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N EVV F EL LO WVS
Dear Academy Fellow:In order to fulfill the admission requirements of AAP Bylaws, you are requested to:Carefully review the following list of new Fellows for Academy mem-bership, and relay yourreactions directly to your District Chairperson, whose name and address is at the end of this
list. In submitting these names of bo'ard-certified pediatricians to you, it is understood thatacademic and pediatric credentials are not in question. Comments are requested concerningpossible legal and/or ethical situations which you might have personal knowledge.Send any comments on the following list of new Fellows to your District Chairperson.
:Siv Fasci, M.D.:139 Chestnut Ave., #3*Jamaica Plain, MA 02130
:Amy Fleischman, M.D.25 Alton Court, #3.Brookline, MA 021 15
Michael Freedman, M.D..477 Southwick Rd..Westfield, MA 01085
Ben Hemandez-Velasco, M.D.1 00 Gran Biv. Paseos, MSC709, Ste. 1 1 2San Juan, PR 00926-5955
DISTRICT I
Eileen M. Ouellette, M.D., J.D.Pediatric NeurologyNorth Shore Children'sHospital57 Highland Ave.Salem, MA 01970-2197e-mail: eouellette.aap.orgDISTRICT 11
Robert M. Corwin, M.D.Medical Director MedBest251 Salina Meadows Pkwy.Suite 100Syracuse, NY 13212-4572e-mail: rcorwin.aap.orgDISTRICT III
Alan E. Kohrt, M.D.Medical Director/Children's Health NetChildren's Hospital ofPhilade ghia34th an Civic Center Blvd.Philadelphia, PA 19104-4399e-mail: akohrt.aap.orgDISTRICT IV
David I Tayloe, Jr, M.D.2706 Medical Office PlaceGoldsboro, NC 27534-9460e-mail: sewards.aap.org
DISTRICT V
Stanford A. Singer, M.D.36700 Woodward Ave.Suite 300Bloomfield Hills, MI 48304-0908e-mail: ssinger.aap.orgDISTRICT VI
Kathryn Piziali Nichol, M.D.1314 Morrison St.Madison, WI 53703-3812e-mail: knichol.aap.org
R :; IVIVIU3 lbidi IU, VVI-t 7OV-tV-Z-I:.)O ;0 0
San Madno, CA 91108-2009
August 2002 wwwaapnewsorg AAP News 97
N EVV F EL LOVWVS
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DISTRICT Vll
Gary Q. Peck, M.D.Office of Public Health325 Loyola Avenue - Suite 513New Orleans, LA 701 12-1829e-mail: gpeck@?aap.org
* DISTRICT Vlill
: Jon R. Almquist, M.D.: Virginia Mason Medical Center* Department of Pediatrics: 33501 First Way South: Federal Way, WA 98003-6208. e-mail: jalmquist?aap.org
DISTRICT IX
: Burton F. Willis, M.D.: 9900 Talbert. Suite 201: Fountain Valley, CA 92708-5153. e-mail: bwillistaap.org
* DISTRICT X
* Charles Linder, M.D.: Medical College of Georgia. 1120 15th St: Rm HF1117: Augusta, GA 30912-0004
e-mail: clinderEaap.org
. American Academy
. of Pediatrics* DEDICATED TO THE HEALTH OF ALL CHILDREN'
Extensive Product SelectionBrand Name AlarmsWatches for Timed VoidingBedwetting ResourcesGuaranteed Low PricesFast DeliveryC-all or email us for a suppilof catalogs for lour patients.
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98 AAP News www.aapnews.org August 2002
tvdwttingdStorv~~~~~~~~~M
The WVIRELESSalarmn that wakes
the BEDWVETTER...not the whole house!
(azitffiomycin for oFal suspension)BRIEF SUMMARY
INDICATIONS AND USAGEZITHROMAX( (azithromycin) is indicated for the treatment of patients Wvth mild to moderate inwfections (pneumonia:see WARNINGS) caLused by susceptible strains of the designated microorganisms in the specific conditions listedbelowv.As reomne oae.drations of theraDvadwlicableDatientwDoulations varv amongthese irnfec-tions. please seeDOAEANDADMINISTAINfrs%ecific dosinagrecommrrendations,Acuie otitis media caused by Haen70philus influenzae, Moraxafla catarrhalis, or Streptococcuspneumoniae.(For specific dosage recommerndation, seeDOSAGEAND ADMINISTRATilON.)Community-acquired pneumonia due to Chlamydia pneumoniae, Haemophilus infiuenzae, Mycoplasmapneumonlae or Streptococcus pneurroniae in patients appropriate for oral therapy. (For specific dosage recom-mendation, see DOSAGE AND ADMINISTRAillON.)
