Malaria is a public health issue that can cause death. According to the Indonesian Health Profile, in the year 2010, an estimated 45% of Indonesia’s population live in malaria-endemic areas. Pesawaran District is one of the malaria-endemic areas in Lampung province, whose Annual Parasite Incidence in 2010 and 2011 were 2.77 and 4.76 respectively. One of the factors that may inhibit the malaria control is Plasmodium resistance to antimalarial drugs. This study aims to conduct a mapping study and see the prevalence of ACT treatment failure, in Pesawaran District, Lampung Province, Indonesia. Data collection was performed at the Primary Health Centers (PHC) Hanura. A total of 69 samples according to the inclusion and exclusion criteria, the microscopic examination serially for 28 days was done. Microscopic examination performed on D0, D1, D2, D3, D7, D14, D28, and a complaint is found outside the schedule. Coordinates of patient house, determined using GPS. Based on observations, microscopic examination and spatial analysis, the prevalence of ACT treatment failure in patients with falcipaum malaria was 11.59%. The malaria falcifarum patient spread around the coast, that were near vector breeding places. There were five clusters of malaria falciparum patients and one cluster of malaria falciparum patient with treatment failure that were formed. Only one significant cluster of malaria falciparum patient (P = 0.0027, radius 0 km) is found, while the other cluster is not statistically significant. The cluster of malaria falciparum patient with treatment failure was not statistically significant (P = 1.000, radius 0.15 km), but this cluster is located in the area of the suspected vector breeding place. The cluster formation means that people living within a radius of these clusters have a greater risk to get malaria infection.