Several classes of antibiotics exert antimalarial activity. The mechanisms of action of antibiotics against malaria parasites have been unclear, and prior studies have led to conflicting results, in part because they studied antibiotics at suprapharmacological concentrations. We examined the antimalarial effects of azithromycin, ciprofloxacin, clindamycin, doxycycline, and rifampin against chloroquine-resistant (W2) and chloroquine-sensitive (3D7) Plasmodium falciparum strains. At clinically relevant concentrations, rifampin killed parasites quickly, preventing them from initiating cell division. In contrast, pharmacological concentrations of azithromycin, ciprofloxacin, clindamycin, and doxycycline were relatively inactive against parasites initially but exerted a delayed death effect, in which the progeny of treated parasites failed to complete erythrocytic development. The drugs that caused delayed death did not alter the distribution of apicoplasts into developing progeny. However, the apicoplasts inherited by the progeny of treated parasites were abnormal. The loss of apicoplast function became apparent as the progeny of antibiotic-treated parasites initiated cell division, with the failure of schizonts to fully mature or for erythrocyte rupture to take place. These findings explain the slow antimalarial action of multiple antibiotics.Malaria, caused by infection with the protozoan parasite Plasmodium falciparum, causes half a billion illnesses and over a million deaths each year, mostly among children (6, 38). Several classes of antibiotics have potent antimalarial effects. Despite relatively slow antimalarial activity, some antibiotics, in particular doxycycline, are used for antimalarial prophylaxis (2) and in combination with more rapidly acting drugs to treat malaria (1). Multiple antibiotics with antimalarial activity at clinically achievable doses exert their antibacterial effects by interfering with targets specific to prokaryotes, including 70S ribosomes (tetracyclines, macrolides, and lincosamides) and prokaryotic RNA polymerases (rifampin) or DNA gyrases (fluoroquinolones) (10). Since plasmodia are eukaryotes, the specific antimalarial mechanisms of these antibiotics have been poorly defined. Previous reports have ascribed activities of antibiotics to action against the plasmodial mitochondrion or an unusual organelle called the apicoplast, which is similar to plant chloroplasts and unique to plasmodia and other apicomplexan parasites (42, 46). However, reconciling these reports has been difficult, due to differences in methodologies and large variations in the concentrations of antibiotics studied (8, 9, 12, 13, 19, 20, 22, 25, 26, 35-37, 44, 45). We recently demonstrated that at clinically relevant concentrations doxycycline specifically disrupted maintenance of the apicoplast during the asexual erythrocytic stages of the P. falciparum life cycle (12). Doxycycline did not block apicoplast segregation but caused nonfunctional apicoplasts to distribute into the progeny of treated parasites, whic...