NOTE.Aikffimmycin should not be used in pediatric padients with pneumonia who are judged to beinapprrit fo oraitlw aray because of moderate to severiness or riskfaeorssuch asan ofth folmlowing:padsnts with cystie fibrosis, patientswith nosocomiall acquired infec-dows, patients with known or sus ted bahen kPatents requiringhopta ztin orpatientswithsini'miet undeyking heai rbesd a opois hi ability to
Whdisloslts caused by Streptococuspyogenesas an altemative to first-lin thrpy inindividjuaswocnt use first-line therapy. (Forspecific dosage recommendation, see DOSG 'AND ADMINIS-TRATION.)NOTE: Penicillinb the intramuscular route is the usual drugof choice in the treatment of Streptococcusyogenes infectio -n -the prophylaxis of rheumatic fever. ZITHROMAX° is often effective in the eradication of s7uscep,-tible strainscof Streptococcusp oenesfrom the nasopharynx. Because some strains are resistant to ZITHROMAX°,susceptibility tests should be pDegrimed wvhen patients are treated with ZITHROMAX°. Data establishing efficacy ofazithromycin in subsequent prevention of rheumatic fever are not available.Appropriate culture and susceptibility tests should be performed before treatment to determine the causative
organism and its susceptibility toazithromycin. Therapy with ZITHROMAX° may be initiated before results of thesetests are known;oncethe results become available, antimicrobial therapy should be adjusted accordingly.
CONTRAINDICATIONSZITHROMAX° is contraindicated in patientsWvth knovvn hypersensitivity to azithromycin, erythromycin or anymacrolide antibiotic. WARNINGSSefious allergic reactions, including angioedema, anaphylaxis, and dermatoloqic reactions including StevensJohnonSndroe an toxc epdermal necrolysis have been reorted rarely In patients on azithromycin therapy.Altougrae, atlites aveben reported. (See CONTRAINDICATIONS. Despite initially successTul sympto-matcteatentof he llegicsymptoms, when symptomatic therapy was discontinued, the allergic symptomsrecrreson fierfte insome patienX without furtheruizfiromycin exposure. These patients requiredprolonged periods of observation and symptomatic treatment The relationship of these episodes to the long tissuehalf-life of azithromycin and subsequent prolonged exposure to anti en is unknown at present.If an allergic reaction occurs, the drug shouldbe discontinuedan appropriatetherpy should be instituted.Physicians should be aware that reappearance of the allergic symptoms may occur when symptomatic therapy isdiscontinued.
InXwtretetof pneu_ia, admy ncin has only been shown tobesafeand effectivein thestea_etof muni_y-acquire luo dueto Ckhh ydisp_iuz _e pHmmo
Aznhromycin should notbe used mpainswt neumonia who areludged to be'inn ropriate fororal~~~~~~~~~~~~ ~ thrapbeas oebt eeeileso ikhtr uh"ayo h ng: patientsNwitc fbeosis paf wilhat tosevealyacurednssoriskfectionsucpatins with kown orsspcebateema --nts -quiring ho pitlializaon,elderly ordblttd patients, or patients with signifi-cantunelm UNltpIFem ta may compromise their abiliyt respond to theirillness (includingimmundiinyo hinction al asplenia).PseudomebranouscolSts has usereoredw theryally antibacterial agents and nay range inseveityfro mid t lif theatnin n V itisimp rWnt consider thisdslagnosisin peant swho~~~~~~~Sftwtineasbeunt the adminsrto ofantbactedal agents.Treamen wihanibateral aent alersthe normal flora of the colon and may permit overgrowth ofclostridia.Studies indicate that a toxinprdcdb Clostridium difficile is a primary cause of "antibiotic-associated colitis."
