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The expert review of antifungal drug resistance mechanisms by Pemán, Cantón and Espinel-Ingroff [1] is an extremely useful and succinct reference for many agents. While it is impossible to delve into every antifungal agent and their mechanism of action, there was a rather important omission from the azole class. Miconazole, as one of the first available imidazole agents, has been used for over 30 years for the treatment of fungal infections [2,3]. While intravenous miconazole is no longer available for systemic use, other formulations are widely used for many common infections [4,5]. Miconazole is unique among azoles in that it has a dual mechanism of action [6]. Like all azoles, miconazole inhibits lanosterol demethylase, thereby inhibiting ergosterol synthesis. In addition, miconazole increases intracellular reactive oxygen species, at least in part through inhibition of fungal catalase and peroxidase [6,7]. This is probably the basis for the fungicidal activity of miconazole, whereas other azoles are fungistatic [6]. Miconazole also exhibits activity against a wide range of species including