<?xml version="1.0" encoding="UTF-8"?><?xml-stylesheet href="https://www.accessdata.fda.gov/spl/stylesheet/spl.xsl" type="text/xsl"?>
<document xmlns="urn:hl7-org:v3" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xsi:schemaLocation="urn:hl7-org:v3 https://www.accessdata.fda.gov/spl/schema/spl.xsd">
   <id root="cebed063-7a8f-44d5-b49d-ce98adda85c5"/>
   <code code="50578-4" codeSystem="2.16.840.1.113883.6.1" displayName="PRESCRIPTION ANIMAL DRUG LABEL"/>
   <title>Kesium<sup>®</sup>
      <br/> (amoxicillin and clavulanate potassium tablets)</title>
   <effectiveTime value="20241030"/>
   <setId root="11813d97-fbc2-4c9e-a349-4d81ae769078"/>
   <versionNumber value="1"/>
   <author>
      <time/>
      <assignedEntity>
         <representedOrganization>
            <id extension="261126049" root="1.3.6.1.4.1.519.1"/>
            <name>Ceva Sante Animale</name>
            <assignedEntity>
               <assignedOrganization/>
            </assignedEntity>
         </representedOrganization>
      </assignedEntity>
   </author>
   <component>
      <structuredBody>
         <component>
            <section ID="DLDE">
               <id root="de0de9e2-f240-40a9-a1ee-fc1358fd5a21"/>
               <code code="48780-1" codeSystem="2.16.840.1.113883.6.1" displayName="SPL PRODUCT DATA ELEMENTS SECTION"/>
               <effectiveTime value="20241030"/>
               <subject>
                  <manufacturedProduct>
                     <manufacturedProduct>
                        <code code="13744-540" codeSystem="2.16.840.1.113883.6.69"/>
                        <name>Kesium</name>
                        <formCode code="C42893" codeSystem="2.16.840.1.113883.3.26.1.1" displayName="TABLET, CHEWABLE"/>
                        <asEntityWithGeneric>
                           <genericMedicine>
                              <name>Amoxicillin and CLAVULANATE POTASSIUM</name>
                           </genericMedicine>
                        </asEntityWithGeneric>
                        <ingredient classCode="ACTIM">
                           <quantity>
                              <numerator value="50" unit="mg"/>
                              <denominator value="1" unit="1"/>
                           </quantity>
                           <ingredientSubstance>
                              <code code="804826J2HU" codeSystem="2.16.840.1.113883.4.9"/>
                              <name>Amoxicillin</name>
                              <activeMoiety>
                                 <activeMoiety>
                                    <code code="9EM05410Q9" codeSystem="2.16.840.1.113883.4.9"/>
                                    <name>AMOXICILLIN ANHYDROUS</name>
                                 </activeMoiety>
                              </activeMoiety>
                           </ingredientSubstance>
                        </ingredient>
                        <ingredient classCode="ACTIM">
                           <quantity>
                              <numerator value="12.5" unit="mg"/>
                              <denominator value="1" unit="1"/>
                           </quantity>
                           <ingredientSubstance>
                              <code code="Q42OMW3AT8" codeSystem="2.16.840.1.113883.4.9"/>
                              <name>CLAVULANATE POTASSIUM</name>
                              <activeMoiety>
                                 <activeMoiety>
                                    <code code="23521W1S24" codeSystem="2.16.840.1.113883.4.9"/>
                                    <name>CLAVULANIC ACID</name>
                                 </activeMoiety>
                              </activeMoiety>
                           </ingredientSubstance>
                        </ingredient>
                        <asContent>
                           <quantity>
                              <numerator value="10" unit="1"/>
                              <denominator value="1"/>
                           </quantity>
                           <containerPackagedProduct>
                              <formCode code="C43168" codeSystem="2.16.840.1.113883.3.26.1.1" displayName="BLISTER PACK"/>
                              <asContent>
                                 <quantity>
                                    <numerator value="10" unit="1"/>
                                    <denominator value="1"/>
                                 </quantity>
                                 <containerPackagedProduct>
                                    <code code="13744-540-01" codeSystem="2.16.840.1.113883.6.69"/>
                                    <formCode code="C43182" codeSystem="2.16.840.1.113883.3.26.1.1" displayName="CARTON"/>
                                 </containerPackagedProduct>
                              </asContent>
                           </containerPackagedProduct>
                        </asContent>
                     </manufacturedProduct>
                     <subjectOf>
                        <approval>
                           <id extension="ANADA200749" root="2.16.840.1.113883.3.150"/>
                           <code code="C73583" codeSystem="2.16.840.1.113883.3.26.1.1" displayName="ANADA"/>
                           <author>
                              <territorialAuthority>
                                 <territory>
                                    <code code="USA" codeSystem="2.16.840.1.113883.5.28"/>
                                 </territory>
                              </territorialAuthority>
                           </author>
                        </approval>
                     </subjectOf>
                     <subjectOf>
                        <marketingAct>
                           <code code="C53292" codeSystem="2.16.840.1.113883.3.26.1.1"/>
                           <statusCode code="active"/>
                           <effectiveTime>
                              <low value="20241028"/>
                           </effectiveTime>
                        </marketingAct>
                     </subjectOf>
                     <subjectOf>
                        <characteristic classCode="OBS">
                           <code code="SPLCOLOR" codeSystem="2.16.840.1.113883.1.11.19255"/>
                           <value code="C48332" codeSystem="2.16.840.1.113883.3.26.1.1" displayName="BROWN" xsi:type="CE">
                              <originalText>Beige</originalText>
                           </value>
                        </characteristic>
                     </subjectOf>
                     <subjectOf>
                        <characteristic classCode="OBS">
                           <code code="SPLSCORE" codeSystem="2.16.840.1.113883.1.11.19255"/>
                           <value value="2" xsi:type="INT"/>
                        </characteristic>
                     </subjectOf>
                     <subjectOf>
                        <characteristic classCode="OBS">
                           <code code="SPLSHAPE" codeSystem="2.16.840.1.113883.1.11.19255"/>
                           <value code="C48345" codeSystem="2.16.840.1.113883.3.26.1.1" displayName="OVAL" xsi:type="CE">
                              <originalText>Oblong</originalText>
                           </value>
