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*Pennsylvania

*.Ayman Arouse, M.D.*.9175 Collington Sq..Allison Park, PA 15101

Marita Lind, M.D.127 Jefferson St.Bala Cynwyd, PA 19004

*.Mayuri Sedani, M.D.*702 Buck Ridge Dr.

I Stroudsburg, PA 18360

*.Christine Sweeney, M.D.233 S 6th St., #1 106*Philadelphia, PA 19106

West Virginia

.Gordon Green, M.D.1541 Bridge Rd.Charleston, WV 25314

*.Florida

Kim Brownell, M.D.I 239 14tth Ave., NEISt. Petersburg, FL 33701

Joaquin Jimnxez DeCana, M.D.*400 University Dr., 3rd Fl..Coral Gables, FL 33134

*.Donna Parker, M.D.*.P.O. Box 100202*.U F H S C.Gainesville, FL 32610

*.Ashok Raj, M.D.*5015 45th St.,WBradenton, FL 34210

.Monica Reina, M.D.2105 Brickell, #218*.Miami, FL 33129

Neurology Specialty Fellow*.Paul K. Winner, D.O..5205 Greenwood Ave.*.Stuite 200West Palm Beach, FL 33407

.Georgia

David Cooperberg, M.D.2501 Trolley Sq. Crossing

IAtlanta, GA 30306

*.Sherry Jester, M.D.*.1885 Windham Park, NEAtlanta, GA 30324

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

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

Hector Florimon, M.D.35 Woodcrest Dr.Syosset, NY 1 1791

Lisa Harris, M.D.228 E Main St.Rochester, NY 14604

Teddy Liu, M.D.57-26 163 Rd.Flushing, NY 11365

Benetta Yee, M.D.107-40 Queens Blvd., Apt #12MForest Hills, NY 11375

NewYork 3

Neurological SurgerySpecialty FellowIra R. Abbott, M.D.Inst For Neurology& NeurosurgeryBeth Israel Med. Ctr.170 East End Ave.New York, NY 10128

Jane Guttenberg, M.D.23W73rd St., #1014New York, NY 10023

Neurology Speclalty FellowDaniel Medeiros, M.D.60W13th St., #1 1-13New York, NY 1001 1

Kentucky

Noel Tan, M.D.103 Adams RidgeHazard, KY 41701

North Carolina

Michael Goodrich, M.D.601 Jones Ferry Rd., #A7Carrboro, NC 27510

Usha Ramkumar, M.D.6813 Neuhoff Ln.Charlotte, NC 28269

Tennessee

Bharathi Bellur, M.D.645 RipplebrookMemphis, TN 38120

Floyd Phillips, M.D.204 Shaver Dr.Talbott, TN 37877

Yolanda Spraggins, M.D.961 Spring Creek Rd.Chatanooga, TN 37412

Virginia

Jennifer Cardone, M.D.713 Boulder Springs Dr., #B13Richmond, VA 23225

Dionne Harewood, M.D.6406 Aberdeen Plc.Suffolk,VA23435

Margaret Nash, M.D.Ped Affiliates Of Hampton Rds..1421 Kempsville Rd., Ste. A.Chesapeake,VA23320

*Indiana

.Barry Phillips, M.D.*2066 Bent Tree Dr.*.Newburgh, IN 47630

.Paul Wolfe, M.D.*706 River Dr.Marion, IN 46952

*.Michigan

.Samer Kafelghazal, M.D.25395 Crown P.O.int Ct..Farmington Hills, Ml 48335

Nagwa Khadr, M.D., M.B., B.Ch..35450 Dequindre Rd., Ste. 105.Sterling Hts., MI 48310

Kristen A. Krieger, M.D.4260 Plymouth Rd.Ann Ar'bor, Ml 48109

Ohio

Anthony France, M.D.4 Greene St.Ft. Thomas, KY 41075

Kimberly Oxley, M.D.94 Township Rd. 1483Chesapeake, OH 45619

Wendy Pomerantz, M.D.Children's Hosp Med Ctr.3333 Burnet Ave., OSB-4Cincinnati, OH 45229

Mylene Santos-Victodano, M.D.1374 Apple Valley Ct..Broadview Hts., OH 44147

.RadiologySpecialtyFellow

.Janet Strife, M.D.

