Antimalarial drug resistance in Africa: the calm before the storm?

Lancet Infect Dis. 2019 Oct;19(10):e338-e351. doi: 10.1016/S1473-3099(19)30261-0. Epub 2019 Jul 30.


Antimalarial drug resistance, in particular resistance to Plasmodium falciparum, challenges the treatment and control of malaria. In this Review, we summarise evolving patterns of antimalarial drug resistance in Africa. Resistance to aminoquinolines and antifolates is long-standing, yet with greatly decreased use of chloroquine to treat malaria, the prevalence of resistance to chloroquine has decreased. Resistance to antifolates, which are used to prevent malaria in some settings, remains widespread. Resistance to artemisinin-based combination therapies, the standard treatments for malaria in Africa, has emerged in southeast Asia. At present, resistance to artemisinins or key partner drugs included in combination therapies does not appear to be a substantial problem in Africa. However, emergence of resistance to artemisinin-based combination therapies in Africa would probably have devastating consequences, and continued surveillance for the emergence of resistance on this continent is a high priority.

Publication types

  • Research Support, N.I.H., Extramural
  • Review

MeSH terms

  • Africa South of the Sahara / epidemiology
  • Antimalarials / therapeutic use*
  • Artemisinins / therapeutic use
  • Child
  • Drug Resistance, Microbial*
  • Drug Therapy, Combination
  • Humans
  • Incidence
  • Malaria, Falciparum / drug therapy*
  • Malaria, Falciparum / epidemiology*
  • Malaria, Falciparum / parasitology
  • Plasmodium falciparum / drug effects*
  • Treatment Outcome


  • Antimalarials
  • Artemisinins
  • artemisinine