When treating mycobacterial diseases, it is important to use multi-drug regimes. The reason for this is that mycobacteria have the ability to develop resistance to inividual drugs. If a single drug regime is used, then there is a possibility that the organism may become resistant to that one drug, and thus the treatment may fail. Long treatment times. Also, mycobacteria can exist in an inactive state, in which they do not metabolise.
Antibiotics can only be effective against bacteria that are actively metabolising.
Since these periods of inactivity can be as long as many months, antibiotic treatment duration must be at least as long as this, and it is possible that the target mycobacteria may never be eradicated. Polar manifestations of the disease. Mycobacterial diseases present in two forms, the contained and aggressive forms. If it is not recognised that the population to be treated under a trial should be split between these two forms, the trial may yield incorrect results. Individual patients usually do not suffer from the extremes mentioned below, but display symptoms that are somewhere between the two extremes.