.Children's Hospital Med Ctr.*.Dept Of Radiology*.3333 Burnet Ave.*.Cincinnati, OH 45229

Wisconsin

MapretScanduraEngdlahl, M.D7094W Beckett Ave.Milwaukee, WI 53216

Reena George, M.D.,M.B.,B.SP.O. Box 1997 MS4119000W Wisconsin Ave.Milwaukee, WI 53201

Elizabeth Ong, M.D.92 Mac Arthur Hwy.Marules ValenzuelaMetro Manila,Philippines

01 _1INAI__:10

Massachusetts

Shireen Atabaki, M.D.3 Concord Ave., Ste.56Cambridge, MA 02138

Catherine Chow, M.D.26 Hemenway St., Apt. 9Boston, MA02115

New Hampshire

Michael Olivier, M.D.162 Maple St.Andover, NH 03216

Uniformed Services-East

Eileen Dwyer, M.D.US Naval Hospital KeflavikPSC 1003 Box 8FPO, AE 09728

Jack Sobrin, D.O.20 Presidential WayHopewell Junction, NY 12533

Louisiana

Hasan Abdallah, M.D.P.O. Box 8385Metarie, LA 70011

Texas

Tonya Brown-Nembhard, M.D.1930 Shady Ln.Beaumont, TX 77706

Scott Coleman, M.D.2821 SilverAve.El Paso, TX 79930

Karen De Ville, M.D.3520 OakdaleHouston, TX 77004

Christine Ferrari, M.D.400 W-1635., Ste. 250Irving, TX 75019

Stephen George, M.D.I808 Cedar Oaks Dr.IHarker Hts., TX 76548

Anna Nelson, M.D.5408 Trailview Dr.Temple, TX 76502

*Maria Quinteros,-M.D..911 Robin Ctr..6900N1Oth St.,#1.IMc Allen, TX 78504

.Victoria Regan, M.D.*.6410 Fannin., Ste. 722*.Houston, TX 77030

.Arizona

.Satish Namjoshi, M.D.

.7425 E. Shea Blvd., #101*Scottsdale, AZ 85260

,,3ti

Illinois

Holly Benjamin, M.D.2257 W 35th St., #3AChicago, IL 60609

Shahida Tanveer, M.D.6 Pennsbury Ct.Bolingbrook, IL 60440

Pamela Weller, M.D.1004 Superior St.Oak Park, IL 60302

Iowa

Mahmood Alasmi, M.D.5661 Vista Dr.IWest Des Moines, IA 50266

Jeffrey Lobas, M.D.Rm 247 Hospital School100 Hawkins Dr.Iowa City, IA 52242

Minnesota

Jamie Lohr, M.D.3630 Rosewood Ln.Plymouth, MN 55441

Nebraska

*.Lisa Whitcomb, M.D.*2121 South 183 Cir.*.Omaha, NE 68130

Maryland

Ozlem Belen, M.D.901 Tamarac Dr.Salisbury, MD 21804

Celia Christie, M.D.9400 Owings Hts. Cir., Apt. 101Owings Mills, MD 21117

Rachel Rennert, M.D.903 Russell Ave., #301Gaithersburg, MD 20879

New Jersey

Jeffrey Parker, M.D.13 Pawtucket Dr.Cherry Hill, NJ 08003

Suparna Patcha, M.D.186 Longwood Dr.Manalapan, NJ 07726

Naheed Rahmet, M.D.22 Pinetree Ln.Manalapan, NJ 07726

New York 1

Aurea De Leon, M.D.436 Robin Ln.Vestal, NY 13850

Diane Montgomery, M.D.4454 Twin Pines Dr.Manlius, NY 13104

Inderjeet Nagpal, M.D.1622 August Rd.N. Babylon, NY 11703

Daniel Saarie, M.D.601 North WayCamillus, NY 13031

NewYork2

Tomas Chan, M.D.84-19 Homelawn StJamaica Estates, NY 11432

David Eisenberg, M.D.39 Twilight WalkHolbrook, NY 11741

DI4I awiIBm.

