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Journal of Antimicrobial Chemotherapy (2001) 48, 345-350
© 2001 The British Society for Antimicrobial Chemotherapy

Reviews

Antifungal resistance and over-the-counter availability in the UK: a current perspective

Margaret M. T. Hudson*

Medicines Control Agency, Market Towers, 1 Nine Elms Lane, London SW8 5NQ, UK


   Introduction
 
Clinical resistance to antifungal agents was rare until the late 1980s, with only isolated cases in patients with chronic mucocutaneous candidiasis.1,2 The incidence of fungal infections, including resistant infections, has increased during the last 10 years, reflecting increased incidence of immunodeficiency associated with cancer chemotherapy, organ and bone marrow transplantation, and the HIV epidemic.1,3 Although the prevalence of drug resistance in fungi is below that observed in bacteria, many mycologists consider that selective pressure will, over time, lead to more widespread resistance.1

There is considerable knowledge concerning the clinical, biochemical and genetic aspects of resistance to antifungal agents.3,4 However, sample selection and inadequate information regarding denominators limit current epidemiological data. At present, there is no established national surveillance scheme to identify changes in antifungal susceptibility that are clearly linked to over-the-counter (OTC) use. In addition, there are no large-scale epidemiological surveys of the extent of antifungal drug resistance in the . . . [Full Text of this Article]


   Legal basis of classification in the UK
 

   Antifungal agents available without prescription in the UK
 

   Definition and mechanisms of fungal resistance
 

   Controlling resistance
 

   Potential impact of increasing the availability of OTC antifungal agents
 

   Other potential contributions to antifungal resistance
 

   Conclusion
 

   Acknowledgements
 

   Notes
 

   References
 

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