Ceftazidime
| Evidence Level: L2 | Predicted Indications: 10 |
Table of Contents
Ceftazidime: From Bacterial Infections to Urinary Tract Infection
One-Sentence Summary
Ceftazidime is a third-generation cephalosporin antibiotic, originally used for bacterial infections such as pneumonia, meningitis, peritonitis and staphylococcal or streptococcal infections. The TxGNN model predicts it may be effective for urinary tract infection (the highest-ranked prediction with real supporting evidence), with 4 clinical trials and 19 publications currently supporting this direction. Note that this is an antibacterial use largely consistent with its existing infectious disease role, so it is not a true repurposing case.
Quick Overview
| Item | Content |
|---|---|
| Original Indication | Bacterial infections (streptococcal infection, bacterial pneumonia, bacterial meningitis, peritonitis, etc.; the licence indication text is not available) |
| Predicted New Indication | Urinary tract infection (the top two model predictions, hyperamylasemia and polyclonal hyperviscosity syndrome, have no supporting evidence and are not biologically plausible, so the first evidence-supported prediction is evaluated here) |
| TxGNN Prediction Score | 99.41% |
| Evidence Level | L2 |
| Singapore Market Status | ✓ Marketed |
| Number of Registrations | 4 |
| Recommended Decision | Proceed with Guardrails |
Why is This Prediction Reasonable?
Detailed mechanism of action data is not available in the data compiled for this report. Based on known information, ceftazidime is a third-generation cephalosporin that inhibits bacterial cell wall synthesis by binding penicillin-binding proteins (PBPs). It is active against Gram-negative uropathogens, including Pseudomonas aeruginosa.
Urinary tract infection is a bacterial disease, so it fits the antibacterial class of ceftazidime. Its approved-type indications (pneumonia, peritonitis, meningitis) are also bacterial infections, which makes the model's prediction mechanistically coherent.
One caution: most of the available evidence concerns ceftazidime-avibactam (a combination with a β-lactamase inhibitor) rather than ceftazidime alone, so applying the findings to the single agent requires care.
Other model predictions were reviewed too. Several are not biologically plausible (hyperamylasemia, polyclonal hyperviscosity syndrome, congenital analbuminemia, blood group incompatibility) and appear to be graph-based artefacts. Ureaplasma urethritis conflicts with the known mechanism, as Ureaplasma has no cell wall. Chronic suppurative otitis media (listed under "infectious otitis media") has some clinical literature and is a reasonable research question.
Clinical Trial Evidence
| Trial Number | Phase | Status | Enrollment | Key Findings |
|---|---|---|---|---|
| NCT00921024 | Phase 2 | Completed | 129 | Randomised, double-blind study of intravenous CXA-101 versus ceftazidime in complicated UTI including pyelonephritis; strongest direct evidence (the ceftazidime arm serves as comparator) |
| NCT04882085 | Phase 4 | Completed | 60 | Open-label randomised study of ceftazidime-avibactam versus best available treatment for carbapenem-resistant Gram-negative infections (including cUTI) in Chinese adults |
| NCT01430910 | Phase 1 | Completed | 43 | Pharmacokinetic and drug interaction study of ceftazidime-avibactam in healthy subjects; no efficacy data |
| NCT04278404 | N/A | Recruiting | 5000 | Pharmacokinetic and safety study of understudied drugs in children; not indication-specific |
Literature Evidence
| PMID | Year | Type | Journal | Key Findings |
|---|---|---|---|---|
| 32094128 | 2020 | Cohort (multicentre, retrospective) | Antimicrob Agents Chemother | Meropenem-vaborbactam versus ceftazidime-avibactam for carbapenem-resistant Enterobacteriaceae infections |
| 38688353 | 2024 | Review | Int J Antimicrob Agents | Practical approach to treating multidrug-resistant Gram-negative infections (Italian and French societies) |
| 35787918 | 2022 | Review | Int J Antimicrob Agents | Clinical data on novel antibiotics for multidrug-resistant Gram-negative infections, supporting ceftazidime-avibactam |
| 33618353 | 2021 | Cohort | Clin Infect Dis | Observational multicentre study of ceftazidime-avibactam for KPC-producing K. pneumoniae infections |
| 39817442 | 2025 | Systematic review / network meta-analysis | J Comp Eff Res | Efficacy of treatment options for complicated UTI including acute pyelonephritis |
| 39934901 | 2025 | Systematic review / meta-analysis | Antimicrob Resist Infect Control | Global trends of ceftazidime-avibactam resistance in Gram-negative bacteria |
| 30270406 | 2018 | RCT | Infect Dis Ther | TANGO II: meropenem-vaborbactam versus best available therapy for CRE infections |
| 30219824 | 2019 | Review | Clin Infect Dis | Renal dosing of antibiotics, including ceftazidime-avibactam, in reduced creatinine clearance |
| 26289307 | 2015 | Review | Pharmacotherapy | Overview of ceftazidime-avibactam against multidrug-resistant Gram-negative bacteria |
| 30224941 | 2018 | Observational | Can J Infect Dis Med Microbiol | Catheter-associated UTI and biofilm-producing uropathogens |
Most of these papers concern ceftazidime-avibactam or other antibiotics, not ceftazidime alone.
Singapore Market Information
| Authorization Number | Product Name | Dosage Form | Approved Indication |
|---|---|---|---|
| SIN15074P | Ceftazidime Kabi Powder for Solution for Injection 1g/vial | Injection, powder, for solution | Not available |
| SIN14738P | Ceftazidime Mevon Powder for Solution for Injection or Infusion 1g/vial | Injection, powder, for solution | Not available |
| SIN15075P | Ceftazidime Kabi Powder for Solution for Injection 2g/vial | Injection, powder, for solution | Not available |
| SIN11470P | Cefazime for Injection 1g/vial | Injection | Not available |
Safety Considerations
- Disease-level cautions (from the knowledge graph, not label text): kidney disease, liver disease, gallbladder disease, blood coagulation disease, Clostridium difficile colitis, pyoureter, perinatal necrotizing enterocolitis and congenital prothrombin deficiency.
- Drug Interactions (100 records found; main moderate-level ones):
- Amphotericin B (including cholesteryl sulfate, lipid complex and liposomal forms)
- Aminoglycosides: kanamycin, neomycin, streptomycin
- Picosulfuric acid
- Several further interactions of unknown severity (e.g. vancomycin, pantoprazole, omeprazole, metformin, morphine)
For full warnings and contraindications, please refer to the package insert.
Conclusion and Next Steps
Decision: Proceed with Guardrails
Rationale: Urinary tract infection is the only prediction with a completed randomised Phase 2 trial, and it fits the drug's antibacterial class. However, the strongest evidence uses ceftazidime as a comparator or in combination with avibactam, and this indication largely overlaps with existing infectious disease use, so it is not a genuine new indication. The other predictions are either implausible (L5) or backed only by weak, indirect evidence, and are held.
To proceed, the following is needed:
- Package insert warnings and contraindications from the HSA (currently missing, and a blocking gap for safety screening)
- Approved indication text for the Singapore licences, to confirm whether UTI is already covered
- Mechanism of action data from DrugBank
- Ceftazidime-alone efficacy data in UTI (the current evidence mostly involves ceftazidime-avibactam)
- Local susceptibility and resistance data for uropathogens in Singapore
- Renal dose adjustment guidance, given the kidney disease caution
- Optional follow-up: chronic suppurative otitis media as a separate research question, based on paediatric studies of ceftazidime versus aztreonam and outpatient parenteral therapy
Disclaimer
This content is for research purposes only and does not constitute medical advice. Clinical validation is required before any clinical application.