36 AnAP Ne<ws May 1999

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Hawaii

William Franks, M.D.28 Kamoi St., Ste. 600P.O. Box 1887Kaunakakai, Hi 96748

Idaho

David Parry, M.D.500 S. 11 th Ave., Ste. 202Pocatello, ID 83201

New Mexico

Flor Caballar-Gonzaga, M.D.1070 Rancho Rd.Gallup, NM 87301

Sanjay Gandhi, M.D.Las Vegas Clinic ForChildren & Youth PA501 Seventh St.Las Vegas, NM 87701

Uniformed Services-West

Christine Horowitz, M.D.PSC 78 Box 3079APO, AP 96326

Rosario Retino, M.D.272 N. Carnegie Ave., #243Claremont, CA 91711

Califomia 3

Sandra Mc Coll, M.D.6356 Sunny Brae Dr.San Diego, CA 92119

Alice Mo, M.D.1387 Caminto DiademaLa Jolla, CA 92037

Dawn Belardinelli, M.D.1200 El Camino RealS. San Francisco, CA 94080

DISTRICT 11

Louis Z. Cooper, M.D.Department of PediatricsColumbia UniversityRoom BHS 114630 W. 16%th St.New York,NY 10032

DISTRICT III

Susan S. Aronson, M.D.605 Moreno Rd.Narbeth, PA 19072

DISTRICT IV

E. Stephen Edwards, M.D.2800 Blue Ridge Blvd.Suite 501Raleigh, NC 27607

DISTRICT V

Stanford A. Singer, M.D.36700 Woodward Ave.Suite 300Bloomfield Hills, MI 48304

DISTRICT VI

Ordean L. Torstenson, M.D.Dean Medical Center, SC1313 Fish Hatchery Rd.Madison, WI 53715

DISTRICT Vll

L. Leighton Hill, M.D.Office of AdmissionsBaylor College of MedicineOne Baylor PlazaIHouston, TX 77030

DISTRICT Vlill

Jon R. Almquist, M.D.Virginia Mason Medical CenterDepartment of Pediatrics33501 First Way SouthFederal Way, WA 98003

DISTRICT IX

Lucy S. Crain, M.D., M.P.H.UCSF Box 0374400 Parnassus Ave.San Francisco, CA 94143

AmericanAcademy ofPediatrics

California 1

Leony Go, M.D.35901 Heim Ct.Fremont, CA 94536

Richard Pan, M.D.UC Davis Med. Ctr.Dept. Of Peds2516 Stockton Blvd.Sacramento, CA 95817

California 2

Margaret Hwang, M.D.3943 Veselich Ave., #6-288Los Angeles, CA 90039

Kyu Kim, M.D.14624 Sherman WaySuite 502Van Nuys,CA91405

Orthopaedics SpecialtyFellowNorman Otsuka, M.D.Shnners Hospitals For Children3160 Geneva St.Los Angeles, CA 90020

PISTRICT I

Eileen M. Ouellette, M.D., J.D.Pediatric NeurologyNorth Shore Children's Hospital57 Highland Ave.Salem, MA 01970

CCAfter 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. Turnbull

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% effective on hard-to-reach TEEN bedwet-ters. (Lo, Perez, Hanchrow and Joseph)

So why just "control" bedwetting with drugs when youcan CURE it! With the WIRELESS alarm that wakesthe BEDWVETTER... 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%/ safe, andcosts just $51.00 + S&H. It comes with a 30 day no-questions guarantee.

For complete inforxnation call: 800-497-6573 or 303-40-8517Or visit our web site: w .pottypager.com

IDEAS FOR LIVING, INC. BOULDER, COLORADO 80304

May 1999 AAP News 37

(: !\ i3 I:1 t X

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I IWAMV..M ...MIME= -lillimillial'I'l,I

16-18, 1999. Four Seasons Hotel, Toronto, Ontario, Canada.Sponsored by SUNYAB 14.5 hours, Category 1, AMA and AAFPcredit. Contact Michelle, Phone (716) 878-7105, Fax (716) 888-3841 or E-mail: mbauerQupa.chob.edu

SeptemberTHE CLEVELAND CLINIC FOUNDATION DEPARTMENT OF PEDI-ATRICS presents PEDIATRIC BOARD REVIEW Aug. 30- Sept. 3,1999. Bunts Auditorium, Cleveland, Ohio. For further information,please contact the Continuing Medical Education Department at:(216) 444-5696 (Local) (800) 862-8173 (Toll Free) or (216) 445-9406 (Fax).