                        </characteristic>
                     </subjectOf>
                     <subjectOf>
                        <characteristic classCode="OBS">
                           <code code="SPLSIZE" codeSystem="2.16.840.1.113883.1.11.19255"/>
                           <value unit="mm" value="11" xsi:type="PQ"/>
                        </characteristic>
                     </subjectOf>
                     <subjectOf>
                        <characteristic classCode="OBS">
                           <code code="SPLIMPRINT" codeSystem="2.16.840.1.113883.1.11.19255"/>
                           <value xsi:type="ST">K;62;5</value>
                        </characteristic>
                     </subjectOf>
                     <consumedIn>
                        <substanceAdministration>
                           <routeCode code="C38288" codeSystem="2.16.840.1.113883.3.26.1.1" displayName="ORAL"/>
                        </substanceAdministration>
                     </consumedIn>
                  </manufacturedProduct>
               </subject>
               <subject>
                  <manufacturedProduct>
                     <manufacturedProduct>
                        <code code="13744-541" codeSystem="2.16.840.1.113883.6.69"/>
                        <name>Kesium</name>
                        <formCode code="C42893" codeSystem="2.16.840.1.113883.3.26.1.1" displayName="TABLET, CHEWABLE"/>
                        <asEntityWithGeneric>
                           <genericMedicine>
                              <name>Amoxicillin and CLAVULANATE POTASSIUM</name>
                           </genericMedicine>
                        </asEntityWithGeneric>
                        <ingredient classCode="ACTIM">
                           <quantity>
                              <numerator value="100" unit="mg"/>
                              <denominator value="1" unit="1"/>
                           </quantity>
                           <ingredientSubstance>
                              <code code="804826J2HU" codeSystem="2.16.840.1.113883.4.9"/>
                              <name>Amoxicillin</name>
                              <activeMoiety>
                                 <activeMoiety>
                                    <code code="9EM05410Q9" codeSystem="2.16.840.1.113883.4.9"/>
                                    <name>AMOXICILLIN ANHYDROUS</name>
                                 </activeMoiety>
                              </activeMoiety>
                           </ingredientSubstance>
                        </ingredient>
                        <ingredient classCode="ACTIM">
                           <quantity>
                              <numerator value="25" unit="mg"/>
                              <denominator value="1" unit="1"/>
                           </quantity>
                           <ingredientSubstance>
                              <code code="Q42OMW3AT8" codeSystem="2.16.840.1.113883.4.9"/>
                              <name>CLAVULANATE POTASSIUM</name>
                              <activeMoiety>
                                 <activeMoiety>
                                    <code code="23521W1S24" codeSystem="2.16.840.1.113883.4.9"/>
                                    <name>CLAVULANIC ACID</name>
                                 </activeMoiety>
                              </activeMoiety>
                           </ingredientSubstance>
                        </ingredient>
                        <asContent>
                           <quantity>
                              <numerator value="10" unit="1"/>
                              <denominator value="1"/>
                           </quantity>
                           <containerPackagedProduct>
                              <formCode code="C43168" codeSystem="2.16.840.1.113883.3.26.1.1" displayName="BLISTER PACK"/>
                              <asContent>
                                 <quantity>
                                    <numerator value="10" unit="1"/>
                                    <denominator value="1"/>
                                 </quantity>
                                 <containerPackagedProduct>
                                    <code code="13744-541-01" codeSystem="2.16.840.1.113883.6.69"/>
                                    <formCode code="C43182" codeSystem="2.16.840.1.113883.3.26.1.1" displayName="CARTON"/>
                                 </containerPackagedProduct>
                              </asContent>
                           </containerPackagedProduct>
                        </asContent>
                     </manufacturedProduct>
                     <subjectOf>
                        <approval>
                           <id extension="ANADA200749" root="2.16.840.1.113883.3.150"/>
                           <code code="C73583" codeSystem="2.16.840.1.113883.3.26.1.1" displayName="ANADA"/>
                           <author>
                              <territorialAuthority>
                                 <territory>
                                    <code code="USA" codeSystem="2.16.840.1.113883.5.28"/>
                                 </territory>
                              </territorialAuthority>
                           </author>
                        </approval>
                     </subjectOf>
                     <subjectOf>
                        <marketingAct>
                           <code code="C53292" codeSystem="2.16.840.1.113883.3.26.1.1"/>
                           <statusCode code="active"/>
                           <effectiveTime>
                              <low value="20241028"/>
                           </effectiveTime>
                        </marketingAct>
                     </subjectOf>
                     <subjectOf>
                        <characteristic classCode="OBS">
                           <code code="SPLCOLOR" codeSystem="2.16.840.1.113883.1.11.19255"/>
                           <value code="C48332" codeSystem="2.16.840.1.113883.3.26.1.1" displayName="BROWN" xsi:type="CE">
                              <originalText>Beige</originalText>
                           </value>
                        </characteristic>
                     </subjectOf>
                     <subjectOf>
                        <characteristic classCode="OBS">
                           <code code="SPLSCORE" codeSystem="2.16.840.1.113883.1.11.19255"/>
                           <value value="2" xsi:type="INT"/>
                        </characteristic>
                     </subjectOf>
                     <subjectOf>
                        <characteristic classCode="OBS">
                           <code code="SPLSHAPE" codeSystem="2.16.840.1.113883.1.11.19255"/>
                           <value code="C48337" codeSystem="2.16.840.1.113883.3.26.1.1" displayName="CLOVER" xsi:type="CE"/>
                        </characteristic>
                     </subjectOf>
                     <subjectOf>
                        <characteristic classCode="OBS">
                           <code code="SPLSIZE" codeSystem="2.16.840.1.113883.1.11.19255"/>
                           <value unit="mm" value="13" xsi:type="PQ"/>
                        </characteristic>
                     </subjectOf>
