Article Impact Level: HIGH Data Quality: STRONG Summary of New England Journal of Medicine, 392(22), 2187–2189. https://doi.org/10.1056/NEJMp2416548 Dr. George R. Thompson III et al.
Points
- Infectious disease experts warn that widespread agricultural use of antifungal pesticides is driving the emergence of dangerous, drug-resistant fungal infections that directly threaten human health outcomes.
- They advocate for a coordinated “One Health” approach, recognizing that environmental pesticide application has significant and direct ripple effects on human and animal medical treatments.
- This growing resistance is especially alarming because few effective antifungal medications exist, and their similarity to human cells often results in significant side effects for many patients.
- The authors call for a shared global regulatory process to thoroughly assess cross-resistance potential before any new antimicrobial pesticides are approved for large-scale environmental or agricultural use.
- This situation is compared to how antibiotic overuse in livestock created widespread bacterial resistance, highlighting the urgent need for judicious and proactive management of all antimicrobial agents.
Summary
In a New England Journal of Medicine commentary, Thompson and Desai raise a critical public health concern regarding the link between agricultural fungicide use and the emergence of clinical antifungal resistance. The authors argue that the large-scale environmental application of new antifungal pesticides may inadvertently select resistant fungal strains, mirroring how widespread antibiotic use in livestock has driven antibacterial resistance. They advocate for a coordinated, global “One Health” approach, which recognizes the interconnectedness of human, animal, and environmental health to regulate the development and deployment of all new antimicrobial agents.
The clinical implications of this issue are significant, particularly given the limited armamentarium of effective and low-toxicity antifungal medications available. Fungi and humans share similar cellular structures, making many antifungal agents inherently challenging for patient use. The commentary highlights the rise of difficult-to-treat pathogens like Candida auris as a stark example of the growing threat. This risk is exacerbated by climate change and global travel, which accelerate the geographic spread of resistant fungi, posing a direct threat to human populations worldwide.
To address this, the authors call for a shared, proactive regulatory framework that assesses the potential for cross-resistance in human pathogens before any new antifungal pesticide is approved for widespread use. They note the recent formation of The U.S. Interagency Drug and Pesticide Resistance and Efficacy Workgroup as a promising domestic model but emphasize the need for such oversight on a global scale.
Link to the article: https://www.nejm.org/doi/10.1056/NEJMp2416548
References Thompson, G. R., & Desai, A. N. (2025). Addressing antifungal drug resistance—A “one health–one world” challenge. New England Journal of Medicine, 392(22), 2187–2189. https://doi.org/10.1056/NEJMp2416548
