Abstract: Background: Along with the discovery of falciparum malaria resistance to treatment with artemisinin in the Greater Mekong Subregion, here, in Pesawaran, a small district in the province of Lampung, Indonesia the failure of malaria treatment with artemisinin-based combination therapies has also found. To determine whether there has been a resistance of Plasmodium falciparum to artemisinin-based combination therapies (ACTs) in the above mentioned district, this study was conducted using dihydroartemisinin-piperaquine (DHP). Materials and Methods: By using inclusive criteria, namely a new falciparum malaria patient with the fever symptoms (>38°C) for more than 2 days with or without chills, aged more than 1 year, the patient or parent/guardian willing to provide informed consent, there were 52 patients participated in the study. Type and density of parasites were determined by microscopic examination of thin and thick smears of patients blood samples. The malarial clinical symptoms and falciparum parasitemia were examined before (day 0) and after (day 1, 2, 3, 7, 14 and 28) DHP treatment. Results: Fever is the only symptom experienced by all (100%) patients, followed by headaches (98.08%), chills (94.23%), myalgia (84.62%), nausea and vomiting (78.85%), diarrhea (25%), impaired consiousness (7.69%) and seizures (3.85%). Asexual parasitaemia counts ranged 196-210880 μL–1. Impaired consciousness was experienced by patients with a parasitaemia count of more than 40,000 μL–1, while seizures experienced only by the patients with parasitaemia count of more than 100,000 μL–1. No significant correlation between patient age and clinical symptom as well as parasite counts and neither between the total of symptomatic types and gametocyte counts (p<0.05). However, there is a strong positive correlation between asexual parasitaemia counts and the total of symptomatic types (R = 0.5347, p<0.001). The dihydroartemisinin-piperaquine treatment only failed in one (1.92%) among a total of 52 falciparum malaria patients. Conclusion: Severity of falciparum malaria determined by the density of asexual parasitemia, not on the gametocyte counts. Falciparum malaria resistance to artemisinin treatment has not been proven in the disrict of Pesawaran and ACT, particularly dihydroartemisinin-piperaquin, remain effective as an anti falciparum malaria drug.