                     <subjectOf>
                        <characteristic classCode="OBS">
                           <code code="SPLIMPRINT" codeSystem="2.16.840.1.113883.1.11.19255"/>
                           <value xsi:type="ST">K;125</value>
                        </characteristic>
                     </subjectOf>
                     <consumedIn>
                        <substanceAdministration>
                           <routeCode code="C38288" codeSystem="2.16.840.1.113883.3.26.1.1" displayName="ORAL"/>
                        </substanceAdministration>
                     </consumedIn>
                  </manufacturedProduct>
               </subject>
               <subject>
                  <manufacturedProduct>
                     <manufacturedProduct>
                        <code code="13744-542" codeSystem="2.16.840.1.113883.6.69"/>
                        <name>Kesium</name>
                        <formCode code="C42893" codeSystem="2.16.840.1.113883.3.26.1.1" displayName="TABLET, CHEWABLE"/>
                        <asEntityWithGeneric>
                           <genericMedicine>
                              <name>Amoxicillin and CLAVULANATE POTASSIUM</name>
                           </genericMedicine>
                        </asEntityWithGeneric>
                        <ingredient classCode="ACTIM">
                           <quantity>
                              <numerator value="200" unit="mg"/>
                              <denominator value="1" unit="1"/>
                           </quantity>
                           <ingredientSubstance>
                              <code code="804826J2HU" codeSystem="2.16.840.1.113883.4.9"/>
                              <name>Amoxicillin</name>
                              <activeMoiety>
                                 <activeMoiety>
                                    <code code="9EM05410Q9" codeSystem="2.16.840.1.113883.4.9"/>
                                    <name>AMOXICILLIN ANHYDROUS</name>
                                 </activeMoiety>
                              </activeMoiety>
                           </ingredientSubstance>
                        </ingredient>
                        <ingredient classCode="ACTIM">
                           <quantity>
                              <numerator value="50" unit="mg"/>
                              <denominator value="1" unit="1"/>
                           </quantity>
                           <ingredientSubstance>
                              <code code="Q42OMW3AT8" codeSystem="2.16.840.1.113883.4.9"/>
                              <name>CLAVULANATE POTASSIUM</name>
                              <activeMoiety>
                                 <activeMoiety>
                                    <code code="23521W1S24" codeSystem="2.16.840.1.113883.4.9"/>
                                    <name>CLAVULANIC ACID</name>
                                 </activeMoiety>
                              </activeMoiety>
                           </ingredientSubstance>
                        </ingredient>
                        <asContent>
                           <quantity>
                              <numerator value="8" unit="1"/>
                              <denominator value="1"/>
                           </quantity>
                           <containerPackagedProduct>
                              <formCode code="C43168" codeSystem="2.16.840.1.113883.3.26.1.1" displayName="BLISTER PACK"/>
                              <asContent>
                                 <quantity>
                                    <numerator value="12" unit="1"/>
                                    <denominator value="1"/>
                                 </quantity>
                                 <containerPackagedProduct>
                                    <code code="13744-542-01" codeSystem="2.16.840.1.113883.6.69"/>
                                    <formCode code="C43182" codeSystem="2.16.840.1.113883.3.26.1.1" displayName="CARTON"/>
                                 </containerPackagedProduct>
                              </asContent>
                           </containerPackagedProduct>
                        </asContent>
                     </manufacturedProduct>
                     <subjectOf>
                        <approval>
                           <id extension="ANADA200749" root="2.16.840.1.113883.3.150"/>
                           <code code="C73583" codeSystem="2.16.840.1.113883.3.26.1.1" displayName="ANADA"/>
                           <author>
                              <territorialAuthority>
                                 <territory>
                                    <code code="USA" codeSystem="2.16.840.1.113883.5.28"/>
                                 </territory>
                              </territorialAuthority>
                           </author>
                        </approval>
                     </subjectOf>
                     <subjectOf>
                        <marketingAct>
                           <code code="C53292" codeSystem="2.16.840.1.113883.3.26.1.1"/>
                           <statusCode code="active"/>
                           <effectiveTime>
                              <low value="20241028"/>
                           </effectiveTime>
                        </marketingAct>
                     </subjectOf>
                     <subjectOf>
                        <characteristic classCode="OBS">
                           <code code="SPLCOLOR" codeSystem="2.16.840.1.113883.1.11.19255"/>
                           <value code="C48332" codeSystem="2.16.840.1.113883.3.26.1.1" displayName="BROWN" xsi:type="CE">
                              <originalText>Beige</originalText>
                           </value>
                        </characteristic>
                     </subjectOf>
                     <subjectOf>
                        <characteristic classCode="OBS">
                           <code code="SPLSCORE" codeSystem="2.16.840.1.113883.1.11.19255"/>
                           <value value="2" xsi:type="INT"/>
                        </characteristic>
                     </subjectOf>
                     <subjectOf>
                        <characteristic classCode="OBS">
                           <code code="SPLSHAPE" codeSystem="2.16.840.1.113883.1.11.19255"/>
                           <value code="C48337" codeSystem="2.16.840.1.113883.3.26.1.1" displayName="CLOVER" xsi:type="CE"/>
                        </characteristic>
                     </subjectOf>
                     <subjectOf>
                        <characteristic classCode="OBS">
                           <code code="SPLSIZE" codeSystem="2.16.840.1.113883.1.11.19255"/>
                           <value unit="mm" value="17" xsi:type="PQ"/>
                        </characteristic>
                     </subjectOf>
                     <subjectOf>
                        <characteristic classCode="OBS">
                           <code code="SPLIMPRINT" codeSystem="2.16.840.1.113883.1.11.19255"/>
                           <value xsi:type="ST">K;250</value>
                        </characteristic>
                     </subjectOf>
                     <consumedIn>
                        <substanceAdministration>
