In recent years, the medical and scientific communities have faced an alarming challenge: the increasing resistance of fungal pathogens to antifungal drugs. UC Davis infectious disease experts George Thompson and Angel Desai have recently sounded a clarion call about the unintended consequences of widespread pesticide use on this very issue. Their commentary published in the esteemed New England Journal of Medicine highlights how the agricultural application of antifungal agents, designed to protect crops, may be fueling a dangerous rise in antifungal drug resistance in human and animal populations. Their appeal focuses on the urgent need for a coordinated, global strategy known as the “One Health” approach that integrates human, animal, and environmental health sectors to tackle this multifaceted problem.
Fungal infections present a significant health burden worldwide, often causing diseases that range from mild to life-threatening, particularly in immunocompromised patients. The economic consequences are immense, with healthcare costs skyrocketing due to prolonged treatments and hospitalizations. In agriculture, fungicides are essential in safeguarding crops from fungal diseases that can devastate food supplies. However, the overlap between agricultural fungicides and medical antifungal drugs means that fungi exposed to pesticides in the environment may develop cross-resistance, which undermines the effectiveness of clinical treatments. This phenomenon is particularly concerning because the arsenal of available antifungal drugs is already limited compared to antibiotics.
Dr. George Thompson, the lead author of the commentary and a professor at UC Davis School of Medicine, underscores the parallel between antifungal resistance and the well-documented rise in antibiotic resistance fueled by antibiotic overuse in livestock. “The lessons learned from antibacterial resistance emphasize the importance of cautious and judicious use of antimicrobial agents,” Thompson remarks. Fungal organisms, like Candida auris, have cellular machinery that closely resembles human cells, which complicates the development of antifungals that selectively target fungi without harming patients. Hence, preventing the emergence of resistance is critical to retaining the efficacy of existing drugs.
The “One Health” framework advocated by Thompson and Desai urges a holistic perspective that recognizes the interconnectedness of ecosystems. Human health cannot be extricated from the health of animals or the environment, especially when considering the spread of fungal pathogens and their resistance profiles. Environmental factors such as climate change and shifting wind patterns also facilitate the dissemination of fungi across geographic boundaries, exacerbating the problem. Human travel and the migration of animals further complicate containment efforts by transporting resistant strains to new locations, creating new epidemiological hotspots.
Among the concerning pathogens, Candida auris stands out as an exemplar of the growing problem of antifungal resistance. Notorious for causing invasive infections that are difficult to treat, C. auris often exhibits multidrug resistance. The limited number of antifungal classes approved for clinical use means that resistance emergence significantly narrows therapeutic options. Furthermore, these drugs often provoke adverse effects in patients due to the similarity between fungal and human cells, highlighting the critical need for stewardship and innovation.
Central to the commentary is a call for tighter global regulation and collaboration in pesticide and antifungal drug development. The authors warn that resistance is strongly influenced by the scale and intensity of antimicrobial use. Therefore, a shared international framework that rigorously evaluates new compounds for their potential impacts on human, animal, and environmental health is imperative. This framework would ideally precede the widespread introduction of any new agricultural pesticides, preventing the inadvertent selection of resistant fungal strains in the environment.
Dr. Angel Desai, co-author and associate professor in the Department of Internal Medicine at UC Davis, stresses the necessity for a unified antimicrobial approval mechanism. Such a system would incorporate environmental safety assessments alongside traditional pharmaceutical evaluations, ensuring that new agents do not undermine medical treatments. She points out that this process would be instrumental in harmonizing the approach to mitigating resistance risks, benefiting regulatory bodies and stakeholders worldwide.
The commentary also highlights the formation of the Interagency Drug and Pesticide Resistance and Efficacy Workgroup under the U.S. Environmental Protection Agency (EPA). This group plays a critical role in scrutinizing proposed pesticide registrations with an eye toward their implications for medical practice. The hope expressed by the authors is for the emergence of analogous collaborations at the global level, allowing for shared expertise and coordinated action to stem the tide of antifungal resistance.
Beyond regulatory measures, the importance of surveillance and research cannot be overstated. Continuous monitoring of resistance patterns and molecular mechanisms in fungal populations will provide vital data for tailoring interventions. Advancements in genomic technologies and bioinformatics enable more precise detection of resistance genes and tracking of pathogen spread. These tools empower researchers and public health officials to respond dynamically as fungal threats evolve.
Addressing the root causes of antifungal resistance also requires innovative scientific endeavors aimed at discovering novel antifungal compounds with unique modes of action. Given the close biological kinship between fungi and humans, drug development is fraught with challenges, requiring agents that can selectively target fungal-specific pathways. This underscores the need for cross-disciplinary collaborations, integrating microbiology, medicinal chemistry, environmental science, and clinical medicine to innovate sustainable solutions.
In summary, the emerging crisis of antifungal drug resistance is a complex, global issue intricately tied to environmental stewardship, regulatory policy, and medical practice. The insightful commentary by UC Davis experts George Thompson and Angel Desai reinforces that only through a comprehensive “One Health” approach, encompassing human, animal, and environmental health, can we hope to mitigate the dangers posed by resistant fungal pathogens. Coordinated global efforts to regulate, monitor, and innovate antifungal use and development are not just prudent but indispensable for safeguarding future generations.
Article Title: Addressing Antifungal Drug Resistance — A “One Health–One World” Challenge
News Publication Date: 7-Jun-2025
Web References:
– https://health.ucdavis.edu/medmicro/Faculty_MR/Thompson/thompson_index_mr.html
– http://www.nejm.org/doi/full/10.1056/NEJMp2416548
– https://health.ucdavis.edu/internal-medicine/team/42806/angel-desai-infectious-diseases-sacramento-sacramento
– https://www.cdc.gov/one-health/about/index.html
– https://www.epa.gov/pesticides/epa-finalizes-framework-interagency-collaboration-resistance-risks-associated
– https://health.ucdavis.edu/news/headlines/cdc-issues-warning-about-increase-of-drug-resistant-candida-auris-infections/2023/03
References:
Thompson, G. R., Desai, A. Commentary: Addressing Antifungal Drug Resistance — A “One Health–One World” Challenge. New England Journal of Medicine, June 7, 2025. DOI: 10.1056/NEJMp2416548
Keywords: Infectious diseases, Antifungal resistance, One Health, Candida auris, Pesticide regulation, Fungal pathogens, Antimicrobial stewardship, Environmental health
