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. 2018 Jul 3;9:1351. doi: 10.3389/fmicb.2018.01351

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Copyright © 2018 de Oliveira Santos, Vasconcelos, Lopes, de Sousa Cartágenes, Filho, do Nascimento, Ramos, Pires, de Andrade, Rocha and de Andrade Monteiro.

This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

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Different mechanisms of multidrug resistance adopted by fungal cells. The main mechanisms of drug resistance against azoles, polyenes, echinocandins, and flucytosine include: (a) alteration of the enzyme target (genes encoding ergosterol biosynthetic pathway enzymes – AZOLES, glucan synthases – ECHINOCANDINS, cytosine deaminase or uracil phosphoribosyltransferase – FLUCYTOSINE) leading to poor binding of toxic drugs to its enzyme target sites, (b) overexpression of drug efflux proteins leading to increased efflux – AZOLES, (c) changes in membrane property/composition affecting normal drug import – FLUCYTOSINE, (d) Reduction of sterols in plasma membrane – POLYENES. Colored balls mean antifungal molecules.