Words matter. Especially when they have life and death meanings. Take the term “antimicrobial resistance” for example. Widespread efforts have been made from intergovernmental agency to grassroots levels since the O’Neill Reports on AMR in 2014 to raise awareness of AMR as a credible threat that needs to be managed proactively if we are to defend the healthcare gains that we have made over the years.
The label “AMR” is however, not always understood in the same way by everybody. “AMR” has often been interpreted to refer only to bacterial infections, the antibiotics used to treat these infections and bacterial resistance to these antibiotic treatments. Fungal infections and resistance to antifungal treatments occur as frequently, are as debilitating but are often not included under the banner of “AMR” in people’s thinking.
This creates a challenge when managing human and animal health, but also more broadly when considering production of sufficient, safe and nutritious food, and when funding and resources are created and distributed. Conservative estimates would suggest that antifungal resistance (AFR) is at least as large a challenge as antibiotic resistance (ABR):
- Fungal pathogens’ abilities to adapt and evolve are less well understood than is the case for bacteria;
- Dual use of the same antifungal substances for both healthcare purposes and for protection of crops and other plants in food production speeds up the development of resistance by fungi to these antifungals;
- The pipeline of new antifungal treatments is significantly smaller than that of new antibiotics and antibacterial treatments;
- The antifungal armoury includes significantly fewer mechanisms of action than is the case for the antibacterial armoury. This amplifies the effect on treatment options should any one the therapeutic classes lose efficacy;
- Funding for antifungal R&D is even more difficult to come by than funding for antibacterial R&D;
- As is the case with bacterial infections, externalities such as climate change and conflict situations are exacerbating the development of AMR.
Michael Graz will be sharing some thoughts about early-stage development of a promising antifungal treatment with a new mechanism of action against Candida species at #Microbio25, the Microbiology Society’s Annual Conference 2025 on 2 April. Candida species make up approximately half of the fungal priority pathogens that on the WHO’s (2022) Critical- and High-priority lists and are one of the most prolific causes of fungal disease. We are looking forward to the discussion around managing emerging antifungal resistance trends and to meeting you in person if you are at the conference.
