He aha ka Amphotericin B Lipid Complex: Nā hoʻohana, ka nui, nā hopena ʻaoʻao a me nā mea hou aku

ʻO ka Amphotericin B lipid complex he lāʻau antifungal ikaika i hāʻawi ʻia ma o ka IV e mālama i nā maʻi fungal koʻikoʻi. Ua hoʻolālā ʻia e ʻoluʻolu i kou mau puʻupaʻa ma mua o ke ʻano kuʻuna o amphotericin B, ʻoiai e pono ana i nā maʻi fungal e hoʻoweliweli ana i ke ola. Hoʻokaʻawale ʻia kēia lāʻau lapaʻau no nā maʻi koʻikoʻi ʻaʻole hiki i nā lāʻau antifungal ʻē aʻe ke mālama pono.

He aha ka Amphotericin B Lipid Complex?

ʻO ka Amphotericin B lipid complex kahi hoʻomākaukau kūikawā o amphotericin B i hui pū ʻia me nā lipids (momona) e palekana ai i kou kino. Kōkua ka uhi lipid i ka pale ʻana i kou mau ʻōpū, ʻoiai kou mau puʻupaʻa, mai nā hopena koʻikoʻi o ka lāʻau lapaʻau ʻoiai e mālama ana i kāna mau waiwai antifungal ikaika.

No kēia lāʻau lapaʻau i kahi papa o nā lāʻau i kapa ʻia ʻo polyene antifungals, a ua manaʻo ʻia ʻo ia kekahi o nā lāʻau antifungal ikaika loa i loaʻa. E kauoha wale kāu kauka i kēia lāʻau lapaʻau ke loaʻa iā ʻoe kahi maʻi fungal koʻikoʻi e hōʻike ana i kahi hoʻoweliweli nui i kou olakino a i ka wā i hana ʻole ai nā lāʻau lapaʻau ʻē aʻe a ʻaʻole kūpono paha no kou kūlana.

No ke aha e hoʻohana ʻia ai ka Amphotericin B Lipid Complex?

Ua kauoha ʻia ka Amphotericin B lipid complex e mālama i nā maʻi fungal koʻikoʻi e hoʻoweliweli ana i ke ola ma kou kino. Hiki ke loaʻa kēia mau maʻi i ka poʻe me nā ʻōnaehana pale nāwaliwali, e like me ka poʻe e hele ana i ka mālama ʻana i ka maʻi kanesa, nā mea loaʻa i ka transplant organ, a i ʻole nā ​​kānaka me kekahi mau maʻi maʻi.

He mea pono loa ka lāʻau lapaʻau i nā ʻano maʻi fungal koʻikoʻi e hiki ke hoʻopilikia i nā ʻāpana like ʻole o kou kino. Eia nā kūlana nui e mālama ai:

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• Aspergillosis: He maʻi i ka māmā i hana ʻia e nā haʻiki Aspergillus i hiki ke laha i nā ʻōkana ʻē aʻe
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• Candidemia: He maʻi i ke kahe koko i hana ʻia e nā hū Candida
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• Invasive candidiasis: Nā maʻi Candida e laha ana i nā ʻōkana o loko
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• Nā maʻi Cryptococcal: ʻOi loa ka poʻe e pili ana i ka lolo a me ka ʻōnaehana nūnū
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• Mucormycosis: He maʻi laha ʻole akā ikaika e hiki ke hoʻopili i nā sinuses, nā māmā, a i ʻole ka lolo
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• Histoplasmosis: He maʻi systemic e hiki ke hoʻopili i nā ʻōkana he nui
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E koho maʻamau kāu hui mālama ola i kēia lāʻau lapaʻau ke ʻaʻole lawa ka ikaika o nā lāʻau antifungal waha maʻamau a i ʻole ke laha nui ka maʻi i loko o kou kino.

Pehea e hana ai ka Amphotericin B Lipid Complex?

Hana ka Amphotericin B lipid complex ma ka hoʻouka ʻana i nā paia o nā cell o nā haʻiki, e luku ana iā lākou mai waho mai. Hoʻopaʻa ka lāʻau lapaʻau i kahi mea kikoʻī i kapa ʻia ʻo ergosterol i loaʻa i nā membrane cell fungal akā ʻaʻole i nā cell kanaka, e kōkua ana i ka pepehi ʻana i nā haʻiki me ka mālama ʻana i kou mau ʻiʻo olakino.

