**2. Drug resistance**

The greatest challenge to malaria control and eradication is the emergence of malaria parasites that are resistant to antimalarial drugs.[13] The reemergence of malaria from the areas where it was eradicated and spread of malaria to new areas is a major threat. The World Health Organization defined antimalarial drug resistance as the "ability of a parasite strain to survive and/or multiply despite the administration and absorption of a drug given in doses equal to or higher than those usually recommended but within tolerance of the subject."[14] It was modified later to specify that the drug in question must "gain access to the parasite or the infected red blood cell for the duration of the time necessary for its normal action."[15] Antimalarial drug resistance occurs through spontaneous mutations that reduces the sensi‐ tivity to a given class of drug(s).[16] Only a single point mutation is sufficient to confer resistance to some drugs, while multiple mutations appear to be required for others.


**Table 1.** Status of resistance in antimalarial drugs.

The malaria parasite has developed some level of resistance against nearly all previous generation antimalarial drugs (Table 1). Recent research has confirmed evidence of artemisinin resistance.[10] Although it is under investigation, immediate actions are needed to restrict resistance to artemisinin from spreading to new areas. It is high time that we should fight this overwhelming menace with improved tools to aim at controlling the mosquito vector and develop new armaments; otherwise, the future looks bleak and grim.
