[Correspondence] Emergence of Plasmodium falciparum triple mutant in Cambodia

We share Mallika Imwong and colleagues'1 concern regarding the spread of single-fit multidrug-resistant Plasmodium falciparum malaria parasites along the borders of Cambodia—ie, to Thailand, Laos, and Vietnam. In 2016, in Cambodia, artesunate-mefloquine (ASMQ) replaced dihydroartemisinin-piperaquine (DHA-PPQ) as the first-line treatment for uncomplicated P falciparum malaria. The rationale for this combination relies on evidence that parasites carrying markers of resistance both to artemisinin (pfKelch13-580Y mutant) and piperaquine (later associated with the amplification of pfplasmepsin2)3,4 have regained susceptibility to mefloquine (low in vitro IC50 [half maximal inhibitory concentration] values and the single-copy pfmdr1, the amplification of which has been associated with mefloquine resistance).

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