After the diagnosis of pseuoebao s colitis has been established,therapeutic measures should be initi-ated. Mild cases of pseuaomembranous colitis usually respond to discontinuation of the drug alone.In moderate to severe cases, consideration should be given to management with fluids andelectrolytes, protein sup-plementation, and treatmentwith an antibacterial drug clirnicallyefective against Clostnidium d0fcilecolitis.PRECAUIIONSGeneral: Because azithromycin isprincipally eliminated via the liver, caution should be exercised when azithromycinis administered to patientsvith imTaired hepatic function.
There are no data regarding azithromcn usagein patientswith renal impairment; thus, caution should be exer-cised when prescribing azzithromycin in=tespatients.Thefollowing adverse events have been reportedwith macrolide products: ventriculararrhthfmias,irncludingventriculartachycardia and torsadesdepointes, in individualswith proloniged OTintervals.There has been a spontaneous report trom the post-mnarketingexprinc o a patientwith previous historyofarrytmias who experienced torsadesdepointesand subsequentmoada infarctionfollowing a course otazithromycin theraDyInformation forPateins: Zithromax*oral suspension can be takenwith orsvithoutfood.Patents should also be cautioned not to take aluminum- and magnesium-containing antacids and azithromycinsimultaneously.
The patient should be directed to discontinueazithromycin immediately and contact a physician if any signs of anallergic reaction occur.
Inlia_ e
nsAluminurm- and magnesiwlHuw"antacids reducefthpeak serumanmatin(rate)but nutthewCfexeit)of azithrmrTi abs b
Administration of cimetidline (806 bmwgtwo hours pfiorto azithromycin had no effect on azithromycin absorptior.Azitromyinid nt afectthe plasmnaconcentrations or phamnaCOKinetics of theophy linieadministered as a sin-gle itraveous dse.Theffe to azithromycirnon the plasma concentrations or pharmacokinetics of theophyllineadminsterdinmultple oses resulting in therapeutic steady-state concentrations of theophy line is not known.Howevr,cnwrrnt ue ofmacr lides and theopnylline has been associatedwith increases in the serum concen-trations of theophylline. Therefore, until further data are available, prudenitmedical practce dictates careful monitor-ing of plasma theophyllirieconcentrations in patients receiving azithromycin and theophylline concomitantly.Azithromycin did not affect the prothrombinbmre response to a single dose of warfarin. However, prudent med-ical pracbce dictates careful monitoring of prothrombin Time in all patients treatedwithazithromycinland warfarinconcomitanty. Concurrent use of macrolides and warfarin in clinical practice has been associated with increasedanticoagulant effects.
Thefolloving druginteractions have not been reported in clinicaltrials withaithromycin; however, no specificdruginteracbon studies have beenprformed to evaluate potential drug-druginteracbon. Noretdieess, they navebeen observed witmacroliide=rdcsU nbl further data are developed regardingdnuginteractions whenaztrmcna nthsdugar used concomitantly, careful monitoring of patients is advised:Ergotminer diydroegota ine-acute ergot toxicity characterized by severe peripheral vasospasm and dyses-Triazolam-decrease the clearance of triazolam and thus may increase the pharmacologic effect oftriazolam.Drugsmetabolized bythe cytochrome P450 system eevations of serum carbnarrapine,terfeadime,cydospodrinehambarbital,arndphe oDn socnrtolaoaorTs iterac donxThere areno reported laboratorytest interactions.Cu ci Mutbgenesis,Impainne t of FerWitybLong-termstudies in animals have not been performed
to evaluatecarcnogenic potential.Azithromycin has shown no mutagenic potential in standard laboratorytests:mouse lymphornaassay, numan lymphocyte clastog,enic assay,anamousemmnmarrowclastogenic assay.No evi-denceOfimpaired fertilityuetoazithromy in wasw ound.Prw eratoenicEffecs. Prgnany CatgoryB: Reproducton studies have been perwrm Ted in rats andmice atdoe up to moderately matemally toxicd ose concentrabons (Le.,200 mg/kg/dayl. These doses, based
