Antifungal Exposure and Resistance Development: Defining Minimal Selective Antifungal Concentrations and Testing Methodologies

This scoping review aims to summarise the current understanding of selection for antifungal resistance (AFR) and compare contrast this with antibacterial resistance, which has received more research attention. AFR is an emerging global threat human health, associated high mortality rates, absence effective surveillance systems few alternative treatment options available. Clinical well documented, additional settings increasingly being recognised play a role in evolution spread AFR. The environment, example, harbours diverse fungal communities that are regularly exposed micropollutants, potentially increasing risk. direct application effect concentrations azole fungicides agricultural crops incomplete removal pharmaceutical antifungals wastewater particular concern. Currently, environmental risk assessment (ERA) guidelines do not require agents terms their ability drive development, there no established experimental tools determine selective concentrations. Without data interpret antifungals, our effectively inform safe thresholds severely limited. In review, potential methods generate concentration proposed, informed by approaches used minimal Such can be considered development regulatory aim reduce