Braden E. Griffin Memorial Symposium -Friday, Sept. 17,1999,sponsored by: Division of Neonatology, UMass Memorial Children'sMedical Center, 119 Belmont Street, Worcester, MA 01605, inconjunction with the AAP District I Neonatal Perinatal Section.Contact: Julie A. Sealey, (508) 793-6206. Event Moderator:

A CME Meeting in Practical Pediatric Topicsand a Practice Management Seminar

Z ys THE C~~~~~~~LOISTER°

June 17-19, 1999 *The Cloister *Sea Island, GeorgiaMartin H. Greenberg, MD, Pzrogram Chair

Sponsored byGeorgia Chapter/American Academy of Pediatrics

For information contact Meg Evans * (404) 881-5067 * Fax (404) 249-9503 * mevansXmag.org

June

Pediatrics by the Sea-American Academy of Pediatrics/ GeorgiaChapter, The Cloister, Sea Island, Ga., June 18-20, 1998. (See ais-play ad for more details.)

PRACTICAL TOPICS IN CHILDREN'S MEDICINE -23rd AnnualFlorida Suncoast Pediatric Conference -June 25 -27, 1999. TradeWinds Resort, St. Pete Beach, Fla. For more information, please call:All Children's Hospital Conference Administration, (727) 892-8834.Sponsored by: University of South Florida College of Medicine.Presented by: All Children's Hospital.

JulyTHE 22ND INTERNATIONAL CONFERENCE ON PEDI-ATRIC/ADULT ALLERGY AND CLINICAL IMMUNOLOGY July

_

-

_

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Providence Health Systemn, AlaskaYear-round, Alaska is a great place to be. With four seasons throughout the year,it offers residents never-ending rivers, breathtaking landscapes and mountainpeaks that extend as far as the eye can see. Here, you'll enjoy summer days ofup to 19 hours long, gentle autumn breezes, beautiful white winter blankets ofsnow, flowery meadows in the spring and abundant recreational opportunities.If this sounds like an environment you'll enjoy - and thrive in - consider joiningus at Matanuska Healthcare Associates Inc. in Wasilia, Alaska.

PediatricianWe are currently seeking an adventurous Pediatrician to join our team of fourfamily practitioners and two pediatricians at Matanuska HealthcareAssociates, Inc. Located in the picturesque Matanuska Susitna Valley located45 miles north of Anchorage, you will have easy access to Anchorage's pedi-atric healthcare resources which include a 32 bed level 111 neonatal intensivecare unit, PICU and Children's Hospital.The Matanuska Susitna Valley is the fastest growing community in Alaska witha population over 50,000. From the Valley, you will be just a few minutes awayfrom recreational areas all seasons of the year.

In addition to the exciting adventures of our Alaska locations, we offer first yearsalary guarantees, CME allowance and health/malpractice insurance. Forimmediate consideration, contact Debbie Brannon at 907-376-6422 or leavea message for Dr. Milton K.W. Lum. Or, send your resume to: ProvidenceHealth System Alaska, Human Resources, PO Box 196990, 701 East Tudor,Suite 135,Anchorage,AK 99519. Fax: (907) 565-6495. EOE. Drug Screeningrequired.

05vX<

~~caring,for each per.son as if theyrwere part ofourfamily.

Providence Health System Alaska

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 they might 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-tilic and free ofdiscrimination.

Published Monthily fAmerican Academy of edatic

Elk Grove Vllage, ILL60009-09277

Publication of an advertisement in AAP News neither consti-tutes nor implies a guarantee or endorsement byAAP News orthe American Academy of Pediatrics of the product or serviceadvertised or of the claims made for the product or service bythe advertiser.

Classification: Classified ads are accepted under BusinessServices, General Announcements, Medical Meetings, Physi-cians Wanted, Positions Wanted, Practices Available, Publica-tions, Real Estate and Residencies/FellowshipsAvailable.

Display Classified Ads: Camera-ready, 4-color, 3-color and2-color display classified ads are accepted under GeneralAnnouncements, Medicaf Meetings, Physicians Wanted,Positions Wanted, Practices Available and Residencies/Fellowships Available. Contact AAP News for display classifedad sizes and rates.

