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<p>Azole antifungals are essential for controlling fungal diseases in medicine, veterinary care and agriculture. However, extensive cross-sector use has accelerated the emergence of resistant fungal pathogens, threatening human health, food security and ecosystem stability. This Review examines the dual role of azoles as life-saving therapeutics and drivers of antifungal resistance. We outline their development, mechanisms of action and applications across sectors, and highlight environmental and evolutionary pressures shaping resistance. Integrating perspectives from microbiology, agriculture and public health, we argue that coordinated One Health stewardship and sustainable antifungal strategies are urgently needed to preserve the efficacy of these critical compounds.</p>

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The dual role of azoles: lifesaving antifungals and drivers of resistance – a One Health perspective

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2026年4月19日

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  • Behrad Roohi,
  • Joel D. A. Tyndall,
  • Thomas Svoboda,
  • Sybren de Hoog,
  • Pedro W. Crous,
  • Brian C. Monk,
  • Birgit Strobl,
  • Annemarie Weissenbacher,
  • Joseph Strauss,
  • Paul E. Verweij,
  • Michaela Lackner

摘要

Azole antifungals are essential for controlling fungal diseases in medicine, veterinary care and agriculture. However, extensive cross-sector use has accelerated the emergence of resistant fungal pathogens, threatening human health, food security and ecosystem stability. This Review examines the dual role of azoles as life-saving therapeutics and drivers of antifungal resistance. We outline their development, mechanisms of action and applications across sectors, and highlight environmental and evolutionary pressures shaping resistance. Integrating perspectives from microbiology, agriculture and public health, we argue that coordinated One Health stewardship and sustainable antifungal strategies are urgently needed to preserve the efficacy of these critical compounds.