Insecticide Resistance Management for Mosquito Control: Mechanisms, Evidence, and Future Challenges.

Insecticide resistance threatens the durability of mosquito control. Extending the effective life span of available insecticides is therefore a key challenge. Resistance management strategies (RMS) have been proposed and incorporated into policy guidance, yet their relative effectiveness remains poorly resolved. This review synthesizes the theoretical and empirical evidence for major RMS: mixtures, rotations, mosaics, high-dose/refuge, dose moderation, and release of susceptible males. Among these RMS, mixtures currently have the strongest support, with models consistently predicting delayed resistance evolution. Evidence for rotations is more limited and context dependent, while support for other strategies remains sparse or largely theoretical in mosquito systems. Many recommendations in current resistance management frameworks remain grounded more strongly in theory than in empirical evidence. Moreover, operational implementation is complicated by heterogeneous exposure, multiple sources of insecticide selection, and logistical constraints. As new insecticides enter operational use, empirical evidence and field-realistic models are urgently needed to guide their deployment and long-term protection.