Experts Warn of Escalating Antifungal Resistance Crisis Amid New Pesticide Use

In a recent commentary published in the New England Journal of Medicine, experts from the University of California, Davis (UC Davis) have issued a stark warning regarding the rising threat of antifungal resistance linked to the increased use of agricultural pesticides. Dr. George Thompson, a professor in the Department of Internal Medicine and the Division of Infectious Diseases at UC Davis, and Dr. Angel Desai, an associate professor in the same department, emphasize the urgent need for a coordinated global approach to tackle this emerging public health crisis.

The use of antifungal agents, or fungicides, is prevalent in both agriculture and medicine. However, the introduction of new pesticides designed to combat harmful fungi in plants may inadvertently contribute to resistance in human and animal populations. As outlined by Dr. Thompson, "Antimicrobial resistant pathogens are a constant reminder for us to use agents judiciously. 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."

The authors highlight the alarming increase in cases of severe fungal infections in humans, such as those caused by Candida auris, a particularly difficult fungus to treat. "Fungi have similar cellular machinery to that of humans, which 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," Dr. Thompson added.

The commentary calls for a 'One Health' approach that recognizes the interconnectedness of human, animal, and environmental health. Dr. Desai notes, "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, especially before any new large-scale environmental and agricultural pesticide use."

The formation of the Interagency Drug and Pesticide Resistance and Efficacy Workgroup by the U.S. Environmental Protection Agency aims to provide insights on upcoming compounds proposed for registration and their potential effects on medical practices. The authors advocate for similar initiatives on a global scale, arguing that coordinated decision-making among national and international regulatory agencies would be cost-effective and could mitigate the risks of widespread resistant pathogens.

In light of these findings, the implications for public health, agriculture, and environmental policy are profound. The increased use of pesticides, while essential for safeguarding crops, must be balanced with the potential long-term consequences for antifungal resistance. Without appropriate regulatory measures and international cooperation, the future of antifungal treatment options could be jeopardized, posing a significant threat to health systems worldwide. The authors stress that immediate action is necessary to prevent a crisis that could compromise the efficacy of existing antifungal treatments and endanger public health.