                           <routeCode code="C38288" codeSystem="2.16.840.1.113883.3.26.1.1" displayName="ORAL"/>
                        </substanceAdministration>
                     </consumedIn>
                  </manufacturedProduct>
               </subject>
               <subject>
                  <manufacturedProduct>
                     <manufacturedProduct>
                        <code code="13744-543" codeSystem="2.16.840.1.113883.6.69"/>
                        <name>Kesium</name>
                        <formCode code="C42893" codeSystem="2.16.840.1.113883.3.26.1.1" displayName="TABLET, CHEWABLE"/>
                        <asEntityWithGeneric>
                           <genericMedicine>
                              <name>Amoxicillin and CLAVULANATE POTASSIUM</name>
                           </genericMedicine>
                        </asEntityWithGeneric>
                        <ingredient classCode="ACTIM">
                           <quantity>
                              <numerator value="300" unit="mg"/>
                              <denominator value="1" unit="1"/>
                           </quantity>
                           <ingredientSubstance>
                              <code code="804826J2HU" codeSystem="2.16.840.1.113883.4.9"/>
                              <name>Amoxicillin</name>
                              <activeMoiety>
                                 <activeMoiety>
                                    <code code="9EM05410Q9" codeSystem="2.16.840.1.113883.4.9"/>
                                    <name>AMOXICILLIN ANHYDROUS</name>
                                 </activeMoiety>
                              </activeMoiety>
                           </ingredientSubstance>
                        </ingredient>
                        <ingredient classCode="ACTIM">
                           <quantity>
                              <numerator value="75" unit="mg"/>
                              <denominator value="1" unit="1"/>
                           </quantity>
                           <ingredientSubstance>
                              <code code="Q42OMW3AT8" codeSystem="2.16.840.1.113883.4.9"/>
                              <name>CLAVULANATE POTASSIUM</name>
                              <activeMoiety>
                                 <activeMoiety>
                                    <code code="23521W1S24" codeSystem="2.16.840.1.113883.4.9"/>
                                    <name>CLAVULANIC ACID</name>
                                 </activeMoiety>
                              </activeMoiety>
                           </ingredientSubstance>
                        </ingredient>
                        <asContent>
                           <quantity>
                              <numerator value="8" unit="1"/>
                              <denominator value="1"/>
                           </quantity>
                           <containerPackagedProduct>
                              <formCode code="C43168" codeSystem="2.16.840.1.113883.3.26.1.1" displayName="BLISTER PACK"/>
                              <asContent>
                                 <quantity>
                                    <numerator value="12" unit="1"/>
                                    <denominator value="1"/>
                                 </quantity>
                                 <containerPackagedProduct>
                                    <code code="13744-543-01" codeSystem="2.16.840.1.113883.6.69"/>
                                    <formCode code="C43182" codeSystem="2.16.840.1.113883.3.26.1.1" displayName="CARTON"/>
                                 </containerPackagedProduct>
                              </asContent>
                           </containerPackagedProduct>
                        </asContent>
                     </manufacturedProduct>
                     <subjectOf>
                        <approval>
                           <id extension="ANADA200749" root="2.16.840.1.113883.3.150"/>
                           <code code="C73583" codeSystem="2.16.840.1.113883.3.26.1.1" displayName="ANADA"/>
                           <author>
                              <territorialAuthority>
                                 <territory>
                                    <code code="USA" codeSystem="2.16.840.1.113883.5.28"/>
                                 </territory>
                              </territorialAuthority>
                           </author>
                        </approval>
                     </subjectOf>
                     <subjectOf>
                        <marketingAct>
                           <code code="C53292" codeSystem="2.16.840.1.113883.3.26.1.1"/>
                           <statusCode code="active"/>
                           <effectiveTime>
                              <low value="20241028"/>
                           </effectiveTime>
                        </marketingAct>
                     </subjectOf>
                     <subjectOf>
                        <characteristic classCode="OBS">
                           <code code="SPLCOLOR" codeSystem="2.16.840.1.113883.1.11.19255"/>
                           <value code="C48332" codeSystem="2.16.840.1.113883.3.26.1.1" displayName="BROWN" xsi:type="CE">
                              <originalText>Beige</originalText>
                           </value>
                        </characteristic>
                     </subjectOf>
                     <subjectOf>
                        <characteristic classCode="OBS">
                           <code code="SPLSCORE" codeSystem="2.16.840.1.113883.1.11.19255"/>
                           <value value="2" xsi:type="INT"/>
                        </characteristic>
                     </subjectOf>
                     <subjectOf>
                        <characteristic classCode="OBS">
                           <code code="SPLSHAPE" codeSystem="2.16.840.1.113883.1.11.19255"/>
                           <value code="C48337" codeSystem="2.16.840.1.113883.3.26.1.1" displayName="CLOVER" xsi:type="CE"/>
                        </characteristic>
                     </subjectOf>
                     <subjectOf>
                        <characteristic classCode="OBS">
                           <code code="SPLSIZE" codeSystem="2.16.840.1.113883.1.11.19255"/>
                           <value unit="mm" value="18" xsi:type="PQ"/>
                        </characteristic>
                     </subjectOf>
                     <subjectOf>
                        <characteristic classCode="OBS">
                           <code code="SPLIMPRINT" codeSystem="2.16.840.1.113883.1.11.19255"/>
                           <value xsi:type="ST">K;375</value>
                        </characteristic>
                     </subjectOf>
                     <consumedIn>
                        <substanceAdministration>
                           <routeCode code="C38288" codeSystem="2.16.840.1.113883.3.26.1.1" displayName="ORAL"/>
                        </substanceAdministration>
                     </consumedIn>
                  </manufacturedProduct>
               </subject>
            </section>
         </component>
         <component>
            <section>
