Antifungal drug resistance: limited data, dramatic impact?

As the clinical use of antifungal agents continues to grow, the spectre of antifungal drug resistance inevitably emerges. This has been most evident with the extensive prescription of fluconazole in HIV-positive patients. In other settings, there has also been concern over changing patterns in the epidemiology of Candida infections related to fluconazole use. There have been some observations on how new antifungals such as voriconazole and caspofungin are impacting the shift in pathogens and drug resistance. For lipid formulations of amphotericin B, drug resistance is uncommon. Although antifungal drug susceptibility tests for Candida spp. are becoming increasingly standardized, there are limited data that confirm a link between in vitro resistance and treatment failure. Hence, more evidence-based data are needed. This paper examines some of the data on antifungal resistance and briefly explores suitable clinical management strategies for treating fungal infections.