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. 2021 May 11;11:9946. doi: 10.1038/s41598-021-89295-0

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© The Author(s) 2021

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

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In vitro IC₅₀ of pyrimethamine and sulfadoxine in relation to individual dhfr-dhps genotype: Here PYR and SDX respectively stand for “pyrimethamine, and sulfadoxine.” The blue line (corresponding to 2000 nM of PYR) represented the in vitro PYR resistance, while the red line (corresponding to 3000 nM of SDX) represented the in vitro SDX resistance. We observed prevalence of SP resistant parasites. The isolates presenting triple dhfr and dhps mutation (AIRNI-SGKGT; ANRNI-SGKGT) and double dhfr and dhps combination mutation (AICNI-AGKAA) represented very high IC₅₀ for pyrimethamine and sulfadoxine and proved to be highly resistant to PYR and SDX (P < 0.01). Isolates contained ANRNI-AGKAA, AICNI-SGKAA, and ANRNI-AAKAA mutations exhibited moderate to high IC₅₀ for pyrimethamine and sulfadoxine but never connected with recrudescence (P = 0.73). Pyrimethamine sensitive and sulfadoxine resistant 3D7 strain was used as a control strain.