Ua manaʻo ʻia he lāʻau antifungal ikaika loa kēia, i kapa pinepine ʻia ʻo ka

Hāʻawi mau ʻia ka amphotericin B lipid complex ma ke ʻano he intravenous (IV) infusion ma kahi haukapila a i ʻole kahi keʻena lapaʻau kūikawā. ʻAʻole hiki iā ʻoe ke lawe i kēia lāʻau lapaʻau ma ka waha, a pono e nānā pono ʻia e nā poʻe loea mālama ola i ke kaʻina hana lapaʻau.

Ma mua o kēlā me kēia infusion, e hāʻawi paha kāu hui lapaʻau iā ʻoe i nā lāʻau lapaʻau e kōkua i ka pale ʻana i nā hopena infusion. Hiki i kēia mau mea ke komo i nā antihistamines, nā mea hoʻemi wela, a i ʻole nā lāʻau anti-nausea. ʻO ka infusion ponoʻī e lawe maʻamau i 2 a 4 mau hola, a pono ʻoe e noho i loko o ke keʻena lapaʻau i kēia manawa i hiki i nā limahana ke nānā iā ʻoe no nā hopena maikaʻi ʻole.

E hoʻokumu kāu hui mālama ola i ke komo ʻana o IV ma o ka vein peripheral a i ʻole ka laina waena, ma muli o kāu kūlana kikoʻī a me ka lōʻihi o ka lapaʻau i hoʻolālā ʻia. E nānā lākou i kāu mau hōʻailona ola i nā manawa maʻamau i ka wā o ka infusion a nānā i nā hōʻailona o nā hopena maʻi a i ʻole nā pilikia ʻē aʻe.

ʻAʻole pono ʻoe e hopohopo e pili ana i nā kapu meaʻai me kēia lāʻau lapaʻau no ka mea e hāʻawi pololei ʻia i loko o kou kahe koko. Eia naʻe, hiki i ka noho ʻana i ka wai maikaʻi ma mua a ma hope o ka lapaʻau ke kōkua i ke kākoʻo ʻana i kāu hana kīkī i ka wā o ka therapy.

Pehea ka lōʻihi e lawe ai au i ka Amphotericin B Lipid Complex?

ʻOkoʻa nui ka lōʻihi o ka lapaʻau ʻana me ka amphotericin B lipid complex ma muli o ke ʻano a me ke koʻikoʻi o kāu maʻi fungal. ʻO ka hapa nui o nā papa lapaʻau e mau ana mai kekahi mau pule a i kekahi mau mahina, me kekahi poʻe maʻi e koi ana i ka lapaʻau no ka lōʻihi o 6 mahina a ʻoi aku paha i nā hihia koʻikoʻi.

E hoʻoholo kāu kauka i ka lōʻihi o ka lapaʻau ʻana ma muli o nā kumu he nui, me ka maikaʻi o kāu pane ʻana i ka lāʻau lapaʻau, nā hopena o nā hoʻokolohua aʻe, a me kou kūlana olakino holoʻokoʻa. E nānā mau lākou i kāu holomua ma o nā hoʻokolohua koko, nā haʻawina kiʻi, a me nā loiloi lapaʻau e hoʻoholo ai i ka wā e palekana ai ke hooki i ka lapaʻau.

No nā maʻi kekahi, e like me ka maʻi meningitis cryptococcal, pono paha ʻoe i kahi mālama ikaika mua a laila e hahai ʻia e kahi manawa mālama lōʻihi me kahi lāʻau antifungal ʻokoʻa. E hana kāu hui mālama ola i kahi hoʻolālā lapaʻau pilikino e kaulike ana i ka pono me ka hōʻemi ʻana i nā hopena ʻaoʻao.

He mea nui e hoʻopau i ka papa lapaʻau holoʻokoʻa ʻoiai inā hoʻomaka ʻoe e ʻoi aku ka maikaʻi, no ka mea, ʻo ka hoʻōki ʻana i ka wā mua hiki ke ʻae i ka maʻi e hoʻi mai a lilo paha i mea paʻakikī ke mālama.

