Ceftiofur Sodium
Ceftiofur sodium
Also known as: Naxcel · Excenel · Accent · CM 31-916 · U 64279E · ceftiofen sodium
Reviewed by the VetSheet Veterinary TeamUpdated Apr 5, 2026Evidence-based veterinary reference
Audited v13 dosing evidence
Structured calculator evidenceSusceptible Infections (extra-label) — UTI
Verified clinician required
- q12-24h
NA
Governing clinical context (3)
- Susceptible Infections (extra-label):
- Patients with diminished renal function may require intensified renal monitoring. Therapeutic drug monitoring is not typically done.
- Concentrated ceftiofur sodium powder for reconstitution should be stored at room temperature (20°C-25°C [68°F-77°F]). Protect from light. Color of the cake may vary from off-white to tan, but this does not affect potency. 4
Doses are a clinical reference for licensed veterinary professionals. Always confirm against the current label and the individual patient.
Overview
Ceftiofur sodium is a veterinary-specific, third-generation cephalosporin antibiotic. It is widely utilized across multiple species for its broad-spectrum efficacy against both gram-positive and gram-negative bacteria.
Key Clinical Highlights:
- Primary Indications: Highly effective for bovine and swine respiratory diseases, foot rot in cattle, and susceptible urinary tract infections (UTIs) and soft tissue infections in dogs and cats.
- Extra-label Use: Frequently used off-label in exotic species (including reptiles, ratites, and elephants) and for various systemic infections in small animals.
- Safety Profile: Generally safe, but can cause transient pain upon intramuscular (IM) injection. It carries a risk of hypersensitivity reactions, and caution is advised in patients with known beta-lactam allergies.
- Metabolism: Rapidly converted in vivo to its active metabolite, desfuroylceftiofur, which maintains potent antibacterial activity.
Mechanism of action
Ceftiofur is a time-dependent, bactericidal antibiotic.
Upon administration, ceftiofur is rapidly cleaved → furoic acid and desfuroylceftiofur (the primary active metabolite).
Desfuroylceftiofur → binds to penicillin-binding proteins (PBPs) located inside the bacterial cell wall → inhibits the third and final stage of bacterial cell wall synthesis by halting peptidoglycan cross-linking → weakens the structural integrity of the cell wall → leads to cell lysis and bacterial death.
Safety & warnings
Contraindications
- Patients with a history of hypersensitivity to cephalosporins
- Caution in patients with documented hypersensitivity to other beta-lactam antibiotics (penicillins, cefamycins, carbapenems)
Adverse effects
- Immediate and transient local pain on IM injection
- Discoloration at SC injection sites (may persist >5 days)
- Localized post-injection bacterial infections/abscesses (cattle)
- Hypersensitivity reactions (rashes, fever, eosinophilia, lymphadenopathy, anaphylaxis)
- Acute diarrhea (especially in stressed horses)
- Granulocytopenia
- Thrombocytopenia
Precautions
Regulatory Warning: Strict adherence to withdrawal times is required for food-producing animals. Not to be used in horses intended for human consumption.
- Renal Impairment: Patients in renal failure may require dosage adjustments due to decreased clearance.
- Cross-Reactivity: Use with caution in patients allergic to penicillins due to potential cross-reactivity (estimated 1-15% in humans; unknown in veterinary species).
- Laboratory Interference: May cause false-positive urine glucose (cupric sulfate methods), falsely elevated serum/urine creatinine (Jaffe reaction), false-positive direct Coombs' test, and falsely elevated 17-ketosteroid values in urine.
- GI Flora: May alter bowel flora, potentially leading to severe diarrhea, particularly in stressed horses.
Drug interactions
Potential for additive nephrotoxicity; in vitro synergy exists, but drugs should not be mixed in the same syringe/fluid line.
Potential for additive nephrotoxicity.
Competitively blocks the tubular secretion of most cephalosporins, increasing serum levels and serum half-lives.
Monitoring
- Clinical efficacy (resolution of infection signs)
- Weekly CBC in small animals (recommended by some clinicians)
- Intensified renal monitoring in patients with diminished renal function
Pharmacokinetics
Absorption
Rapidly absorbed following IM or SC injection. In cattle, peak levels occur 30-45 minutes after IM dosing. In dairy goats, IM administration demonstrates 100% bioavailability.
Distribution
Volume of distribution in cattle is approximately 0.3 L/kg. Cephalosporins cross the placenta and are excreted in milk in small quantities. In horses, regional IV perfusion induces significantly higher intraarticular concentrations in the radiocarpal joint compared to systemic IV administration.
Metabolism
Rapidly cleaved into furoic acid and desfuroylceftiofur (the active metabolite).
Elimination
Primarily eliminated via the kidneys.
Overdose
Cephalosporin overdoses are generally well-tolerated and unlikely to cause significant systemic toxicity.
- Clinical Signs: Primarily limited to gastrointestinal distress (nausea, vomiting, diarrhea) or localized injection site reactions.
- Food Animal Considerations: Overdoses in food-producing animals may result in significantly extended tissue withdrawal times. Contact FARAD for specific guidance on withdrawal interval adjustments.
Available products
Formulations
- Powder for injection (50 mg/mL when reconstituted)
Veterinary
- Ceftiofur Sodium Powder for Injection 50 mg ceftiofur/mL when reconstituted in 1 g & 4 g vials (Naxcel, generic)
Regulatory status
No regulatory data for: 🇺🇸 US · 🇪🇺 EU · 🇬🇧 UK · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU
Storage & stability
Unreconstituted powder: Store at room temperature and protect from light. Reconstituted solution: Stable up to 7 days when refrigerated (2-8°C) and for 12 hours at room temperature (15-30°C). Frozen reconstituted solutions are stable up to 8 weeks. Thaw at room temperature or under warm running water; do not rapidly freeze/thaw.
Client information
• Administration: This medication is given by injection. It is normal for your pet to experience mild, temporary stinging or pain at the injection site. • Allergic Reactions: While rare, allergic reactions can occur. Contact your veterinarian immediately if you notice facial swelling, hives, rash, or difficulty breathing. • Gastrointestinal Upset: Watch for signs of diarrhea. In horses, severe diarrhea can be a serious complication; stop the medication and contact your veterinarian if this occurs. • Storage: If you are sent home with reconstituted medication, keep it refrigerated and use it within 7 days. Discard any unused portion after this time or consult your vet about freezing it.
VetSheet drug reference is intended for licensed veterinary professionals as a clinical decision-support aid, not a substitute for professional judgement or the manufacturer’s current label.