Biotax-O-200 CD TABLET Uses

How do you administer this medicine?
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What is Biotax-O-200 CD TABLET?

Biotax-O-200 CD TABLET is used to treat bacterial infections in many different parts of the body. It belongs to the class of medicines known as cephalosporin antibiotics. It works by killing bacteria or preventing their growth. However, Biotax-O-200 CD TABLET will not work for colds, flu, or other virus infections.

Biotax-O-200 CD TABLET is available only with your doctor's prescription.

Biotax-O-200 CD TABLET indications

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To reduce the development of drug resistant bacteria and maintain the effectiveness of Biotax-O-200 CD TABLET (Biotax-O-200 CD TABLET) and other antibacterial drugs, Biotax-O-200 CD TABLET should be used only to treat infections that are proven or strongly suspected to be caused by susceptible bacteria. When culture and susceptibility information are available, they should be considered in selecting or modifying antimicrobial therapy. In the absence of such data, local epidemiology and susceptibility patterns may contribute to the empiric selection of therapy.

Biotax-O-200 CD TABLET (Biotax-O-200 CD TABLET) is a cephalosporin antibacterial drug indicated in the treatment of adults and pediatric patients six months of age or older with the following infections when caused by susceptible isolates of the designated bacteria:

Uncomplicated Urinary Tract Infections

Uncomplicated Urinary Tract Infections caused by Escherichia coli and Proteus mirabilis.

Otitis Media

Otitis Media caused by Haemophilus influenzae, Moraxella catarrhalis, and Streptococcus pyogenes. (Efficacy for Streptococcus pyogenes in this organ system was studied in fewer than 10 infections.)

Note: For patients with otitis media caused by Streptococcus pneumoniae, overall response was approximately 10% lower for Biotax-O-200 CD TABLET than for the comparator.

Pharyngitis and Tonsillitis

Pharyngitis and Tonsillitis caused by Streptococcus pyogenes. (Note: Penicillin is the usual drug of choice in the treatment of Streptococcus pyogenes infections. Biotax-O-200 CD TABLET is generally effective in the eradication of Streptococcus pyogenes from the nasopharynx; however, data establishing the efficacy of Biotax-O-200 CD TABLET in the subsequent prevention of rheumatic fever is not available.)

Acute Exacerbations of Chronic Bronchitis

Acute Exacerbations of Chronic Bronchitis caused by Streptococcus pneumoniae and Haemophilus influenzae.

Uncomplicated Gonorrhea (cervical/urethral)

Uncomplicated Gonorrhea (cervical/urethral) caused by Neisseria gonorrhoeae (penicillinase-and non-penicillinase-producing isolates).

How should I use Biotax-O-200 CD TABLET?

Use Biotax-O-200 CD TABLET chewable tablets as directed by your doctor. Check the label on the medicine for exact dosing instructions.

Ask your health care provider any questions you may have about how to use Biotax-O-200 CD TABLET chewable tablets.

Uses of Biotax-O-200 CD TABLET in details

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Use: Labeled Indications

Treatment of uncomplicated urinary tract infections (due to Escherichia coli and Proteus mirabilis), otitis media (due to Haemophilus influenzae, Moraxella catarrhalis, and Streptococcus pyogenes), pharyngitis and tonsillitis (due to Streptococcus pyogenes), acute exacerbations of chronic bronchitis (due to Streptococcus pneumoniae and Haemophilus influenzae); uncomplicated cervical/urethral gonorrhea (due to N. gonorrhoeae [penicillinase- and nonpenicillinase-producing])

Note: Due to concerns of resistance, the CDC no longer recommends use of Biotax-O-200 CD TABLET as a first-line regimen in the treatment of uncomplicated gonorrhea in the US; ceftriaxone is the preferred cephalosporin in combination with azithromycin (CDC 2012; CDC [Workowski 2015]).

Off Label Uses

Gonococcal infection, expedited partner therapy

Based on the Centers for Disease Control and Prevention (CDC) sexually transmitted diseases treatment guidelines, Biotax-O-200 CD TABLET in combination with azithromycin is an effective and recommended treatment of gonorrhea only in the following circumstances: Heterosexual partners with gonorrhea if health department partner-management strategies are impractical/unavailable and there is concern by the provider for the prompt evaluation and treatment of the partner; medication may be delivered to partner by patient, collaborating pharmacy, or disease investigation specialist as permitted by law; written materials to educate partners about their exposure to gonorrhea, importance of therapy, and when to seek clinical evaluation for adverse reactions/complications must also be provided with the medication.

