The Mechanisms of Drug Resistance in Plasmodium Ovale: Treatment Strategies in Malaria

Plasmodium ovale remains the most deadly malaria parasite species, contributing to significant global morbidity and mortality, especially in sub-Saharan Africa and Southeast Asia. Although antimalarial drugs—particularly artemisinin-based combination therapies— have played a vital role in reducing the malaria burden, the emergence and spread of drug- resistant P. Ovale strains now threaten to reverse these gains. This review synthesizes current understanding of the pharmacological actions of key antimalarial drugs and the molecular mechanisms underlying resistance, including genetic mutations, gene amplifications, epigenetic adaptations, and altered drug transport. It also explores advancements in diagnostic and surveillance tools, such as molecular markers, in vitro sensitivity assays, and genomic epidemiology, which are crucial for tracking resistance in real time. Furthermore, the paper discusses promising directions for future research, including the development of novel antimalarials with resistance-breaking potential, the integration of vaccines and transmission-blocking interventions, and the need for strengthened health systems and policy innovation. Addressing P. Ovale drug resistance will require sustained global collaboration, multidisciplinary research, and proactive investment in next-generation strategies to preserve treatment efficacy and advance malaria elimination efforts.