               <id root="e758ee65-d757-4a45-9ae4-eb3ca12a1d0f"/>
               <code code="42229-5" codeSystem="2.16.840.1.113883.6.1" displayName="SPL UNCLASSIFIED SECTION"/>
               <text>
                  <paragraph>
                     <content styleCode="bold">Chewable Tablets</content>
                  </paragraph>
                  <paragraph>
                     <content styleCode="italics">Antimicrobial For Oral Use In Dogs and Cats</content>
                  </paragraph>
               </text>
               <effectiveTime value="20241030"/>
            </section>
         </component>
         <component>
            <section>
               <id root="db9ca807-4afc-4746-80e7-0afcd23bca15"/>
               <code code="42229-5" codeSystem="2.16.840.1.113883.6.1" displayName="SPL UNCLASSIFIED SECTION"/>
               <text>
                  <paragraph>
                     <content styleCode="bold">CAUTION:</content> Federal (USA) law restricts this drug to use by or on the order of a licensed veterinarian.</paragraph>
               </text>
               <effectiveTime value="20241030"/>
            </section>
         </component>
         <component>
            <section>
               <id root="d0cefdbb-ccc1-4afe-a465-b7d84f46a604"/>
               <code code="34089-3" codeSystem="2.16.840.1.113883.6.1" displayName="DESCRIPTION SECTION"/>
               <text>
                  <paragraph>
                     <content styleCode="bold">DESCRIPTION:</content> Kesium Chewable Tablet (amoxicillin and clavulanate potassium tablets) is an orally administered formulation comprised of the broad-spectrum antibiotic amoxicillin trihydrate and the β-lactamase inhibitor, clavulanate potassium (the potassium salt of clavulanic acid).</paragraph>
                  <paragraph>Amoxicillin trihydrate is a semisynthetic antibiotic with a broad spectrum of bactericidal activity against many gram-positive and gram-negative, aerobic and anaerobic microorganisms. It does not resist destruction by β-lactamases; therefore, it is not effective against β-lactamase-producing bacteria. Chemically, it is D(-)-α- amino-p-hydroxybenzyl penicillin trihydrate.</paragraph>
                  <paragraph>Clavulanic acid, an inhibitor of β-lactamase enzymes, is produced by the fermentation of <content styleCode="italics">Streptomyces clavuligerus.</content> Clavulanic acid by itself has only weak antibacterial activity. Chemically, clavulanate potassium is potassium z-(3R,5R)-2-β-hydroxyethylidene clavam-3-carboxylate.</paragraph>
               </text>
               <effectiveTime value="20241030"/>
            </section>
         </component>
         <component>
            <section>
               <id root="3d887ed3-e7a6-4291-ae92-ae634924a0f5"/>
               <code code="50745-9" codeSystem="2.16.840.1.113883.6.1" displayName="VETERINARY INDICATIONS SECTION"/>
               <text>
                  <paragraph>
                     <content styleCode="bold">INDICATIONS:</content> Kesium Chewable Tablets are indicated in the treatment of:</paragraph>
               </text>
               <effectiveTime value="20241030"/>
               <component>
                  <section>
                     <id root="0dffee9b-151e-4fb6-b61f-ca07b0175ac9"/>
                     <code code="42229-5" codeSystem="2.16.840.1.113883.6.1" displayName="SPL UNCLASSIFIED SECTION"/>
                     <text>
                        <paragraph>
                           <content styleCode="italics">Dogs:</content> Skin and soft tissue infections such as wounds, abscesses, cellulitis, superficial/juvenile and deep pyoderma due to susceptible strains of the following organisms: β-lactamase-producing <content styleCode="italics">Staphylococcus aureus</content>, non-β-lactamase-producing <content styleCode="italics">Staphylococcus aureus</content>, <content styleCode="italics">Staphylococcus</content> spp., <content styleCode="italics">Streptococcus</content> spp., and <content styleCode="italics">E. coli</content>.</paragraph>
                        <paragraph>Periodontal infections due to susceptible strains of both aerobic and anaerobic bacteria. Kesium has been shown to be clinically effective for treating cases of canine periodontal disease.</paragraph>
                     </text>
                     <effectiveTime value="20241030"/>
                  </section>
               </component>
               <component>
                  <section>
                     <id root="30776b1b-4197-4e13-a285-2cd05d3ed580"/>
                     <code code="42229-5" codeSystem="2.16.840.1.113883.6.1" displayName="SPL UNCLASSIFIED SECTION"/>
                     <text>
                        <paragraph>
                           <content styleCode="italics">Cats</content>: Skin and soft tissue infections such as wounds, abscesses, and cellulitis/dermatitis due to susceptible strains of the following organisms: β-lactamase-producing <content styleCode="italics">Staphylococcus aureus</content>, non-β-lactamase-producing <content styleCode="italics">Staphylococcus aureus, </content>
                           <content styleCode="italics">Staphylococcus</content> spp., <content styleCode="italics">Streptococcus</content> spp., <content styleCode="italics">E. coli</content>, and <content styleCode="italics">Pasteurella</content> spp.</paragraph>
                        <paragraph>Urinary tract infections (cystitis) due to susceptible strains of <content styleCode="italics">E. coli</content>.</paragraph>
                        <paragraph>Therapy may be initiated with Kesium prior to obtaining results from bacteriological and susceptibility studies. A culture should be obtained prior to treatment to determine susceptibility of the organisms to Kesium. Following determination of susceptibility results and clinical response to medication, therapy may be reevaluated.</paragraph>
                     </text>
                     <effectiveTime value="20241030"/>
                  </section>
               </component>
            </section>
         </component>
         <component>
            <section>
               <id root="f8f83007-d64c-4c14-8f8a-b486d246c68d"/>
               <code code="34068-7" codeSystem="2.16.840.1.113883.6.1" displayName="DOSAGE &amp; ADMINISTRATION SECTION"/>
               <title>DOSAGE AND ADMINISTRATION:</title>
               <text>
                  <paragraph>The dose should be prescribed using a combination of whole tablet strengths (62.5 mg, 125 mg, 250 mg, 375 mg). Do not remove from foil blister until ready to use. Pierce the foil blister cavity to access the tablet. Even if the tablet is broken, the entire tablet should be consumed.</paragraph>
               </text>
               <effectiveTime value="20241030"/>
               <component>
                  <section>
                     <id root="a2888a0c-4cc2-4c1b-a17b-1c0da241ffa0"/>
                     <code code="42229-5" codeSystem="2.16.840.1.113883.6.1" displayName="SPL UNCLASSIFIED SECTION"/>
                     <text>
                        <paragraph>
                           <content styleCode="italics">Dogs:</content> The recommended dosage of Kesium Chewable Tablet is 6.25 mg/lb of body weight twice a day.</paragraph>
