To evaluate the prescribing pattern of anti-malarial drug and to assess the adherence of anti-malarial drugs prescribing according to Guidelines for diagnosis and treatment of malaria in India 2011 and to explore the possibility of development of resistance with anti-malarial drugs.A retrospective, Single-centric study with cases of anti-malarial drugs prescribed in duration of 1 year from Jan-2011 to Dec-2011 at Lions General hospital, Mehsana, Gujarat, India. Data were analyzed with different evaluations. A total of 474 cases were collected including 282 (59.49%) male and 192 (40.51%) female. Out of these 283 (59.70%) were uncomplicated, 115(24.26%) were complicated and 76 (16.04%) were seen of non-malaria prescribed with anti-malarial drugs. Artemisinin Combination Therapy (ACT) was prescribed in 44(7.96%) patients. Artesunate monotherapy were prescribed in 230 (41.59%) patients. Adherence to National Guideline in cases with P. vivax malaria is 71.53% and for pregnant women and with mixed infection is 100%, while non adherence is more than 80% seen in P. falciparum malaria (87.39%) and clinical malaria (84%) cases. Artesunate and Chloroquine were also prescribed in non-malarial patients. Among all the cases IV injection of anti-malarial drugs prescribed were 48.82%. Average drug cost/prescription is INR 123.28 Rs and % drug cost on injection is 87.50%.This study shows the prescribing pattern of anti-malarial drug adherence to National Guideline therapy is low. Inappropriate use of anti-malarial drugs among the patients is very high. So possibility of development of resistance with anti-malarial drugs in the population will rapidly spread and cost of the prescription will burden on the patients. Key Words: Malaria, Anti-malarial drugs, Artesunate, Chloroquine, Drug resistance