Gonococcal, uncomplicated infection of the rectum

Based on the Centers for Disease Control and Prevention (CDC) sexually transmitted diseases treatment guidelines, Biotax-O-200 CD TABLET, in combination with azithromycin, may be used as an alternative agent to ceftriaxone (in combination with azithromycin) for the treatment of uncomplicated gonococcal infections of the rectum only if ceftriaxone is unavailable.

Rhinosinusitis, acute bacterial

Based on the Infectious Diseases Society of America (IDSA) guidelines for acute bacterial rhinosinusitis (ABRS) in children and adults, Biotax-O-200 CD TABLET (among other cephalosporins) is effective and recommended alternative agent (in combination with clindamycin) for the treatment of ABRS.

Clinical experience suggests the utility of Biotax-O-200 CD TABLET (in combination with clindamycin) for the treatment of ABRS. Additional trials may be necessary to further define the role of Biotax-O-200 CD TABLET for this condition.

Biotax-O-200 CD TABLET description

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Biotax-O-200 CD TABLET, an antibiotic, is a 3rd-generation cephalosporin like ceftriaxone and cefotaxime. Biotax-O-200 CD TABLET is highly stable in the presence of β-lactamase enzymes. As a result, many organisms resistant to penicillins and some cephalosporins due to the presence of β-lactamases may be susceptible to Biotax-O-200 CD TABLET. The antibacterial effect of Biotax-O-200 CD TABLET results from inhibition of mucopeptide synthesis in the bacterial cell wall.

Biotax-O-200 CD TABLET dosage

Adults

The recommended dose of Biotax-O-200 CD TABLET is 400 mg daily. This may be given as a 400 mg tablet or capsule daily or the 400 mg tablet may be split and given as one half tablet every 12 hours. For the treatment of uncomplicated cervical/urethral gonococcal infections, a single oral dose of 400 mg is recommended. The capsule and tablet may be administered without regard to food.

In the treatment of infections due to Streptococcus pyogenes, a therapeutic dosage of Biotax-O-200 CD TABLET should be administered for at least 10 days.

Pediatric Patients (6 months or older)

The recommended dose is 8 mg/kg/day of the suspension. This may be administered as a single daily dose or may be given in two divided doses, as 4 mg/kg every 12 hours.

Note: A suggested dose has been determined for each pediatric weight range. Refer to Table 1. Ensure all orders that specify a dose in milliliters include a concentration, because Biotax-O-200 CD TABLET for oral suspension is available in three different concentrations (100 mg/5 mL, 200 mg/5 mL, and 500 mg/5 mL).

Table 1: Suggested doses for pediatric patients

PEDIATRIC DOSAGE CHART

Doses are suggested for each weight range and rounded for ease of administration

Biotax-O-200 CD TABLET (Biotax-O-200 CD TABLET) for

Oral Suspension

Biotax-O-200 CD TABLET (Biotax-O-200 CD TABLET) Chewable Tablet
100 mg/5 mL 200 mg/5 mL 500 mg/5 mL
Patient Weight (kg) Dose/Day (mg)- Dose/Day (mL) Dose/Day (mL) Dose/Day (mL) Dose
5 to 7.5* 50 2.5 -- -- --
7.6 to 10* 80 4 2 -- --
10.1 to 12.5 100 5 2.5 1 1 tablet of 100 mg
12.6 to 20.5 150 7.5 4 1.5 1 tablet of 150 mg
20.6 to 28 200 10 5 2 1 tablet of 200 mg
28.1 to 33 250 12.5 6 2.5 1 tablet of 100 mg and 1 tablet of 150 mg
33.1 to 40 300 15 7.5 3 2 tablets of 150 mg
40.1to 45 350 17.5 9 3.5 1 tablet of 150 mg and 1 tablet of 200 mg
45.1 or greater 400 20 10 4 2 tablets of 200 mg
* The preferred concentrations of oral suspension to use are 100 mg/5 mL or 200 mg/5 mL for pediatric patients in these weight ranges.

