The first signs of trouble were subtle. Several patients living near the Thai-Cambodia border had received first-line malaria treatment of artemisinin-combination therapy (ACT), but failed to clear the Plasmodium parasites from their blood. Their doctors were flummoxed. "There were these sentinel sites reporting reduced efficacy of ACTs," recalls Arjen Dondorp, deputy director of the Mahidol-Oxford Tropical Research Unit in Bangkok. Dondorp and his colleagues suspected drug resistance. "But it was always uncertain, and could potentially be ascribed to the drugs not being taken properly or underdosed." In 2006, they started to investigate the likelihood of ACT resistance more thoroughly.
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