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However, resistance in <jats:italic>Plasmodium falciparum<\/jats:italic> to artemisinin-based combinations emerging in the Greater Mekong Sub-region is a major problem hindering malaria elimination. To continuously monitor the potential spread of ACT-resistant parasites, this study assessed the efficacy of artemether-lumefantrine (AL) for falciparum malaria in western Myanmar.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>Ninety-five patients with malaria symptoms from Paletwa Township, Chin State, Myanmar were screened for <jats:italic>P. falciparum<\/jats:italic> infections in 2015. After excluding six patients with a parasite density below 100 or over 150,000\/\u00b5L, 41 <jats:italic>P. falciparum<\/jats:italic> patients were treated with AL and followed for 28\u00a0days. Molecular markers associated with resistance to 4-amino-quinoline drugs (<jats:italic>pfcrt<\/jats:italic> and <jats:italic>pfmdr1<\/jats:italic>), antifolate drugs (<jats:italic>pfdhps<\/jats:italic> and <jats:italic>pfdhfr<\/jats:italic>) and artemisinin (<jats:italic>pfk13<\/jats:italic>) were genotyped to determine the prevalence of mutations associated with anti-malarial drug resistance.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>For the 41 <jats:italic>P. falciparum<\/jats:italic> patients (27 children and 14 adults), the 28-day AL therapeutic efficacy was 100%, but five cases (12.2%) were parasite positive on day 3 by microscopy. For the <jats:italic>pfk13<\/jats:italic> gene, the frequency of NN insert after the position 136 was 100% in the day-3 parasite-positive group as compared to 50.0% in the day-3 parasite-negative group, albeit the difference was not statistically significant (<jats:italic>P\u2009<\/jats:italic>=\u20090.113). The <jats:italic>pfk13<\/jats:italic> K189T mutation (10.0%) was found in Myanmar for the first time. The <jats:italic>pfcrt<\/jats:italic> K76T and A220S mutations were all fixed in the parasite population. In <jats:italic>pfmdr1<\/jats:italic>, the Y184F mutation was present in 23.3% of the parasite population, and found in both day-3 parasite-positive and -negative parasites. The G968A mutation of <jats:italic>pfmdr1<\/jats:italic> gene was first reported in Myanmar. Prevalence of all the mutations in <jats:italic>pfdhfr<\/jats:italic> and <jats:italic>pfdhps<\/jats:italic> genes assessed was over 70%, with the exception of the <jats:italic>pfdhps<\/jats:italic> A581G mutation, which was 3.3%.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>AL remained highly efficacious in western Myanmar. <jats:italic>Pfk13<\/jats:italic> mutations associated with artemisinin resistance were not found. The high prevalence of mutations in <jats:italic>pfcrt<\/jats:italic>, <jats:italic>pfdhfr<\/jats:italic> and <jats:italic>pfdhps<\/jats:italic> suggests high-degree resistance to chloroquine and antifolate drugs. The <jats:italic>pfmdr1<\/jats:italic> N86\/184F\/D1246 haplotype associated with selection by AL in Africa reached\u2009&gt;\u200920% in this study. The detection of\u2009&gt;\u200910% patients who were day-3 parasite-positive after AL treatment emphasizes the necessity of continuously monitoring ACT efficacy in western Myanmar.<\/jats:p>\n<\/jats:sec>","DOI":"10.1186\/s12936-020-03376-5","type":"journal-article","created":{"date-parts":[[2020,8,27]],"date-time":"2020-08-27T14:02:47Z","timestamp":1598536967000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Efficacy of artemether-lumefantrine for treating uncomplicated Plasmodium falciparum cases and molecular surveillance of drug resistance genes in Western Myanmar"],"prefix":"10.1186","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5008-4300","authenticated-orcid":false,"given":"Yanrui","family":"Wu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Myat Thut","family":"Soe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pyae Linn","family":"Aung","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luyi","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weilin","family":"Zeng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lynette","family":"Menezes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhaoqing","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Myat Phone","family":"Kyaw","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liwang","family":"Cui","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2020,8,27]]},"reference":[{"key":"3376_CR1","volume-title":"World malaria report 2019","author":"WHO","year":"2019","unstructured":"WHO. 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