Basis for Antifungal Prescriptions Among Clinicians in the South of the Democratic Republic of Congo (DR Congo)

Abstract

Background: In sub-Saharan Africa, fungal skin infections are a frequent reason for consultation. In Kolwezi, the lack of medical facilities often leads to empirical treatment. This study aimed to analyze the factors influencing clinicians' therapeutic choices, particularly the use of oral medications.

Methods: A descriptive and analytical cross-sectional study was conducted among clinicians treating patients with cutaneous mycoses (n = 51). Data were collected via patient follow-up forms. Logistic regression analysis was used to identify factors independently associated with the prescription of oral antifungals.

Results: The study population was predominantly pediatric (43.13% under 10 years of age). Humidity (39.22%) and malnutrition (27.45%) were the main contributing factors identified. Diagnosis was exclusively clinical (100%), without recourse to laboratory mycology. Azoles represented the most frequently prescribed class (>40%). Multivariate analysis revealed three major determinants of oral prescription: nail involvement (adjusted OR = 2.7; 95% CI: [1.2–6.1]; p = 0.01), environmental humidity (adjusted OR = 2.4; 95% CI: [1.1–5.3]; p = 0.03), and the pediatric setting (adjusted OR = 2.2; 95% CI: [1.0–4.8]; p = 0.04).

Conclusion: Antifungal prescribing in Kolwezi is largely empirical and heavily influenced by clinical location and environmental factors. This reliance on systemic administration without biological confirmation increases the risk of resistance development. Strengthening local diagnostic capacity (direct examination with potassium hydroxide) is essential to streamline care.