                        <paragraph>Skin and soft tissue infections such as abscesses, cellulitis, wounds, superficial/juvenile pyoderma, and periodontal infections should be treated for 5–7 days or for 48 hours after all symptoms have subsided. If no response is seen after 5 days of treatment, therapy should be discontinued and the case reevaluated. Deep pyoderma may require treatment for 21 days; the maximum duration of treatment should not exceed 30 days.</paragraph>
                     </text>
                     <effectiveTime value="20241030"/>
                  </section>
               </component>
               <component>
                  <section>
                     <id root="b8c44f4a-f640-4633-8f8f-bb7e04a6c403"/>
                     <code code="42229-5" codeSystem="2.16.840.1.113883.6.1" displayName="SPL UNCLASSIFIED SECTION"/>
                     <text>
                        <paragraph>
                           <content styleCode="italics">Cats:</content> The recommended dosage of Kesium Chewable Tablet is 62.5 mg twice a day.</paragraph>
                        <paragraph>Skin and soft tissue infections such as abscesses and cellulitis/dermatitis should be treated for 5–7 days or for 48 hours after all symptoms have subsided, not to exceed 30 days. If no response is seen after 3 days of treatment, therapy should be discontinued and the case reevaluated.</paragraph>
                        <paragraph>Urinary tract infections may require treatment for 10 - 14 days or longer. The maximum duration of treatment should not exceed 30 days.</paragraph>
                     </text>
                     <effectiveTime value="20241030"/>
                  </section>
               </component>
            </section>
         </component>
         <component>
            <section>
               <id root="94293380-6be3-4377-a015-5b15f166c3b2"/>
               <code code="34070-3" codeSystem="2.16.840.1.113883.6.1" displayName="CONTRAINDICATIONS SECTION"/>
               <text>
                  <paragraph>
                     <content styleCode="bold">CONTRAINDICATIONS:</content> The use of this drug is contraindicated in animals with a history of allergic reaction to any of the penicillins or cephalosporins.</paragraph>
               </text>
               <effectiveTime value="20241030"/>
            </section>
         </component>
         <component>
            <section>
               <id root="6cd567dc-f7de-474b-842c-9dd11aa5d135"/>
               <code code="34071-1" codeSystem="2.16.840.1.113883.6.1" displayName="WARNINGS SECTION"/>
               <text>
                  <paragraph>
                     <content styleCode="bold">WARNINGS: Store Kesium out of reach of dogs, cats, and other pets in a secured location in order to prevent accidental ingestion or overdose.</content>
                  </paragraph>
               </text>
               <effectiveTime value="20241030"/>
            </section>
         </component>
         <component>
            <section>
               <id root="2c97cabc-64d0-486a-98dc-32d6a16d5c17"/>
               <code code="50741-8" codeSystem="2.16.840.1.113883.6.1" displayName="SAFE HANDLING WARNING SECTION"/>
               <text>
                  <paragraph>
                     <content styleCode="bold">HUMAN WARNINGS:</content> Not for human use. Keep this and all drugs out of reach of children. Antimicrobial drugs, including penicillins and cephalosporins, can cause allergic reactions in sensitized individuals. To minimize the possibility of allergic reactions, those handling such antimicrobials, including amoxicillin and clavulanate potassium, are advised to avoid direct contact of the product with the skin and mucous membranes.</paragraph>
               </text>
               <effectiveTime value="20241030"/>
            </section>
         </component>
         <component>
            <section>
               <id root="07977a1b-f1d3-44cb-ac86-f70557e06199"/>
               <code code="42232-9" codeSystem="2.16.840.1.113883.6.1" displayName="PRECAUTIONS SECTION"/>
               <text>
                  <paragraph>
                     <content styleCode="bold">PRECAUTIONS:</content> Prescribing antibacterial drugs in the absence of a proven or strongly suspected bacterial infection is unlikely to provide benefit to treated animals and may increase the risk of the development of drug-resistant animal pathogens. Safety of use in pregnant or breeding animals has not been determined.</paragraph>
               </text>
               <effectiveTime value="20241030"/>
            </section>
         </component>
         <component>
            <section>
               <id root="03066618-2917-46f8-bec0-58e8d7b15e85"/>
               <code code="34084-4" codeSystem="2.16.840.1.113883.6.1" displayName="ADVERSE REACTIONS SECTION"/>
               <text>
                  <paragraph>
                     <content styleCode="bold">ADVERSE REACTIONS:</content> Kesium contains a semisynthetic penicillin (amoxicillin) and has the potential for producing allergic reactions. If an allergic reaction occurs, administer epinephrine and/or steroids.</paragraph>
               </text>
               <effectiveTime value="20241030"/>
               <component>
                  <section>
                     <id root="dce98cb7-27f3-46d3-af9e-63d72ebce411"/>
                     <code code="42229-5" codeSystem="2.16.840.1.113883.6.1" displayName="SPL UNCLASSIFIED SECTION"/>
                     <text>
                        <paragraph>
                           <content styleCode="bold">Post-Approval Experience (July, 2017):</content> The following adverse events are based on post-approval adverse drug experience reporting. Not all adverse events are reported to FDA/CVM.</paragraph>
                        <paragraph>It is not always possible to reliably estimate the adverse event frequency or establish a causal relationship to product exposure using these data. The following adverse events reported for dogs and cats are listed in decreasing order of reporting frequency for amoxicillin and clavulanate potassium: Anorexia, lethargy, vomiting and diarrhea.</paragraph>
                        <paragraph>To report suspected adverse drug events, for technical assistance or to obtain a copy of the Safety Data Sheet, contact Ceva Animal Health, LLC at 1-800-999-0297. For additional information about adverse drug experience reporting for animal drugs, contact FDA at 1-888-FDA-VETS or www.fda.gov/reportanimalae</paragraph>
                     </text>
                     <effectiveTime value="20241030"/>
                  </section>
               </component>
            </section>
         </component>
         <component>
            <section>
               <id root="4c5f7a5a-0070-4cc0-bce4-21f2d71da75b"/>
               <code code="42229-5" codeSystem="2.16.840.1.113883.6.1" displayName="SPL UNCLASSIFIED SECTION"/>
               <text>
                  <paragraph>
                     <content styleCode="bold">ACTIONS:</content> The 2 components are rapidly absorbed resulting in amoxicillin and clavulanic acid concentrations in serum, urine, and tissues similar to those produced when each is administered alone.</paragraph>