on a mg/mlbasis, are estimated to be 4 and 2 times, respectively, the human daily dose of 500 mg. In the animalstudies, no evidence of harm to the fetus due to azithromycin was found. There are, however, no adequate and well-controlled studies in pregnant women. Because animal reproduction studies are not always predictive of humanresponse, azithromycin should be used during pregnancy onlyif clearly needed.NursingMdomes It is not knovvn whether azitnromycin is excreted In human milk. Because many drugs areexcreted in human milk, caution should be exercised wnen azithromycin is administered to a nursing woman.PediiiricUe:(eI NDCAillONSAND USAGEAND DOSAGEAND ADMINISTRATION.)Acute Otitis Media (total dosage regimen: 30m/g, see DOSAGEAND ADMINISTRATilON): Safety andeffectiveness in the treatment of children with otitis media under 6 months of agqe have not been established.CommunityAcquired Pneumonia (dosage regimen: 10 mg/kg on Day 1 followved by 5 mg/kg on Days 2-51:Safety and effectiveness in the treatmeont of children with community-acquired pneumonia under 6 months ofage have not been established. Safety and effectiveness for pneumonia due to Chlamydia pneumoniae andMycoplasmapneumoniaewere documented in pediatric clinical trials. Safety and effectiveness for pneumoniadue to Haemophilus influenzaeand Streptococcuspneumonliaewere not documented bacteriologically in thepediatric clinical trial due to difficuIt in obtaining specimens. Use of azithromycin for these two microorganismsIS supported, however, by evidencefrom adequate andwelk-ontrolled studies in adults.PhayngtisTonilltis(doageregmen'12 mg/kg on Days 1-5): Safety and effectiveness in the treatment of chil-drenwithphayngiis/tnsilitiuneir2 years oTage have not been established.Sudies~ ~ ~~~omvZXueirpeated courAs ofdop have notbeen conducted.Geriic se:hamacoknetc paameers n oder oluteers M6-5 years old) wmere similar to those in youngervolunteers (18-40 years old)foth5-athrpuireie.Dsgadsmntosnt appear to be necessaryfor older patients with normlrnladhptcfnto eevn ramn mt hsdsg regimen.In clinical trials, most of the reported side effects were mild to moderate in severity and were reversible upon dis-continuation of the drug. Potentially serious side effects of angioedema and cholestatic jaundice were reportedrarely Approximately O.7% of the patients (adults and children) from the 5-day multiple-dose clinical trialsdiscontin-ued YIHROMAXII(azithromycin)therapy because of treatment-related side effects.In clinical trials in children given30 mg/kg, eite aasiaedsoroe3 a,dscninuation from thetrials due to treatment-related side effectswas approximtl 1.(eDOAEN MIISTRATION.) Most of the side effects leading to discontinua-tion were reltdtthgatonetalrc, e.g., nausea, vomiting, diarrhea, or abdominal pain.Clinical:Children: Single andMultiple-dose regimens,The types of side effects in childrenwmere comparable to those seenin adults, with different incidence rates for the dosage regimens recomnmended in children.Acute Otitis Media: Forthe recommended total dosage regimen of 30 mg/kg, the most frequent side effects(21 %)attributed to treatment were diarrhea, abdominal pain, vomiting, nausea and rash. (See DOSAGEAND ADMINISTRATIlON.)The incidence, based on dosingroimen, is described in the table below:
Community-Acquired Pneumonia: Fortherecommended dosage regimen of 10 mg/kg on Day 1 followved bv5 mg/kgon Days 2-5, the most frequent side effectsattributed to treatmnent were diarrhea71oose stools (5.8%), abdominalpainvomiinogan nauea (.9% each),and rash (11.6%).Piarngits/tnsiliti: hrtherecomrHnanded dosageregimen of 12 ma/go Days 1-5, the most frequentrshdONfctattibtdhoteadacent.V were diarrhea (5.4%), vomiting (5.6%-e),abdominal pain (3.4%), nausea (2%),With any of the treatment regimens, no other treatment-related side effects occurred in children treated with
