1. Klebsiella pneumoniae is a gram –ve organism and it presents resistance to antibiotics through the efflux pump present in it which actively removes antibiotics from its body.
2. MRSA resistance to most commercially available β-lactam antibiotics is because of the modified penicillin-binding proteins which has lower affinity for these drugs.
3. Resistance to penicillin G is due to mutations in one or more of the bacterial penicillin-binding proteins.
4. Penicillin V, amoxicillin, and dicloxacillin are acid stable and available only as oral preparations.
5. Procaine penicillin G and benzathine penicillin G are administered IM and serve as depot forms.
6. All the penicillinase-resistant penicillins should be taken on an empty stomach as food decreases their absorption, for as gastric emptying time increases, the drugs are destroyed by stomach acid.
7. All the penicillins cross the placental barrier, but none have been shown to have teratogenic effects which makes them safe during pregnancy.
8. Distribution of penicillins into bone or cerebrospinal fluid (CSF) is insufficient for therapy unless these sites are inflamed.
9. Inflamed meninges are more permeable to the penicillins, resulting in an increased ratio of the drug in the CSF compared to the serum.
10. The primary route of elimination of penicillins is renal (tubular secretion plus glomerular filteration) and thus dosage adjustment will be needed in case of renal impairment. Nafcillin and oxacillin are exceptions for they are primarily metabolized in the liver and do not require dose adjustment in renal insufficiency.
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