Potential Strategies to Control the Risk of Antifungal Resistance in Humans: A Comprehensive Review

Abstract

Fungal infections are becoming one of the main causes of morbidity and mortality in people with weakened immune systems. Mycoses are becoming more common, despite greater knowledge and better treatment methods, due to the regular emergence of resistance to the antifungal medications used in clinical settings. Antifungal therapy is the mainstay of patient management for acute and chronic mycoses. However, the limited availability of antifungal drug classes limits the range of available treatments. Additionally, several drawbacks to treating mycoses include unfavourable side effects, a limited activity spectrum, a paucity of targets, and fungal resistance, all of which continue to be significant issues in developing antifungal drugs. The emergence of antifungal drug resistance has eliminated accessible drug classes as treatment choices, which significantly compromises the clinical management of fungal illnesses. In some situations, the emergence of strains resistant to many antifungal medications is a major concern. Although new medications have been developed to address this issue, antifungal drug resistance has grown more pronounced, particularly in patients who need long-term care or are undergoing antifungal prophylaxis. Moreover, the mechanisms that cause resistance must be well understood, including modifications in drug target affinities and abundances, along with biofilms and efflux pumps that diminish intracellular drug levels, to find novel antifungal drugs and drug targets. In this review, different classes of antifungal agents, and their resistance mechanisms, have been discussed. The latter part of the review focuses on the strategies by which we can overcome this serious issue of antifungal resistance in humans.

Antifungal resistance and stewardship: a call to action in Zambia

“…Antifungal Resistance (AFR) is a public health problem, that occurs when fungi develop resistance to antifungal drugs [ 3 ]. This phenomenon has been exacerbated by the often inappropriate use and misuse of antifungals in treating fungal infections [ 6 ]. Notably, these antifungals are prescribed empirically, and in most cases obtained without using prescriptions.…”

Metal Nanomaterials and Hydrolytic Enzyme-Based Formulations for Improved Antifungal Activity

“…The accumulation of information about the role that microscopic fungi can play in the development of a number of negative processes affecting human health [1][2][3] has led to increasing interest in antifungals that can control and reduce the growth, as well as the metabolic activity, of these biological objects, especially those associated with pathogens [4]. The seriousness of these tasks is increasing due to the fact that in some cases, fungal cells may develop resistance to the chemical formulations used against them [5][6][7].…”

“…A number of current scientific studies are related to the development of effective antifungals [8]. Among the new trends in the development of effective antifungals, the prospects of a possible combination of various chemical compounds [7] with different mechanisms of action on fungal cells are being considered. This approach can enable researchers to overcome the development of adaptive processes in fungi and, possibly, reduce the doses of the substances used, increasing the effectiveness of their action in such combinations.…”

Antifungal resistance and stewardship: a knowledge, attitudes and practices survey among pharmacy students at the University of Zambia; findings and implications

“… 60 , 62 , 63 This is essential with sustainable antifungal stewardship programmes (AFSPs) needing to be developed and promoted globally to reduce AFR. 17 , 23 , 64–69 …”