The rapid evolvement of fungal resistance to therapeutic agents merits a thorough understanding of the molecular and genetic basis of this deleterious phenomenon. Accumulating efforts expanded our understanding of potential resistance mechanisms that fungi utilize to combat Antifungal therapy like modification of biological targets, gene overexpression, efflux pumps, and regulation of transcriptional factors in response to stress and biofilm formation. The tremendous genomic plasticity of fungi added to the involvement of a multitude of molecular resistance determinants and the paucity of novel targets for therapy mandate utilizing innovative approaches to therapy in parallel to relentless research to develop effective antifungal agents surmounting rapidly increasing resistance. In this chapter, we illustrate a myriad of resistance mechanisms along with other relevant topics like the mechanism of action of antifungal classes, laboratory methods for detecting resistance, clinical susceptibility testing and future insights.
Keywords: Allylamines, Antifungal agents, Azoles, Echinocandins, Fungal resistance, Nucleoside Analogues, Polyenes.