Addressing Antifungal Drug Resistance — A 'One Health–One World' Challenge

This Perspective explores the mounting global threat of antifungal drug resistance, underscoring its intertwined impacts on human, animal, and environmental health. Rising temperatures and the expanding use of agricultural fungicides particularly triazole-based compounds like tebuconazole have accelerated the selection of resistant fungal strains such as Aspergillus fumigatus, complicating treatment outcomes. The overlap between clinical and agricultural antifungal agents threatens the efficacy of next-generation therapeutics like olorofim and fosmanogepix. In response, the U.S. EPA, in coordination with CDC, FDA, and USDA, has initiated a new regulatory framework to assess resistance risks when approving new pesticides. This includes the formation of the Interagency Drug and Pesticide Resistance and Efficacy Workgroup (IDPREW). The authors advocate for global adoption of such intersectoral efforts, proposing a "One Health–One World" model to coordinate environmental, veterinary, and human healthcare regulatory bodies. Only with unified decision-making and forward-looking policies can we preserve vital antifungal therapies in an era of growing microbial resilience.

This Perspective explores the mounting global threat of antifungal drug resistance, underscoring its intertwined impacts on human, animal, and environmental health. Rising temperatures and the expanding use of agricultural fungicides particularly triazole-based compounds like tebuconazole have accelerated the selection of resistant fungal strains such as Aspergillus fumigatus, complicating treatment outcomes. The overlap between clinical and agricultural antifungal agents threatens the efficacy of next-generation therapeutics like olorofim and fosmanogepix. In response, the U.S. EPA, in coordination with CDC, FDA, and USDA, has initiated a new regulatory framework to assess resistance risks when approving new pesticides. This includes the formation of the Interagency Drug and Pesticide Resistance and Efficacy Workgroup (IDPREW). The authors advocate for global adoption of such intersectoral efforts, proposing a "One Health–One World" model to coordinate environmental, veterinary, and human healthcare regulatory bodies. Only with unified decision-making and forward-looking policies can we preserve vital antifungal therapies in an era of growing microbial resilience.