Antifungal resistance

Rates of serious, invasive fungal disease are increasing globally and the antifungal medicines needed to treat these infections are becoming less effective.

There are limited treatment options for serious fungal infections, and the World Health Organization (WHO) says there is a “critical lack” of new diagnostic tools and medicines for fungal disease. On 30 June 2026, WHO published a blueprint to help countries respond to the increasing burden of fungal disease and antifungal resistance.

What is antifungal resistance?

Antifungal resistance happens when fungal infections stop responding to antifungal medicines. Like other forms of antimicrobial resistance, antifungal resistance is a natural phenomenon driven by fungi adapting to their environment.

Some fungi have inherent, or primary resistance, to existing antifungal medicines. However, exposure to antifungal medicines and agricultural fungicides has accelerated the emergence of resistant strains of fungi that can cause disease in humans, animals and plants.

‘Dual use’ antifungal agents, like azoles, are used in both agriculture and human medicine. Agricultural use involves spraying azoles across wide areas, reaching large populations of fungi, which can lead to the development of azole-resistant fungal spores that spread in the environment. If drug-resistant spores are inhaled by people, they can cause infections which are resistant to azole antifungal medicines.

Why does antifungal resistance matter?

Antifungal resistance can have a serious effect on human health. Common fungal infections like ringworm, athlete’s foot and thrush do not pose serious health concerns for most people. However, people with weakened immune systems are at risk of serious, invasive fungal infections that affect the body’s internal organs and can lead to serious illness and death. These infections are currently very difficult to treat.

Research published in the medical journal The Lancet Infectious Diseases estimates that there are around 6.5 million serious, invasive fungal infections globally each year, causing 2.5 million deaths. Researchers forecast that fungal infections will increase further because of climate change, as warmer temperatures drive fungal adaptation and spread.

Drug-resistant fungi that can cause serious infections include:

• Aspergillus fumigatus: a mould that can cause a serious lung infection called aspergillosis
• Candida: a yeast that can live harmlessly on the skin and inside the body, but can cause a serious infection if it enters body tissues (invasive candidiasis) or the bloodstream (candidemia).

Fungal infections also affect plant and animal health. Fungal infections can damage food crops, and there is increasing concern that widespread use of antifungal agents to treat crops is leading to increased resistance.

Is antifungal resistance increasing?

Accumulating evidence suggests that yes, antifungal resistance is increasing. New variants of fungi that have evolved resistance have been identified, as well as entirely new species of fungi that are resistant to existing antifungals. In 2022, the WHO published the fungal priority pathogens list, identifying key disease-causing fungi of public health importance.

In England, the UK Health Security Agency (UKHSA) monitors rates of serious fungal infections and antifungal resistance. Its data shows that invasive bloodstream infections (known as fungaemia) caused by yeast are rare but increasing. There were 2,408 laboratory reports in 2025, an increase of 6% compared since 2024, and a 27% increase since 2016.

The UKHSA has highlighted increased rates of some drug-resistant fungal infections, including:

• Candidozyma auris, a multi-drug-resistant fungal pathogen with limited treatment options. Although rates of fungaemia caused by this pathogen remain low overall, UKHSA has identified multiple outbreaks in UK hospitals since 2015. In April 2025 it became a notifiable organism, meaning it must be reported to UKHSA whenever it is detected. In August 2025, the UKHSA published guidance for healthcare organisations about how to prevent and control candidozyma auris infections.
• Trichophyton indotinae, is a drug-resistant pathogen that causes ringworm. It is resistant to some antifungals and requires prolonged treatment.

What about new antifungal medicines?

There are currently only three main types of antifungal medicines: polyenes, azoles and echinocandins. All three can cause significant side effects, especially when used for longer periods, and all three are affected by increasing drug resistance.

According to the WHO, there were 43 new antifungal products in development globally as of 30 September 2024, including 21 medicines being tested in humans. Nine of these products are considered to be ‘novel agents’, including two examples of entirely new types of antifungals. In the past decade, only four new antifungal agents have been approved by the US, EU or Chinese medical regulators.

The WHO says that the pipeline of new antifungal medicines does not currently meet global need for them and that there is an urgent need for more research and development.

There is also concern that the benefit of new antifungal medicines is undermined when the same agents are used in agriculture.

Addressing antifungal resistance

The WHO has described fungal disease and antifungal resistance as “one of global health’s most underestimated and neglected threats”, noting that the issue remains absent from many national health plans and antimicrobial resistance strategies worldwide. In the UK, the national action plan for antimicrobial resistance for 2024 to 2029 recognises the increasing threat of antifungal resistance and the need for more research in this area.

In January 2026, the government reported that the Department of Health and Social Care had provided £12 million of funding over the previous five years for research on fungal infections and antifungal resistance. It also noted that the Department for the Environment, Food and Rural Affairs had co-funded a research programme on transdisciplinary research to tackle antimicrobial resistance.

The government has also reported that the Environment Agency is conducting research on the transmission of antimicrobial resistance in the environment. The agency is responsible for regulating ‘bioaerosol risks’, which includes the risk that fungal spores can be spread from composting facilities and crop residues.

Government-funded research includes the Fungal One Health and Antimicrobial Resistance Network (F1AMR) collaboration, the FAILSAFE project based at the University of Exeter, and a project to improve antifungal therapies based at King’s College London. F1AMR has published a roadmap to understand and mitigate antifungal resistance. They recommend more research, improved surveillance, and better stewardship to enable the “judicious use” of antifungals in agricultural, veterinary and human health settings.