ZITHROM "Iwith a frequency greater than 1%. Side effects that occurred with a frequency of 1% or less includedthe following:Cardiovascular:Chest pain.Gasumntestinal: Dyspepsia, constipation, anorexia, enteritis, flatulence, gastritis, jaundice, loose stools and oralmoniliasis.He ican Lnn hatic: Anemia andleukopeiN tenrousm Heaaache (otitis media dosage) rhyperkinesia, dizziness, agitation, nervousness and insomnia.GnrlFee,face ederma, fatigue, fungal infection, malaise and pain.Aeic: Rash and allergic reactiorLRepaoy Couq increased, pharyngitis, pleural effusion and rhinitis.Skinand Appendages: Eczema, fungal dermatitis, prufitus, swveating, urticaria and vesiculobullous rash.Special Senses: Conjunctivitis.Post-MafkeingExperiene:Adverse events reported withazithromycin during the post-marketing period inadult and/or pedi'atric patients for which a causal relationship may not be establis-hed include:Alri:Arthralgia, edema, urticaria and angioedema.Cadosclr Arrhythmias including ventricular tachycardia and hypotension.Gastrontestinal: Anorexia, constipation,dyspepsia, flatulence, vomiting/diarrhea rarely resulting in dehydration,pseudomembranous colitis, pancreatitis, ora candidiasis and rare reports of tongue discoloration.General: Asthenia, paresthesia, fatigue, malaise and anaphylaxis (rarely fatal).Genitourinary-Interstitial nephritis and acute renal failure and vaginitis.Hematopoitic: Thrmbocytop nia.Live/Bifarybnoral lver uncton including hepatitis and cholestatic jaundice, as well as rare cases of hepaticnecrsisandhepticfaiure so eo which have resulted in death.NervosSysem: Cnvulsons,dizziness/vertigo, headache, somnolence, hyperactivity, nervousness, agitation andsy coDe
Psciti:Aggressive reaction and anxiety.SnAp ndagesPruritus, rarely serious skin reactions including erythema multiforme, Stevens-Johnson syn-drmn oxic epidermal necrolysis.Special Senses:Hearing disturbances including hearing loss, deafness and/ortinnitus and rare reportsof tasteperversion.Labatr AbnormnalitiOne,Threeand FrveDay RegimensLaboratory data collected from comparative clinical trials employing two 3-day regimens (30 mg/kgor 60 mg/kg individed doses over 3 days), or two 5-day regimens (30 mg/kg or 60 mg/kg in divided doses over baays) were simi-lar for regimens of azithromycin and all comparators combined,vvith most clinically significant laboratory abnor-malities occurring at incidences of 1-5%. Laboratory data for patients receiving 30mgk as a single dose werecollected in one single center trial. In that tfial, an absolute neutrophil count betwveen%501500 cefls/mm'wiasobserved in 10/64 patients receiving 30 mg/kg as a single dose, 9/62 patients receivn 30 m/Auqiven over 3davs, and 8/63 comparator patients. No patient had an absolute neutrophil count<0 cells/mnr3.7See DOSAGEAb*ADMINISTRATilON)Inmultiple-doseclinical trialsirnvolvng approximately 4700 pediatric pafients, no patients discontinued therapybecause of treatment-related laboratorv abnormalities.DOSAGEAND ADMINISTRA;IION (See INDICArIONSAND USAGE)Zithromax°for oral suspension can be takenvWth orwithout foodAcute OdtisMedia: The recomnmended dose of ZITHROMAX°for oral suspensionfor the treatment of childrenvv th acute otitis media is 30 mg/aggiven as a singledose or 10 m g/konce dailyfor 3 days or 10 mg/kg as a singledose on theifirst day fbllowved by 5 mg/kg/dayon Days2 through 5.Tlieosafety of re-dosingazithromycin in childrenwhovomit afterreceiving 30 mg/kg as a singiedosehnasnot been established. In clinical studiesinvolvinq 487patients~~~~ ~ ~~~~~wihaueoii!ei ie ig 30mg/ g dose ofazithromycin, eight patientswvho vomitewithin 30minutes of dosingwvere re-dosed at the same total rose.Community-Acquired Pneuona:The recommended dose ofZlTHROMAX"fororal suspension forthetreatmentof childrenwith community-acquired pneumonia is 10 mg/kg as asirngle dose on the first dayfollowed by 5 mg/kg onLays2_ouh 5.PhrynWFoniiUWis The recommended dose of ZITHROMAX)fo r childrenwith pharyngitis/tonsillitis is12 mgtKgonce daily for 5 days.For moredetailedproductinfomrnationplease refertothe fullprescribing informabon orcall 1,Mo8793477.
