Resistance to antimalarial drugs: An endless world war against Plasmodium that we risk losing

•This review describes the ‘state of the art’ of Plasmodium falciparum resistance to the main antimalarial drugs.•Particular emphasis has been placed on the emergence of artemisinin resistance in Southeast Asia.•A brief note on what happens in Plasmodium vivax is also discussed.

The objective of this review was to describe the ‘state of the art’ of Plasmodium falciparum resistance to the main antimalarial drugs. A brief note on Plasmodium vivax is also included. Resistance of P. falciparum to the various antimalarials has a long history of hits and misses. During the last 60 years, the pace at which this parasite has developed resistance to antimalarial drugs has exceeded the pace at which new drugs have been developed. In the last decade, the introduction of artemisinin-based combination therapies (ACTs) as a first-line drug treatment for non-complicated P. falciparum malaria had led to extraordinary results in disease control, especially in sub-Saharan Africa. However, the emergence and spread of resistance to artemisinin in Southeast Asia jeopardise these results. In conclusion, the possible spread of artemisinin resistance in Africa should be considered as an epochal disaster.