Children weighing more than 45 kg or older than 12 years should be treated with the recommended adult dose. Biotax-O-200 CD TABLET (Biotax-O-200 CD TABLET) Chewable Tablets must be chewed or crushed before swallowing.

Otitis media should be treated with the chewable tablets or suspension. Clinical trials of otitis media were conducted with the chewable tablets or suspension, and the chewable tablets or suspension results in higher peak blood levels than the tablet when administered at the same dose. Therefore, the tablet or capsule should not be substituted for the chewable tablets or suspension in the treatment of otitis media.

In the treatment of infections due to Streptococcus pyogenes, a therapeutic dosage of Biotax-O-200 CD TABLET should be administered for at least 10 days.

Renal Impairment

Biotax-O-200 CD TABLET may be administered in the presence of impaired renal function. Normal dose and schedule may be employed in patients with creatinine clearances of 60 mL/min or greater. Refer to Table 2 for dose adjustments for adults with renal impairment. Neither hemodialysis nor peritoneal dialysis removes significant amounts of drug from the body.

Table 2: Doses for Adults with Renal Impairment

Renal Dysfunction Biotax-O-200 CD TABLET (Biotax-O-200 CD TABLET) for

Oral Suspension

Tablet Chewable Tablet
Creatinine Clearance (mL/min) 100 mg/5 mL 200 mg/5 mL 500 mg/5 mL 400 mg 200 mg
Dose/Day (mL) Dose/Day (mL) Dose/Day (mL) Dose/Day Dose/Day
60 or greater Normal dose Normal dose Normal dose Normal dose Normal dose
21 to 59 * OR renal hemodialysis* 13 6.5 2.6 Not Appropriate Not Appropriate
20 or less OR continuous peritoneal dialysis 8.6 4.4 1.8 0.5 tablet 1 tablet
* The preferred concentrations of oral suspension to use are 200 mg/5 mL or 500 mg/5 mL for patients with this renal dysfunction

Reconstitution Directions For

Oral Suspension

Strength Bottle Size Reconstitution Directions
100 mg/5 mL and 200 mg/5 mL 100 mL To reconstitute, suspend with 68 mL water. Method: Tap the bottle several times to loosen powder contents prior to reconstitution. Add approximately half the total amount of water for reconstitution and shake well. Add the remainder of water and shake well.
100 mg/5 mL and 200 mg/5 mL 75 mL To reconstitute, suspend with 51 mL water. Method: Tap the bottle several times to loosen powder contents prior to reconstitution. Add approximately half the total amount of water for reconstitution and shake well. Add the remainder of water and shake well.
100 mg/5 mL and 200 mg/5 mL 50 mL To reconstitute, suspend with 34 mL water. Method: Tap the bottle several times to loosen powder contents prior to reconstitution. Add approximately half the total amount of water for reconstitution and shake well. Add the remainder of water and shake well.
200 mg/5 mL 37.5 mL To reconstitute, suspend with 26 mL water. Method: Tap the bottle several times to loosen powder contents prior to reconstitution. Add approximately half the total amount of water for reconstitution and shake well. Add the remainder of water and shake well.
200 mg/5 mL 25 mL To reconstitute, suspend with 17 mL water. Method: Tap the bottle several times to loosen powder contents prior to reconstitution. Add approximately half the total amount of water for reconstitution and shake well. Add the remainder of water and shake well.
500 mg/5 mL 20 mL To reconstitute, suspend with 14 mL water. Method: Tap the bottle several times to loosen powder contents prior to reconstitution. Add approximately half the total amount of water for reconstitution and shake well. Add the remainder of water and shake well.
500 mg/5 mL 10 mL To reconstitute, suspend with 8 mL water. Method: Tap the bottle several times to loosen powder contents prior to reconstitution. Add approximately half the total amount of water for reconstitution and shake well. Add the remainder of water and shake well.

After reconstitution, the suspension may be kept for 14 days either at room temperature, or under refrigeration, without significant loss of potency. Keep tightly closed. Shake well before using. Discard unused portion after 14 days.

