Piperacillin, a new semisynthetic penicillin, was evaluated for efficacy and safety in 26 patients, most of whom had pneumonia. Included were four patients with gram-negative meningitis in whom the penetration of piperacillin into cerebrospinal fluid was determined. Cure was achieved in 11 of 17 patients with pneumonia; another 4 were improved. One relapse and one failure occurred among nine patients with gram-negative pneumonia. Cure or improvement occurred in seven of nine patients with gram-negative infection in various extrapulmonary sites. Piperacillin given by continuous infusion in a dosage ranging from 324 to 436 mg/kg of body weight per day to four patients with meningitis resulted in a mean cerebrospinal fluid level of 23 tig/ml at 24 h; the mean penetration of piperacillin into the cerebrospinal fluid was 32% at this interval. Levels of piperacillin in cerebrospinal fluid collected later during the course of therapy were also adequate. Adverse effects were noted in six patients, but only one episode of granulocytopenia was serious. Emergence of resistance to piperacillin did not occur, and only one superinfection was noted. Piperacillin appeared to be efficacious in the treatment of pneumonia. It penetrated well into the cerebrospinal fluid of patients with meningitis and may be useful for treatment of selected gram-negative infections in extrapulmonary sites.Piperacillin is a new semisynthetic antibiotic formed by the attachment of a piperazine derivative to aminobenzylpenicillin. This agent has a broad spectrum of activity that includes Pseudomonas aeruginosa and many species of Enterobacteriaceae. Most P. aeruginosa isolates are inhibited at concentrations of piperacillin that are considerably lower than those of carbenicillin or ticarcillin (4,8,11,27). The antibacterial spectrum of piperacillin is greater than that of other penicillins now available and includes Klebsiella pneumoniae, a species usually resistant to the other penicillin derivatives (17,26,29). Piperacillin is not active against penicillinase-producing staphylococci or certain isolates of gram-negative bacilli that have acquired resistance to the other ,B-lactam antibiotics, since it is inactivated by some 8-lactamases (26). Piperacillin can be given in sufficient quantities to achieve levels in the serum well above the concentrations needed to inhibit many bacteria that commonly cause serious infections (1).

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A 24‐year‐old male patient seropositive for the human immunodeficiency virus with Burkitt's Leukemia was treated successfully with aggressive systemic chemotherapy and central nervous system prophylaxis. He presented with a leukocyte count of 68,900/μl with 33% L3 lymphoblasts, massive hepatosplenomegaly, generalized lymphadenopathy, a lactic dehydrogenase level of 9105 IU/l, creatinine level of 5.8 mg/dl, and a uric acid level of 43.5 mg/dl. Hemodialysis, intrathecal methotrexate, hydrocortisone and cytosine arabinoside, and fractionated doses of cyclophosphamide followed by vincristine and doxorubicin were promptly instituted. He received eight subsequent courses of chemotherapy consisting of either methotrexate with leucovorin rescue and high dose, continuous infusion cytosine arabinoside or cyclophosphamide, vincristine, and methotrexate with leucovorin. There was marked hematologic toxicity resulting from this treatment. However, the patient was alive and in complete remission more than 6 years from diagnosis. This paper demonstrated that it is possible to successfully treat a patient who is HIV‐1 antibody positive with poor prognosis Burkitt's Leukemia. Further studies need to be undertaken to define the least toxic, most effective therapy for this disease.

Lemierre’s Syndrome (LS) is a septic thrombophlebitis of the internal jugular vein following acute pharyngitis commonly caused by anaerobic bacteria. We postulate a rare source of infection in a young male never before cited in the literature, scuba diving. We discuss the patient’s risk factors which we postulate likely caused an altered innate immunity, and when combined with superimposed barotrauma, likely provoked the infection. We then consider the possibility of disease recurrence and make certain recommendations for prevention. Additionally, we highlight the importance of early diagnosis in potentially critical diseases such as LS.