Fluoroquinolones are increasingly used in the empiric therapy of community-acquired respiratory infections likely caused by Streptococcus pneumoniae because of the rise in resistance to p-lactams and macrolides. However, fluoroquinolone resistance in S. pneumoniae has recently emerged. Fluoroquinolone resistance in S. pneumoniae is mediated by two main mechanisms: spontaneous point mutations in the fluoroquinolones' target enzymes (DNA gyrase and topoisomerase IV) and by active efflux. This article focuses on the chromosomal mutations associated with fluoroquinolone resistance in S. pneumoniae, their frequency, and the impact of these mutations on clinical outcomes. Automated DNA sequencing methods are usually used to identify fluoroqui-nolone resistance mutations, but new techniques such as PCR-oligonucleotide ligation assays are currently being evaluated.
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The use of dumbbells gives you a much more comprehensive strengthening effect because the workout engages your stabilizer muscles, in addition to the muscle you may be pin-pointing. Without all of the belts and artificial stabilizers of a machine, you also engage your core muscles, which are your body's natural stabilizers.