How supplied

Dosage Forms And Strengths

Biotax-O-200 CD TABLET is available for oral administration in the following dosage forms and strengths:

Storage And Handling

Biotax-O-200 CD TABLET® is available for oral administration in following dosage forms, strengths and packages listed in the table below:

Dosage Form Strength Description Package Size NDC Code Storage
Biotax-O-200 CD TABLET® (Biotax-O-200 CD TABLET) Tablets USP 400 mg White to off-white, film-coated, capsule shaped tablets with beveled edges and a divided score line on each side, debossed with “Biotax-O-200 CD TABLET” across one side and “LUPIN” across other side, containing 400 mg of Biotax-O-200 CD TABLET as the trihydrate. Bottles of 10 tablets 27437-201-10 Store at 20 to 25°C (68 to 77°F).
Bottle of 50 tablets 27437-201-08
Bottle of 100 tablets 27437-201-01
Biotax-O-200 CD TABLET® (Biotax-O-200 CD TABLET) Capsules 400 mg Size “00EL” capsules with pink opaque cap and pink opaque body, imprinted with “LU” on cap and “U43” on body in black ink, containing white to yellowish white granular powder containing 400 mg of Biotax-O-200 CD TABLET as the trihydrate. Bottle of 50 capsules 27437-208-08 Store at 20 to 25°C (68 to 77°F).
Unit Dose Package of 10 (1 blister of 10 capsules) 27437-208-11
Biotax-O-200 CD TABLET® (Biotax-O-200 CD TABLET) Chewable Tablets 100 mg Pink, round tablet, debossed with “Biotax-O-200 CD TABLET 100” on one side and “LUPIN” on other side. Bottles of 10 tablets 27437-203-10 Store at 20 to 25°C (68 to 77°F).
Bottle of 50 tablets 27437-203-08
Unit Dose Package of 10 (1 blister of 10 tablets) 27437-203-11
150 mg Pink, round tablet, debossed with “Biotax-O-200 CD TABLET 150” on one side and “LUPIN” on other side. Bottles of 10 tablets 27437-204-10
Bottle of 50 tablets 27437-204-08
Unit Dose Package of 10 (1 blister of 10 tablets) 27437-204-11
200 mg Pink, round tablet, debossed with “Biotax-O-200 CD TABLET 200” on one side and “LUPIN” on other side. Bottles of 10 tablets 27437-205-10
Bottle of 50 tablets 27437-205-08
Unit Dose Package of 10 (1 blister of 10 tablets) 27437-205-11
Biotax-O-200 CD TABLET® (Biotax-O-200 CD TABLET) for

Oral Suspension USP

100 mg/5 mL Off-white to pale yellow colored powder. After reconstituted as directed, each 5 mL of reconstituted suspension contains 100 mg of Biotax-O-200 CD TABLET as the trihydrate. Bottle of 50 mL 68180-202-03 Prior to reconstitution: Store drug powder at 20 to 25°C (68 to 77°F). After reconstitution: Store at room temperature or under refrigeration. Keep tightly closed.
Bottle of 75 mL 68180-202-02
Bottle of 100 mL 68180-202-01
200 mg/5 mL Off-white to pale yellow colored powder. After reconstituted as directed, each 5 mL of reconstituted suspension contains 200 mg of Biotax-O-200 CD TABLET as the trihydrate. Bottle of 25 mL 27437-206-05
Bottle of 37.5 mL 27437-206-06
Bottle of 50 mL 27437-206-03
Bottle of 75 mL 27437-206-02
Bottle of 100 mL 27437-206-01
500 mg/5 mL Off white to cream colored powder forming off-white to pale yellow suspension with characteristic fruity odor on constitution. After reconstituted as directed, each mL of reconstituted suspension contains 100 mg of Biotax-O-200 CD TABLET as the trihydrate. Bottle of 10 mL 27437-207-02
Bottle of 20 mL 27437-207-03

Manufactured for: Lupin Pharma Baltimore, Maryland 21202 United States. Manufactured by:Lupin Limited Mandideep 462 046 India. Revised: January 2016

Biotax-O-200 CD TABLET interactions

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What other drugs will affect Biotax-O-200 CD TABLET?

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Carbamazepine: Elevated carbamazepine levels have been reported when administered concomitantly with Biotax-O-200 CD TABLET. Drug monitoring when these drugs are given together is advised.

Chloramphenicol: In vitro and in vivo antagonism have been noted between cephalosporins and chloramphenicol against a variety of gram-positive and gram-negative bacteria; therefore, it is recommended that combined therapy with chloramphenicol and a cephalosporin be avoided, particularly when bactericidal activity is considered important.