Rev. January 2002
11A lytl
SOUTHEAST
General Pediatricians - The Department ofPediatrics at the University of Florida HealthScience Center-Jacksonville seeks applicantsfor 3 new positions in the General PediatricsDivision as a General Pediatrician at the levelof Clinical Assistant Professor/ClinicalAssociate Professor. These appointments arefull-time, non-tenure, clinical track appoint-ments. Major responsibilities for these positionwill include patient care and teaching withopportunities in research possible. Applicantsshould possess a M.D. degree and be BoardEligible/Board Certified Pediatricians. Deadlinefor receiving applications is Aug. 15, with ananticipated negotiable start date of Sept. 15.Salary is negotiable. Forward letter of intent,curriculum vitae, and the names and addressesof three references to: Mobeen H. Rathore,M.D., Professor & Assistant Chairman, SearchCommittee Chairman, Department ofPediatrics, University of Florida-Jacksonville,653-1 W. Eighth St., Jacksonville, FL 32209.Phone: (904) 244-3050. Fax: (904) 244-3028.E-mail: mobeen.rathore?jax.ufl.edu. TheUniversity of Florida is an AffirmativeAction/Equal Opportunity Employer.
Kentucky: Pediatrician needed immediately inHPSA location. J-1,HlB,Permanent Residentor US Citizen all welcome. Computer literacypreferred. Send CV to AAP 8,P.O. Box 149,Bel Air, MD 21014.
ANDERSON, S.C. - Well-established privatepractice seeks associate; senior partner retiring.BC/BE, energetic; must have excellent training;communications skills. Primarily OP practice;easy call. Stable office staff. Salary year one;partnership track. One hosp; 587- beds, NFP.Low managed care. Foothills of northwesternSouth Carolina; on 1 85 and Lake Hartwell; 30miles from Greenville (MSA 200,000). RecentALL AMERICA CITY; 2 hrs to Charlotte orAtlanta; less to Asheville and mountain areas.CLEMSON UNIVERSITY, 16 miles. ...drive toCharleston by lunch. Sherry Chastain, MedicalStaff Development, Anderson Area MedicalCenter; schastaiOanmed.com; (800) 226-3103 Does not qualify for Jlwaiver. NORECRUITERS.
FLORIDA, Palm Beach County. Progressive,well-established 7 MD/5 PNP practice lookingfor new MD. Wonderful location with appre-ciative patients. Relaxed pace, excellent work-ing cond ition s. E-mail:dpke?pbpediatrics.com
NORTHWEST
Beautiful Oregon Coast-The Bay Clinic is seek-ing a BC/BE Pediatrician to replace a physician
AmericanAcademy ofPediatrics
who is retiring at the end of 2002. Bay Clinicis a 20-physician multi-specialty group with afive member Pediatric department that wasestablished in 1957. The location is on thebeautiful Southern Oregon Coast in an areawith abundant recreational opportunities forquality family living. It is predominantly fee-for-service with in-house laboratory and x-raydepartments for efficient and convenient serv-ice to our patients. Emergency call rotationfor the community includes a total of eightPediatricians. The year's salary is guaranteed,with an incentive bonus. All office overheads,
including malpractice, are covered. Partnershipis available at the end of the first year, with no.buy-in. Bay Area Hospital is located directlyacross the street and is the main referral cen-ter for the entire Southern Oregon Coast. It isa completely modern 1 72-bed, publicly-owned acute care facility which has just com-pleted a major $15 million remodel andexpansion. The Coos Bay/North Bend areahas a combined population of 30,000 and adrawing area of another 60,000. If you areinterested in this opportunity please fax or e-mail a copy of your CV to: Daniel E. Walsh,
Administrator, Bay Clinic, LLP, 1750 ThompsonRd., Coos Bay, Oregon 97420. (541) 266-4400, fax (541) 267-6905, e-mail:dwaish?harborside.com .
Pediatrics for the Practitioner-Big Island ofHawaii, Oct. 14-17. Sponsored by Saint Luke'sHospital and The Children's Mercy Hospital ofKansas City. Call (816) 932-2220 or send e-mail to cmeEsaint-lukes.org for more infor-mation.
Augmentin (amoxicillir/clavulanate potassium) is a registered trademark of GlaxSmithlline.References:t Data on file. Pfizer Inc., NewYork, WY. Block SLArrieta A, Seibe M, McLinn S, Eppes SC. Single dose azithiromycin (30 mg/kg) in acute oftits media. Paper presented at Infectious Diseases Society ofAmerica 38tAnnual Meeting; SeplBmber7-10, 2000;New Odeans, La.Abstact174.
4MUS. PharmaceuticalsZX12067 (B 2002 Pfizer Inc. All rights reserved.