Fullerene derivatives have gained attention as potential photosensitizers for photodynamic inactivation of microorganisms. Modifying the carbon cage of C60 fullerenes with various functional groups enhances their performance in biological environments. When activated by white light, these compounds efficiently generate reactive oxygen species that cause cellular damage. Studies have demonstrated that positively charged fullerenes are highly potent photosensitizers with broad-spectrum antimicrobial properties against pathogens. In these compounds, the hydrophobic nature of the C60 structure promotes membrane penetration, while the cationic groups strengthen interactions with microbial cells, significantly enhancing their antimicrobial efficacy. Furthermore, covalently attaching light-harvesting antenna structures to fullerene C60 extends their absorption into the visible spectrum. In these systems, the fullerenes act as spin converters through an efficient intersystem crossing. Fullerene derivatives have also been proposed for the development of photodynamic materials, nanocomposites, and polymers with diverse applications aimed at achieving aseptic conditions to prevent microbial contamination. Therefore, this chapter highlights the advances in fullerene derivatives specifically designed to optimize photodynamic inactivation of pathogens.