What is the duration of action of cefovecin and which infections is it appropriate to treat in cats?

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Cefovecin provides 14 days of therapeutic activity in cats following a single 8 mg/kg SC injection, but persists in the body for approximately 65 days before 97% of the dose is eliminated. 25 This pharmacokinetic mismatch — therapeutic window far shorter than elimination — is a central stewardship concern, because any adverse reaction requires monitoring for the full 65-day elimination period. 2 The only labeled indication for cefovecin in cats is skin infections (wounds and abscesses) caused by susceptible strains of Pasteurella multocida. 2 The 2023 AAHA Allergic Skin Disease guidelines list cefovecin at 8 mg/kg SC every 14 days as a first- or second-tier option for allergic skin disease. 12 For botryomycosis caused by susceptible Staphylococcus aureus, cefovecin has been used at 8 mg/kg SC every 2 weeks for 8 weeks as adjunctive therapy following surgical excision. 8 Cefovecin is a World Health Organization "highest priority critically important" third-generation cephalosporin, and World Organisation for Animal Health guidelines explicitly discourage its use as a first-line antimicrobial. 13 Despite this, cefovecin accounts for roughly one-third of all antimicrobials administered to cats. 13 Veterinarians overestimate the difficulty of oral administration in cats and owner preference for an injectable, and owner convenience is not an appropriate justification for selecting a broader-spectrum, longer-acting drug over a narrower oral alternative. 14 Cefovecin is not appropriate for feline pyelonephritis. As a highly protein-bound drug, free drug levels in serum do not reach the minimum inhibitory concentration for E. coli, and there are no Clinical and Laboratory Standards Institute breakpoints for cefovecin against Enterobacterales in tissue. 14 Since E. coli is the predominant cause of pyelonephritis, cefovecin was administered to 35% of cats diagnosed with pyelonephritis in one large practice network — a prescribing pattern that raises direct efficacy concerns.