Nifedipine: Concomitant administration of Biotax-O-200 CD TABLET and nifedipine increases oral bioavailability of Biotax-O-200 CD TABLET as a result of higher Cmax and AUC.

Probenecid: Concomitant administration of probenecid reportedly increases Cmax and AUC of Biotax-O-200 CD TABLET and decreases renal clearance and volume of distribution of the drug.

Salicylates: Concomitant administration of 650 mg oral dose of aspirin and a 400 mg oral dose of Biotax-O-200 CD TABLET in healthy adult men may result in a 20-25% decrease in Cmax and AUC of Biotax-O-200 CD TABLET but did not affect protein-binding, serum t½ or renal clearance. This effect may not be clinically important since serum concentrations of Biotax-O-200 CD TABLET remained higher than the MIC values reported for most susceptible organisms. However, some clinicians state that this effect may be clinically important in certain infections.

Warfarin and other Anticoagulants: Increased prothrombin time, with or without clinical bleeding, has been reported when Biotax-O-200 CD TABLET is given concomitantly.

Interference with Laboratory Tests: Nitroprusside Test: A false-positive reaction for ketones in the urine may occur with tests using nitroprusside but not with those using nitroferricyanide.

Coombs' Test: A false-positive Coombs' test has been reported during treatment with other cephalosporin antibiotics; therefore, it should be recognized that a positive Coombs' test may be due to the drug, eg, Coombs' testing of newborns whose mothers have received cephalosporin antibiotics before parturition or in hematologic studies or in transfusion cross-matching procedures when antiglobulin tests are performed.

Clinitest, Benedict's Solution, Fehling's Solution: A false-positive reaction for glucose in the urine using Clinitest, Benedict's solution, or Fehling's solution may result when done during therapy with Biotax-O-200 CD TABLET. It is recommended that other tests based on enzymatic glucose oxidase reactions (eg, Clinistix) be used.

Biotax-O-200 CD TABLET side effects

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What are the possible side effects of Biotax-O-200 CD TABLET?

Biotax-O-200 CD TABLET is generally well tolerated. The majority of adverse reactions observed in clinical trials were mild and self-limiting in nature.

Gastrointestinal Disturbances: The most frequent side effects seen with Biotax-O-200 CD TABLET are diarrhoea and stool changes; diarrhoea has been more commonly associated with higher doses. Some cases of moderate to severe diarrhoea have been reported; this has occasionally warranted cessation of therapy. Biotax-O-200 CD TABLET should be discontinued if marked diarrhoea occurs. Other GI side effects seen less frequently are nausea, abdominal pain, dyspepsia, vomiting and flatulence. Pseudomembranous colitis has been reported.

Central Nervous System: Headache and dizziness.

Hypersensitivity Reactions: Allergies in the form of rash, pruritus, urticaria, drug fever and arthralgia have been observed. These reactions usually subsided upon discontinuation of therapy. Rarely, erythema multiforme, Stevens-Johnson syndrome and toxic epidermal necrolysis have been reported.

Haematological and Clinical Chemistry: Thrombocytopenia, leukopenia and eosinophilia have been reported. These reactions were infrequent and reversible.

Mild transient changes in liver and renal function tests have been observed.

Miscellaneous: Other possible reactions include genital pruritus and vaginitis.

Biotax-O-200 CD TABLET contraindications

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What is the most important information I should know about Biotax-O-200 CD TABLET?

Do not take this medication if you are allergic to Biotax-O-200 CD TABLET, or to similar antibiotics, such as Ceftin, Cefzil, Keflex, Omnicef, and others.

Before taking this medication, tell your doctor if you are allergic to any drugs (especially penicillin).

Take this medication for the entire length of time prescribed by your doctor. Your symptoms may get better before the infection is completely treated. Biotax-O-200 CD TABLET will not treat a viral infection such as the common cold or flu.

Antibiotic medicines can cause diarrhea, which may be a sign of a new infection. If you have diarrhea that is watery or has blood in it, call your doctor. Do not use any medicine to stop the diarrhea unless your doctor has told you to.