                  <paragraph>Amoxicillin and clavulanic acid diffuse readily into most body tissues and fluids with the exception of brain and spinal fluid, which amoxicillin penetrates adequately when meninges are inflamed. Most of the amoxicillin is excreted unchanged in the urine. Clavulanic acid's penetration into spinal fluid is unknown at this time. Approximately 15% of the administered dose of clavulanic acid is excreted in the urine within the first 6 hours.</paragraph>
                  <paragraph>Kesium combines the distinctive properties of a broad-spectrum antibiotic and a β-lactamase inhibitor to effectively extend the antibacterial spectrum of amoxicillin to include β-lactamase-producing as well as non-β-lactamase-producing aerobic and anaerobic organisms.</paragraph>
               </text>
               <effectiveTime value="20241030"/>
            </section>
         </component>
         <component>
            <section>
               <id root="d320b65e-fe42-492c-b357-d40aad9ed4f0"/>
               <code code="49489-8" codeSystem="2.16.840.1.113883.6.1" displayName="MICROBIOLOGY SECTION"/>
               <text>
                  <paragraph>
                     <content styleCode="bold">MICROBIOLOGY:</content> Amoxicillin is bactericidal in action and acts through the inhibition of biosynthesis of cell wall mucopeptide of susceptible organisms. The action of clavulanic acid extends the antimicrobial spectrum of amoxicillin to include organisms resistant to amoxicillin and other β-lactam antibiotics. Amoxicillin/clavulanate has been shown to have a wide range of activity which includes β-lactamase-producing strains of both gram-positive and gram-negative aerobes, facultative anaerobes, and obligate anaerobes. Many strains of the following organisms, including β-lactamase-producing strains, isolated from veterinary sources, were found to be susceptible to amoxicillin/clavulanate <content styleCode="italics">in vitro</content> but the clinical significance of this activity has not been demonstrated for some of these organisms in animals.</paragraph>
                  <paragraph>Aerobic bacteria, including <content styleCode="italics">Staphylococcus aureus<footnote ID="f1">The susceptibility of these organisms has also been demonstrated in <content styleCode="italics">in vivo</content> studies.</footnote>
                     </content>, β-lactamase-producing <content styleCode="italics">Staphylococcus aureus<footnoteRef IDREF="f1"/>
                     </content>(penicillin resistant), <content styleCode="italics">Staphylococcus</content> species<footnoteRef IDREF="f1"/>, <content styleCode="italics">Staphylococcus epidermidis, Staphylococcus intermedius, Streptococcus faecalis, Streptococcus</content> species<footnoteRef IDREF="f1"/>, <content styleCode="italics">Corynebacterium pyogenes, Corynebacterium</content> species, <content styleCode="italics">Erysipelothrix rhusiopathiae, Bordetella bronchiseptica, Escherichia coli <footnoteRef IDREF="f1"/>, Proteus mirabilis, Proteus</content> species, <content styleCode="italics">Enterobacter</content> species, <content styleCode="italics">Klebsiella pneumoniae, Salmonella dublin, Salmonella typhimurium, Pasteurella multocida, Pasteurella hemolytica, Pasteurell</content>a species<footnoteRef IDREF="f1"/>.</paragraph>
                  <paragraph>Studies have demonstrated that both aerobic and anaerobic flora are isolated from gingival cultures of dogs with clinical evidence of periodontal disease. Both gram-positive and gram-negative aerobic and anaerobic subgingival isolates indicate sensitivity to amoxicillin/clavulanic acid during antimicrobial susceptibility testing.</paragraph>
               </text>
               <effectiveTime value="20241030"/>
            </section>
         </component>
         <component>
            <section>
               <id root="e9683bff-2ea4-4d34-a42a-4a57734407e4"/>
               <code code="42229-5" codeSystem="2.16.840.1.113883.6.1" displayName="SPL UNCLASSIFIED SECTION"/>
               <text>
                  <paragraph>
                     <content styleCode="bold">SUSCEPTIBILITY TEST:</content> The recommended quantitative disc susceptibility method (FEDERAL REGISTER 37:20527-29; Bauer AW, Kirby WMM, Sherris JC, <content styleCode="italics">et al:</content> Antibiotic susceptibility testing by standardized single disc method. <content styleCode="italics">Am J Clin Path</content> 45:493, 1966) utilized 30 mcg Augmentin<sup>®</sup> (AMC) discs for estimating the susceptibility of bacteria to amoxicilln and clavulanate potassium tablets.</paragraph>
               </text>
               <effectiveTime value="20241030"/>
            </section>
         </component>
         <component>
            <section>
               <id root="cc92af26-7899-40c7-9eb6-fa62ff612713"/>
               <code code="44425-7" codeSystem="2.16.840.1.113883.6.1" displayName="STORAGE AND HANDLING SECTION"/>
               <text>
                  <paragraph>
                     <content styleCode="bold">STORAGE INFORMATION:</content> Do not store above 25°C (77°F). Do not remove from foil blister until ready to use.</paragraph>
               </text>
               <effectiveTime value="20241030"/>
            </section>
         </component>
         <component>
            <section>
               <id root="fd82811b-43d4-4d6b-bf21-cab87c0c37ae"/>
               <code code="34069-5" codeSystem="2.16.840.1.113883.6.1" displayName="HOW SUPPLIED SECTION"/>
               <text>
                  <paragraph>
                     <content styleCode="bold">HOW SUPPLIED:</content> Kesium Chewable Tablets in the following strengths of 62.5 mg, 125 mg, 250 mg and 375 mg are supplied in foil blister cards. Each carton of 62.5 mg and 125 mg strength holds 10 blister cards with10 tablets (100 tablets per carton). Each carton of 250 mg and 375 mg strength holds 12 blister cards with 8 tablets (96 tablets per carton).</paragraph>
                  <paragraph>Each 62.5-mg tablet contains amoxicillin trihydrate equivalent to 50 mg of amoxicillin activity and 12.5 mg of clavulanic acid as the potassium salt. For use in dogs and cats.</paragraph>
                  <paragraph>Each 125-mg tablet contains amoxicillin trihydrate equivalent to 100 mg of amoxicillin activity and 25 mg of clavulanic acid as the potassium salt. For use in dogs only.</paragraph>
                  <paragraph>Each 250-mg tablet contains amoxicillin trihydrate equivalent to 200 mg of amoxicillin activity and 50 mg of clavulanic acid as the potassium salt. For use in dogs only.</paragraph>
                  <paragraph>Each 375-mg tablet contains amoxicillin trihydrate equivalent to 300 mg of amoxicillin activity and 75 mg of clavulanic acid as the potassium salt. For use in dogs only.</paragraph>
                  <paragraph>Dispense according to recommendations outlined in Dosage and Administration section.</paragraph>
               </text>
               <effectiveTime value="20241030"/>
            </section>
         </component>
         <component>
            <section>
               <id root="0e01c5d7-7604-4436-b395-b8e23a970220"/>
               <code code="42229-5" codeSystem="2.16.840.1.113883.6.1" displayName="SPL UNCLASSIFIED SECTION"/>
               <text>
