Publications

Artemisinin and its derivatives are the cornerstone of global malaria treatment, primarily through artemisininbased combination therapies (ACTs). These drugs have significantly reduced malaria morbidity and mortality due to their rapid parasite clearance and broad efficacy. However, the emergence of artemisinin resistance, first detected in Southeast Asia, now poses a critical threat to malaria elimination efforts. Resistance is characterized clinically by delayed parasite clearance and is strongly associated with mutations in the Plasmodium falciparum kelch13 (PfK13) gene. Beyond PfK13, multiple genetic loci, biochemical adaptations, and physiological mechanisms contribute to parasite survival under drug pressure. This review synthesizes current knowledge of resistance mechanisms, geographical spread, clinical implications, and strategies to mitigate the threat. Effective containment will require continued molecular surveillance, novel therapeutic development, and integrated malaria control strategies.