For more information, contact: Pete Petersen, Classified AdCoordinator, at (800) 433-9016, ext. 7667. In Illinois, (847) 981-

7667. Ad copyand payments maybe sent to: ClassifiedAds, AAPNews, P.O. Box927, Elk GroveVillage, IL60009-0927.

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 muffi-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: wendy.bass@osfhealthcare.org

38 AAP News May 1999

m

A Ph.D. in Health ServicesPave the way tO success with a Walden degree.Walden University's convenient, distance-deliveredprograms enable health care professionals tO pursuedoctoral degrees without interrupting career andfamily commitments.

A general program in health senrvices is offeredalong with specialized study in:* Health Administration* Community Health* Health and Human Behavior

Our innovative delivery model combines tech-nology, faculty mentors and flexible residencies.Programs are also offered in Management (Ph.D.);Hwnan Services (Ph.D.); Psychology (M.S./Ph.D.);and Education (M.S./Ph.D.)

Global in reach...Personal in approach...Our student-centered programs have been servingdistance learners for 28 years.

Walden UnivmritEy is accreditedby the North CentralAssociation ofCoUqes 6- Schools

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CIASSIFIED ADVERTISING POLICY

Whenyou need to contactpediatricians, contactAAPNews. Each month more than 55,000pediatricians,pediatric specialists, third-year pediatric residents and other subscribers turn toAAPNewsfor child healthinformation theycannotgetelsewhere. With a classifiedad,you can speakdirectly to those readers.

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please call Dr. Brent Page or Stefanie Petersen at PEGUSResearch (800) 949-0089.

NATIONWIDE CLINNICAL TRIAL -PEDIATRICHYPERTENSION -For more informationabout participation in this study CALL: (800)489-7389

California

PEDIATRICIAN - TWIN CITIES: Park NicolletClinic-One of the largest multispecialty clin-ics in the United States, is seeking BC/BE pedi-atricians to join their Pediatrics Department.Positions available at Park Nicollet Clinic -Minnetonka, Bloomington, Shakopee, andBurnsville. Part-time opportunities are alsoavailable. For immediate consideration, pleasesend CV and letter of inquiry to Ms. Fisher,HealthSystem Minnesota Park Nicollet Clinic,Professional Practice Resources, 3800 ParkNicollet Blvd., St. Louis Park, MN 55416; or fax(612) 993-2819. For additional information,call Ms. Fisher at (612) 993-6025.

References: 1. Greenberg RN. Overview of patient compliance with medication dosing: a literature review. Clin Ther1984;6:592-599. 24 RedBook' 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 appolicable patient populations vary among theseinfectaons- please see DOSAGE AND ADMINISTRATION for specific dosing recommendations.

Acute otitis 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 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 orfunctionel asplenia).

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 ANO 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 pyougenes from the nasopharynx. Because some strains are resistant toZITHROMAXI, susceptibility tests should be performed when patients are treated with ZITHROMAXI. Dataestablishing efficacy of azithromycin in subsequent prevention of rheumatic fever are not available.

Appropriate culture and susceptibility tests should be performed before treatment to determine the causativeorganism and its susceptibility to azithromycin. Therapy with ZITHROMAX" may be initiated before results of thesetests are known; once the results become available, antimicrobial therapy should be adjusted accordingly.

CONTRAINDICATIONSZITHROMAX3 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 recurmd soon thereafter in some patients without hfuther azithromycin axposurs. 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, ezithromyein has only been shown to be safe and effective in thetreatment of community-acquired pneumonia due to Chlemydis pneumoniae, Hwmophilus influenzwo,Mycoplasm pnoumoniao, or Stroptococcus pneumonine in patients appropriate for oral therapy.Azithromycin should not be used in patients wiith pneumonia who are judged to be inappropriate for oraltherapy because of moderate to severe illness or risk factorssuch as any of the following: patients withcystic fibrosis, patients with nosocomially acquired infections, patients with known or suspectedbacteremia, paffents requiring hospitalizaffon, elderly or debilitated patients, or patients with significantunderlying health problems that may compromise their ability to respond to th ir illonas (includingimmunodeficiency orfunctional asplenia).

Pseudomembranous colitis has been reported with nearly all antibacterial agents and may range inseverity from mild to life-thrmatbning. Therefore, it is important to consider this diaginosis in patientswho present with diarrhea subsequent to the administraton 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,oointes, in individuals with prolongedQT intervals.