Active ingredient matches for Biotax-O-200 CD TABLET:

Cefixime


Unit description / dosage (Manufacturer)Price, USD
BIOTAX-O-200 CD TABLET 1 strip / 10 tablets each (Biochem Pharmaceutical Industries)$ 1.32

List of Biotax-O-200 CD TABLET substitutes (brand and generic names):

BIOTAX-O dry syr 50 mg x 5 mL x 30ml (Biochem)$ 1.17
Bioxime 200 mg Tablet (Biosmith Laboratories)$ 0.20
Bioxime 500 mg Tablet (Biosmith Laboratories)$ 0.72
Bioxime CV 200+125 Tablet (Valcret Lifesciences Pvt Ltd)$ 0.25
Bioxime DT 100 mg Tablet (Biosmith Laboratories)$ 0.12
Bixi 200 mg Tablet (Adventure Life Sciences Pvt Ltd)$ 0.19
Bixi 200+LB Tablet (Adventure Life Sciences Pvt Ltd)$ 0.17
Bixi DT 100 mg Tablet (Adventure Life Sciences Pvt Ltd)$ 0.10
Bixigard 100mg TAB / 100 (Biomax Biotechnics)$ 13.86
Bixigard 200mg TAB / 100 (Biomax Biotechnics)$ 19.88
100 mg x 100's (Biomax Biotechnics)$ 13.86
200 mg x 100's (Biomax Biotechnics)$ 19.88
Bixigard 200 mg Tablet (Biomax Biotechnics)$ 0.20
Bixigard 100 mg Tablet (Biomax Biotechnics)$ 0.14
BIXIGARD 100MG TABLET DT 1 strip / 10 tablet dts each (Biomax Biotechnics)$ 1.48
BIXIGARD 200MG TABLET 1 strip / 10 tablets each (Biomax Biotechnics)$ 1.35
BIXIGARD 50MG DRY SYRUP 1 bottle / 30 ML dry syrup each (Biomax Biotechnics)$ 0.59
BIXIGARD tab 100 mg x 10's (Biomax Biotechnics)$ 1.39
BIXIGARD tab 200 mg x 10's (Biomax Biotechnics)$ 1.99
Bixigard 100mg Tablet DT (Biomax Biotechnics)$ 0.15
Bixigard 200mg Tablet (Biomax Biotechnics)$ 0.14
Bixigard 50mg Dry Syrup (Biomax Biotechnics)$ 0.59
Bixigard C 200+125 Tablet (Biomax Biotechnics)$ 0.39
Bixigard C 200mg/125mg Tablet (Biomax Biotechnics)$ 0.39
Bixigard-C Cefixime 200 mg, Clavulanicacid 125 mg. TAB / 30 (Biomax)$ 11.69
30's (Biomax)$ 11.69
BIXIGARD-C tab 6's (Biomax)$ 2.35
Blaxime 200 mg Tablet (Blaze Pharma)$ 0.16
BRUTACEF-DS dry syr 100 mg x 5 mL x 30ml (Mankind (Magnet))$ 0.48
BRUTACEF-DT dispertab 100 mg x 10's (Mankind (Magnet))$ 0.66
BRUTACEF-DT dispertab 200 mg x 10's (Mankind (Magnet))$ 1.03
Buceff 200 mg Tablet (Burgeon Pharmaceuticals Pvt. Ltd.)$ 0.23
Buceff CV 200+125 Tablet (Burgeon Pharmaceuticals Pvt. Ltd.)$ 0.36
Buceff DT 50 mg Tablet (Burgeon Pharmaceuticals Pvt. Ltd.)$ 0.07
Buceff DT 100 mg Tablet (Burgeon Pharmaceuticals Pvt. Ltd.)$ 0.12
Bygocef 200 mg Tablet (Boyeger Biotech Pvt. Ltd.)$ 0.16
Bygocef 30 ml Syrup (Boyeger Biotech Pvt. Ltd.)$ 0.08
Bygocef 100 mg Tablet (Boyeger Biotech Pvt. Ltd.)$ 0.09

References

  1. DailyMed. "CEFIXIME: DailyMed provides trustworthy information about marketed drugs in the United States. DailyMed is the official provider of FDA label information (package inserts).". https://dailymed.nlm.nih.gov/dailyme... (accessed September 17, 2018).
  2. PubChem. "CEFIXIME". https://pubchem.ncbi.nlm.nih.gov/com... (accessed September 17, 2018).
  3. DrugBank. "CEFIXIME". http://www.drugbank.ca/drugs/DB00671 (accessed September 17, 2018).

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