                  <paragraph>Approved by FDA under ANADA # 200-749<br/>Augmentin is a trademark owned by GlaxoSmithKline.<br/>Marketed by: Ceva Animal Health, LLC, Lenexa, KS 66215<br/>Kesium trademark is the property of Ceva Santé Animale S.A.<br/>Made in Germany</paragraph>
                  <paragraph>Rev # 11/23<br/>Package Code # C66210B 08-A1-v1<br/>23002177</paragraph>
               </text>
               <effectiveTime value="20241030"/>
            </section>
         </component>
         <component>
            <section>
               <id root="7ab23933-362e-4d94-b255-67ad0a9affac"/>
               <code code="51945-4" codeSystem="2.16.840.1.113883.6.1" displayName="PACKAGE LABEL.PRINCIPAL DISPLAY PANEL"/>
               <title>PRINCIPAL DISPLAY PANEL - 62.5 mg Tablet Blister Pack Carton</title>
               <text>
                  <paragraph>62.5 mg<br/>Chewable Tablets</paragraph>
                  <paragraph>Kesium<sup>®</sup>
                     <br/>(amoxicillin and clavulanate potassium tablets)<br/>Antimicrobial For Oral Use In Dogs and Cats</paragraph>
                  <paragraph>Each chewable tablet contains amoxicillin trihydrate equivalent to 50 mg of amoxicillin activity and 12.5 mg<br/>of clavulanic acid as the potassium salt.</paragraph>
                  <paragraph>Caution: Federal (USA) law restricts this drug to use by or on the order of a licensed veterinarian.</paragraph>
                  <paragraph>Approved by FDA under ANADA # 200-749</paragraph>
                  <paragraph>Net Contents: 10 blister cards, 10 chewable tablets each<br/>100 chewable tablets<br/>ceva</paragraph>
                  <renderMultiMedia referencedObject="MM1"/>
               </text>
               <effectiveTime value="20241106"/>
               <component>
                  <observationMedia ID="MM1">
                     <text>PRINCIPAL DISPLAY PANEL - 62.5 mg Tablet Blister Pack Carton</text>
                     <value xsi:type="ED" mediaType="image/jpeg">
                        <reference value="kesium-01.jpg"/>
                     </value>
                  </observationMedia>
               </component>
            </section>
         </component>
         <component>
            <section>
               <id root="144e1666-4df1-4183-9365-d73496656a23"/>
               <code code="51945-4" codeSystem="2.16.840.1.113883.6.1" displayName="PACKAGE LABEL.PRINCIPAL DISPLAY PANEL"/>
               <title>PRINCIPAL DISPLAY PANEL - 125 mg Tablet Blister Pack Carton</title>
               <text>
                  <paragraph>125 mg<br/>Chewable Tablets</paragraph>
                  <paragraph>Kesium<sup>®</sup>
                     <br/>(amoxicillin and clavulanate potassium tablets)<br/>Antimicrobial For Oral Use In Dogs</paragraph>
                  <paragraph>Each chewable tablet contains amoxicillin trihydrate equivalent to 100 mg of amoxicillin activity and 25 mg of clavulanic <br/>acid as the potassium salt.</paragraph>
                  <paragraph>Caution: Federal (USA) law restricts this drug to use by or on the order of a licensed veterinarian.</paragraph>
                  <paragraph>Approved by FDA under ANADA # 200-749</paragraph>
                  <paragraph>Net Contents: 10 blister cards, 10 chewable tablets each<br/>100 chewable tablets<br/>ceva</paragraph>
                  <renderMultiMedia referencedObject="MM2"/>
               </text>
               <effectiveTime value="20241106"/>
               <component>
                  <observationMedia ID="MM2">
                     <text>PRINCIPAL DISPLAY PANEL - 125 mg Tablet Blister Pack Carton</text>
                     <value xsi:type="ED" mediaType="image/jpeg">
                        <reference value="kesium-02.jpg"/>
                     </value>
                  </observationMedia>
               </component>
            </section>
         </component>
         <component>
            <section>
               <id root="e4974837-e0de-48ee-ab82-e062f859f087"/>
               <code code="51945-4" codeSystem="2.16.840.1.113883.6.1" displayName="PACKAGE LABEL.PRINCIPAL DISPLAY PANEL"/>
               <title>PRINCIPAL DISPLAY PANEL - 250 mg Tablet Blister Pack Carton</title>
               <text>
                  <paragraph>250 mg<br/>Chewable Tablets</paragraph>
                  <paragraph>Kesium<sup>®</sup>
                     <br/>(amoxicillin and clavulanate potassium tablets)<br/>Antimicrobial For Oral Use In Dogs</paragraph>
                  <paragraph>Each chewable tablet contains amoxicillin trihydrate equivalent to 200 mg of amoxicillin activity and <br/>50 mg of clavulanic acid as the potassium salt.</paragraph>
                  <paragraph>Caution: Federal (USA) law restricts this drug to use by or on the order of a licensed veterinarian.</paragraph>
                  <paragraph>Approved by FDA under ANADA # 200-749</paragraph>
                  <paragraph>Net Contents: 12 blister cards, 8 chewable tablets each<br/>96 chewable tablets<br/>ceva</paragraph>
                  <renderMultiMedia referencedObject="MM3"/>
               </text>
               <effectiveTime value="20241106"/>
               <component>
                  <observationMedia ID="MM3">
                     <text>PRINCIPAL DISPLAY PANEL - 250 mg Tablet Blister Pack Carton</text>
                     <value xsi:type="ED" mediaType="image/jpeg">
                        <reference value="kesium-03.jpg"/>
                     </value>
                  </observationMedia>
               </component>
            </section>
         </component>
         <component>
            <section>
               <id root="b9a8f0fc-5e76-4c15-b671-00bcc8925a1e"/>
               <code code="51945-4" codeSystem="2.16.840.1.113883.6.1" displayName="PACKAGE LABEL.PRINCIPAL DISPLAY PANEL"/>
               <title>PRINCIPAL DISPLAY PANEL - 375 mg Tablet Blister Pack Carton</title>
               <text>
                  <paragraph>375 mg<br/>Chewable Tablets</paragraph>
                  <paragraph>Kesium<sup>®</sup>
                     <br/>(amoxicillin and clavulanate potassium tablets)<br/>Antimicrobial For Oral Use In Dogs</paragraph>
                  <paragraph>Each chewable tablet contains amoxicillin trihydrate equivalent to 300 mg of amoxicillin activity and 75 mg of clavulanic <br/>acid as the potassium salt.</paragraph>
                  <paragraph>Caution: Federal (USA) law restricts this drug to use by or on the order of a licensed veterinarian.</paragraph>
                  <paragraph>Approved by FDA under ANADA # 200-749</paragraph>
                  <paragraph>Net Contents: 12 blister cards, 8 chewable tablets each<br/>96 chewable tablets<br/>ceva</paragraph>
                  <renderMultiMedia referencedObject="MM4"/>
               </text>
               <effectiveTime value="20241106"/>
               <component>
                  <observationMedia ID="MM4">
                     <text>PRINCIPAL DISPLAY PANEL - 375 mg Tablet Blister Pack Carton</text>
                     <value xsi:type="ED" mediaType="image/jpeg">
                        <reference value="kesium-04.jpg"/>
                     </value>
                  </observationMedia>
               </component>
            </section>
         </component>
      </structuredBody>
   </component>
</document>