There has been a spontaneous report from the post-marketing experience of a patient with previous history ofarrhythmias who experienced torsades de ,oointes and subsequent myocardial infarction following a course ofazithromycin therapy.Information for Patients: Patients should be cautioned to take ZITHROMAX" suspension at least one hour prior toa meal or at least twvo 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.Drugll ntbradtons: Aluminum- and magnesium-containing antacids reduce the peak serum levels (rate) but not theAUC (extent) of azithromycin absorption.

Administration of cimetidine (BOO 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 assDciated with increases in the serum concentrations of theophylline.Therefore, until further data are available, prudent medical practice dictates careful monitoring of plasmatheophylline levels in patients receiving azithromycin and theophylline concomitantly.

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

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

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

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

T\pL_E

ADVERSE EVENTS in patients following exposures toinsect repellents containing DEET. The National DEETRegistry was established in 1995 to study patients whoreport an adverse event, primarily CNS or a systemiceffect, associated with the use of N,N-Diethyl-m-tolu-amide (DEET). PEGUS Research, Inc., an independentresearch company in Salt Lake City, Utah, is seekinginformation from health care professionals regardingpatients who may have experienced such an event.With their consent, patients will be asked to participatein a telephone interview conducted by PEGUS staff. Ifyou would like more information about the registry orif you are involved in the treatment of a patientexposed to DEET and experiencing an adverse event,

Augusto Sola, M.D., speakers, Jerold Lucey, M.D.,Linda Wright, M.D., L. Joseph Butterfield, M.D., AlanJobe, M.D., Robert Vannucci, M.D.

MINNESOTA

the delivery of patient care to a largely indigent pop-ulation of our primary care practice and may include theopportunity for involvement in the curricular designand implementation. Interest in the management ofabused and/or neglected children is preferred. In addi-tion to providing patient care and teaching, the indi-vidual will be expected to participate in research andother scholarly activities of the division, department andschool. Interested individuals should contact Dr. LindseyGrossman, chair, Division of General Pediatrics andEmergency Care. PO Box 980646, Medical College ofVirginia, Virginia Commonwealth University,Richmond, VA 23298. MCV/VCU is an EqualOpportunity/Affirmative Action Employer. Women,minorities and persons with disabilities are encouragedto apply.

A well established solo pediatric practice in the SanFrancisco Bay area -Owner retiring. Respond to:Phone: (650) 877-0857, Fax (650) 570-5500.

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 2-51: 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 evaluatingl the use of repeated courses of tharapy have not been conducted.Geriatric Use: Pharmacokinetic parameters in older volunteers (65-85 years old) were similar to those in youngervolunteers (18-40 years old) for the 5-day therapeutic regimen. Dosage adjustment does not appear to be necessaryfor older patients with normal renal and hepatic function receiving treatment with this dosage regimen.

ADVERSE REACTIONSIn clinical trials, most of the reported side effects were mild to moderate in severity and were reversible upondiscontinuation of the drug. Approximately 0.7% of the patients (adults and children) from the multiple-dose clinicaltrials discontinued 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 113%), and abdominal pain (3%) 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.Gastrointestinal: Dyspepsia, flatulence, vomiting, melena, and cholestatic jaundice.Genitouriinary. Monilia, vaginitis, and nephritis.Nervous System: Dizziness, headache, vertigo, and somnolence.General: Fatigue.Allergic: Rash, photosensitivity, and angioedema.Single 1-gram dose regimeff Overall, the most common side effects in patients receiving a single-dose regimen of1 gram of ZITHROMAX5 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 ZITHROMAXO with a frequency of1% or greater included diarrhea/loose stools (7%), nausea (5%), abdominal pain (5%), vomiting (2%), dyspepsia (11%),and vaginitis (11%).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 (118%), diarrhea/loose stools (14%), vomiting (7%), abdominal pain (7%),vaginitis (2%), dyspepsia (1%), and dizziness (1 %). The majority of these complaints were mild in nature.Children: Multiple-dose regimens, The types of side effects in children were comparable to those seen in adults,with different incidence rates for the two dosage regimens recommended in children.

