr. CathyBedford, CEO, or Marilyn Hathaway, ClinicManager at (651 ) 426-1 141.
"jPEDIATRIC INFECTIOUS DISEASE SEMI-NAR" -(11th Annual Lloyd Noland), atthe Wyndham Place, Walt Disney World,Florida, Oct. 20-23, 1999. Faculty: Drs.Chadwick, Chesney, Lieberman, Littman &Rennels. Call, fax or write: George M.Converse 111, M.D., FAAP, Department ofMedical Education, Lloyd NolandFoundation, P.O. Box 925, Fairfield, AL35064-0925. Phone: (205) 783-5276(voice & fax). Visit the Lloyd Noland CMEWeb site: http://www.Iloydnolandcme.org.
" PEDIATRICS ON PEACHTREE" -A CMEmeeting in practical pediatric topics and a prac-tice management seminar. Oct. 21-24, 1999,at Sheraton Buckhead, Atlanta. A. GeraldReisman, M.D., Program Chair. Sponsored byGeorgia Chapter/American Academy ofPediatrics. For information, contact Meg Evans(404) 881-5067. Fax: (404) 249-9503. e-mail:mevansOmag.org. (See Ad).
(C)1998, Pfizer Inc ZC21 9A98
August1999 AAPNews 31
COVERAGE OF KEY RESPIRATORY PATHOGENS
T Y P I C A L iA T Y P I C A LStreptococcus pneumoniae Chlamydia pneumoniaeHaemophilus influenzae Mycoplasma pneumoniaeMoraxella catarrhalisl
* BETTER COMPLIANCE MAY IMPROVE PATIENT OUTCOMES'* COSTS LESS THAN MOST BRAND-NAME ANTIBIOTICS'* PROVEN TOLERABILITY
In acute otitis media, the most common side effects are diarrhea/loose stools (2%), abdominal pain (2%),vomiting (1 %), and nausea (1 %). In community-acquired pneumonia, the most common side effects arediarrhea/loose stools (5.8%), abdominal pain, vomiting, and nausea (1.9% each), and rash (1.6%).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 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 th'erapy 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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Please see brief summary of prescribinginformation on adjacent page.
