Infectious diseases experts raise alarm about antifungal resistance, call for global effort

UC Davis infectious diseases experts George Thompson and Angel Desai are raising the alarm about the role new pesticides can play in building resistance to antifungal medical treatments. In a commentary in the New England Journal of Medicine, they call for a coordinated, global "One Health" approach to developing, testing and using agents to fight pathogens like fungi and bacteria.

Fungal diseases cause huge economic and health burdens. Antifungal agents (fungicides) are widely used in agriculture and medicine to combat their spread. However, developing new compounds to kill harmful fungi in plants (pesticides) may increase fungal resistance to treatments in humans and animals.

"Antimicrobial resistant pathogens are a constant reminder for us to use agents judiciously," Thompson said. "We have learned that the widespread use of antibiotics for livestock resulted in the rapid development of resistance to antibacterials. We have similar concerns regarding the use of antifungals in the environment."

Thompson is the article's lead author. He is a professor at the UC Davis School of Medicine in the Department of Internal Medicine, Division of Infectious Diseases, and the Department of Medical Microbiology and Immunology.

A One Health approach proposes a more holistic view to health. It emphasizes how changes in one area - like human activity, animal health, or the environment - can have ripple effects across all three.

About antifungal resistance

Changes in the climate and the wind patterns can help spread pathogens like fungi. Also, human travelers, migrating animals and the movement of contaminated items can carry pathogens to new areas.

In the last few decades, there has been a rapid increase in fungus types that cause severe infections in humans. One example of difficult-to-treat fungus is Candida auris (C. auris).

"Fungi have similar cellular machinery to that of humans. This is why medications that kill fungi like C. auris often have side effects for people. With few antifungals to choose from during clinical care, preventing resistance is of paramount importance," Thompson explained.

Coordinated pesticide development and use

Resistance to treatments is highly linked to the amount of each agent used, the authors wrote. They called for coordinated global regulation to slow the development of resistance to new antimicrobial agents.

"There is a need for a shared antimicrobial approval process that includes a thorough assessment of potential impacts on the environment and human and animal health. This is especially true before any new large-scale environmental and agricultural pesticide use," Desai said. She is an associate professor in the Department of Internal Medicine.

Their report also noted the foundation of The Interagency Drug and Pesticide Resistance and Efficacy Workgroup, a new entity under The U.S. Environmental Protection Agency. It is tasked with providing input on upcoming compounds proposed for registration, including potential effects on medical practice. The authors said similar efforts are needed on a global scale.

They noted that shared decision-making among national and global regulatory agencies would be cost-effective. It might help avoid the more expensive and riskier prospects of the rapid spread of resistant pathogens.

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