Resistance to Antimalarial Monotherapy Is Cyclic

Rachel Weitzman, Ortal Calfon-Peretz, Trishna Saha, Naamah Bloch, Karin Ben Zaken, Avi Rosenfeld, Moshe Amitay, Abraham O. Samson

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


Malaria is a prevalent parasitic disease that is estimated to kill between one and two million people—mostly children—every year. Here, we query PubMed for malaria drug resistance and plot the yearly citations of 14 common antimalarials. Remarkably, most antimalarial drugs display cyclic resistance patterns, rising and falling over four decades. The antimalarial drugs that exhibit cyclic resistance are quinine, chloroquine, mefloquine, amodiaquine, artesunate, artemether, sulfadoxine, doxycycline, halofantrine, piperaquine, pyrimethamine, atovaquone, artemisinin, and dihydroartemisinin. Exceptionally, the resistance of the two latter drugs can also correlate with a linear rise. Our predicted antimalarial drug resistance is consistent with clinical data reported by the Worldwide Antimalarial Resistance Network (WWARN) and validates our methodology. Notably, the cyclical resistance suggests that most antimalarial drugs are sustainable in the end. Furthermore, cyclic resistance is clinically relevant and discourages routine monotherapy, in particular, while resistance is on the rise. Finally, cyclic resistance encourages the combination of antimalarial drugs at distinct phases of resistance.

Original languageEnglish
Article number781
JournalJournal of Clinical Medicine
Issue number3
StatePublished - 31 Jan 2022

Bibliographical note

Publisher Copyright:
© 2022 by the authors. Licensee MDPI, Basel, Switzerland.


Funding: We thank the Ginsberg Foundation and the Katz Foundation (grant to AOS) for funding this study.

FundersFunder number
Ginsberg Foundation
Jerold B. Katz Foundation


    • Antibiotic resistance
    • Antimalarial resistance
    • Drug of choice
    • Drug resistance
    • Health policy
    • Malaria
    • Parasitology
    • Plasmodium
    • Plasmodium falciparum
    • Plasmodium vivax
    • Text-mining


    Dive into the research topics of 'Resistance to Antimalarial Monotherapy Is Cyclic'. Together they form a unique fingerprint.

    Cite this