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

Community-Acquired Pneumonia: For the recommended dosage regimen of 10 mg/kg on Day 1 followed by5 mg/kg on Days 2-5, the most frequent side effects attributed to treatment were diarrhea/loose stools (5.8%),abdominal pain, vomiting, and nausea (1.9% each), and rash (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 (5%), abdominal pain (3%), nausea (2%),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.Gastrointestnal: Dyspepsia, constipation, anorexia, flatulence, and gastritis.Nervous System: Headache (otitis media dosage), hyperkinesia, dizziness, agitation, nervousness, insomnia.General: Fever, fatigue, malaise.Allergic: Rash.Skin and Appendages: Pruritus, urticaria.Special Senses: Conjunctivitis.Post-Marketing Experience: Adverse events reported with azithromycin during the post-marketing period in adultand/or pediatric patients for which a causal relationship may not be established include:Allergic: Arthralgia, edema, urticaria.Cardiovascular Arrhythmias including ventricular tachycardia.Gastointestinal: Anorexia, constipation, dyspepsia, flatulence, vomiting/diarrhea rarely resulting in dehydration.General: Asthenia, paresthesia.Genitourinery: Interstitial nephritis and acute renal failure.Livar/Bilibry- Abnormal liver function including hepatitis and cholestatic jaundice.Nervous Sysftm 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 allreported at a frequency of less than 1%, but were similar in type to the adult pattem.

DOSAGE AND ADMINISTRATION(SegINDICATIONS AND USAGE.)Acute Otitis Mediaand Community-Acquired Pneumonia: The recDmmended 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/lonsillitis: The recommended dose for children with pharyngitis/tonsillitis is 12 mg/kg once a day for5 days (not to exceed 500 mg/day).ZITHRONAXsfor oral suspension should be givenat leastI hour beforeor 2 hoursafter a meal.ZITHROMAXfor omlsuspension should not be taken wirth food.More detailed professional infonrmation available on requestRevised January 1997

Pediatric Health

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CS/-A \O

MISSISSIPPI

Department of Pediatrics/Division of ChildDevelopment at University of Mississippi MedicalCenter in Jackson, has immediate opening tor full-timedevelopmental pediatrician (open rank). BC in pedi-atrics and fellowship in developmental pediatricsrequired. Individual will participate in multidisciplinaryteam, teaching, research. Please submit CV to SusanButtross, M.D., Chief, Division of Child Development,2500 North State Street, Jackson, MS 39216-4505.EOE, M/F/D/V.

OREGON

NEONATOLOGIST - PORTLAND, OREGON -

Northwest Permanente, P.C. has an excellent oppor-tunity for a BC/BE Neonatologist to join oneNeonatologist in a stimulating professional environ-ment with one of the most successful managed caresystems in the country, and enjoy a quality lifestyleinherent to the beautiful Pacific Northwest! Our physi-cian-managed multispecialty group, who provides carefor over 440,000 members of Kaiser Permanente, hasa full-time position available for a BC/BE Neonatologistat a state-of-the-art level 3 NICU in one of our affili-ated medical centers in suburban Portland. Dutiesinvolve covering level 3 and 2 newborns in an expand-ing 30-bed unit, as well as coordinating newborn serv-ices in the greater Portland area. Call is shared with alarge neonatal group. We offer our physicians a com-petitive salary and a benefits package, which includesa generous retirement program, professional liabilitycoverage, sabbatical leave and more. For informationregarding these exciting opportunities, please forwardCV to: A.P. Weiland, M.D., Regional Medical Director,Northwest Permanente, P.C., 4500 N.E. Multnomah,Suite 100, Portland, OR 97232-2099. EOE.

TEXAS

SOUTHWEST HOUSTON PEDIATRIC CLINIC in searchof a third. Complete package to include paid mal-practice, competitive salary and incentive program.Bilingual very helpful. Contact: Rebekah at (713) 777-1415 or Fax: (713) 777-2226

VIRGINIA

THE DIVISION OF GENERAL PEDIATRICS AND EMER-GENCY CARE, MEDICAL COLLEGE OF VIRGINIACOMMONWEALTH UNIVERSITY seeks a full-timephysmician at the assistant professor level. The individ-ual must be BC/BE in General Pediatrics. The positionwill involve teaching medical students and residents in

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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 (l %). 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, orSpneumoniae, and community-acquired pneumonia due to C pneumoniae, H influenzae, Mpneumoniae, orSpneumoniae.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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Please see briefsummary of prescribinginformation on adjacentpage.