Azoles act on lanosterol 14-alpha demethylase, inhibiting ergosterol synthesis. Resistance to azoles is associated with defects in enzymes on the biosynthetic pathway for ergosterol, or to decreased intracellular concentrations of the drugs. Both impermeability and pumps that remove the drug from the fungal cell have been described. Much work has been done on the pumps, of which there are two main categories, the ABC and MFS transporters. Azole cross-resistance is probably common.
Secondary resistance is common.
Newer antifungals such as echinocandin B analogues, and possibly pradimicins have not yet been thoroughly investigated regarding fungal resistance. Viral resistance To be completed. Vol 4 No 3 pp319-392. Numerous state-of the art articles on antimicrobial resistance in the intensive care unit. WE A fairly good article that focuses on beta lactam resistance.