EU agencies are recommending actions the agriculture sector should take toward the more responsible use of azole-based fungicides, due to the risk of Aspergillus becoming azole-resistant, making treatment for human infections less effective.

Supported by the EU Joint Research Center (JRC), the five EU health and environment agencies—the European Food Safety Authority (EFSA), the European Center for Disease Control (ECDC), the European Chemicals Agency (ECHA), the European Environment Agency (EEA), and the European Medicines Agency (EMA)—reviewed how the use of azole substances outside human medicine affects public health. The report highlights that the broad use of azole substances outside human medicine, particularly in agriculture, contributes to the risk of Aspergillus becoming azole-resistant, which would render treatment of aspergillosis less effective.

Azole medicines are essential for treating aspergillosis, a serious infection caused by Aspergillus fungi. However, these fungi are increasingly becoming resistant to azole therapies, making treatment less effective. Additionally, azole substances are widely used as plant protection products to control fungal diseases in agriculture.

Data collected from European countries between 2010 and 2021 indicate that plant protection products account for most of the reported azole sales across all sectors. In EU agriculture, an important contributor to azole resistance includes stockpiled agricultural waste used to improve and fertilize soil for crops like indoor growing fruiting vegetables, wine grapes, maize, sugar beets, olives, pome fruit, citrus fruit, and field heaps.

Taking a One Health approach to preventing the rise in azole resistance, the five EU agencies recommended actions across sectors:

• Adding new, specific requirements for the approval and authorization processes for azole fungicides
• Supporting research into and development of new fungicides with innovative mechanisms of action that do not lead to resistance to antifungal medicines used in human treatments
• Following good agricultural and horticultural practices, properly storing organic waste, managing waste effectively, and using and disposing azole-treated products responsibly
• Collecting more data on the uses of azole-based fungicides and of azole-based antifungals
• Further developing specific technical guidance and risk assessment methodologies to support regulatory decisions on the approval of azole substances and to mitigate the risk of azole resistance in Aspergillus
• Conducting further research to address existing uncertainties.

In agriculture, the report emphasized the importance of the thoughtful use of azole fungicides, promoting best practices for waste management and soil fertilization, as well as further research.