He aha nā hopena ʻaoʻao o Amphotericin B Lipid Complex?

E like me nā lāʻau ikaika a pau, hiki i ka amphotericin B lipid complex ke hoʻoulu i nā hopena ʻaoʻao, ʻoiai ʻoi aku ka maikaʻi o ka hoʻohana ʻana i ka lipid ma mua o ka amphotericin B maʻamau. ʻO ka hapa nui o nā kānaka e ʻike i kekahi mau hopena ʻaoʻao i ka wā o ka mālama ʻana, akā ʻaʻole maʻamau nā pilikia koʻikoʻi me kēia hoʻohana.

Eia nā hopena ʻaoʻao maʻamau e ʻike ai ʻoe i ka wā o ka mālama ʻana:

• Nā hopena e pili ana i ka hoʻokomo ʻana: ʻO ke kuni, nā anu, ka nausea, a i ʻole ke poʻo i ka wā a i ʻole ma hope koke o ka hoʻokomo ʻana i ka IV
• Nā loli hana o ka puʻupaʻa: Hoʻonui manawa i nā pae creatinine, ʻoiai ʻaʻole ʻoi aku ka koʻikoʻi ma mua o ka amphotericin B maʻamau
• Nā kaulike ʻole o ka electrolyte: Nā pae potassium a i ʻole magnesium haʻahaʻa e pono ai ka hoʻohui
• Luhi a me ka nāwaliwali: ʻO ka manaʻo luhi a i ʻole ka liʻiliʻi o ka ikehu ma mua o ka maʻamau
• Nā pilikia digestive: Nausea, luaʻi, a i ʻole ka nalowale o ka ʻai
• Nā hopena ʻili: ʻO ka ʻulaʻula a i ʻole ka ʻili ʻana ma ke kahua hoʻokomo

ʻAʻole maʻamau akā ʻoi aku ka koʻikoʻi o nā hopena ʻaoʻao e hiki ke komo i nā pilikia puʻupaʻa koʻikoʻi, nā hopena maʻi maʻi koʻikoʻi, a i ʻole nā ​​mea ʻino o ka puʻuwai. E nānā pono kāu hui mālama ola iā ʻoe no kēia mau pilikia hiki ke hana ma o nā hoʻokolohua koko maʻamau a me nā loiloi lapaʻau.

Hiki ke mālama ʻia ka hapa nui o nā hopena ʻaoʻao e pili ana i ka hoʻokomo ʻana me nā lāʻau lapaʻau ma mua a me ka hoʻoponopono ʻana i ka helu hoʻokomo. Inā loaʻa iā ʻoe nā hopena koʻikoʻi, hiki i kāu hui lapaʻau ke hoʻōki i ka hoʻokomo ʻana no kekahi manawa a hāʻawi i ka mālama kākoʻo hou aʻe ma mua o ka hoʻomau ʻana i ka lāʻau lapaʻau.

ʻO wai ka mea pono ʻole e lawe i ka Amphotericin B Lipid Complex?

ʻOiai ʻoi aku ka palekana o ka amphotericin B lipid complex ma mua o ka amphotericin B maʻamau, ʻaʻole kūpono ia no nā mea a pau. E loiloi pono kāu kauka i kāu mōʻaukala olakino a me ke kūlana olakino i kēia manawa ma mua o ke kau ʻana i kēia lāʻau.

Pono ka poʻe me kekahi mau maʻi i ka mālama hou a i ʻole nā lāʻau lapaʻau ʻē aʻe. Aia kēia mau kūlana:

• Maʻi kīkī koʻikoʻi: ʻOiai ʻoi aku ka palekana ma mua o ka amphotericin B maʻamau, hiki nō ke hoʻopilikia i ka hana kīkī
• ʻIke ʻia ka hypersensitivity: Nā hopena maʻi koʻikoʻi i ka amphotericin B a i ʻole kekahi ʻāpana o ka lipid complex
• Maʻi ate koʻikoʻi: Hiki ke hoʻopilikia i ke ʻano o kou kino e hana ai i ka lāʻau lapaʻau
• Nā maʻi puʻuwai: ʻO ka poʻe e pili ana i nā puʻuwai puʻuwai ʻole
• Nā manaʻo hāpai: Hoʻohana ʻia inā ʻoi aku ka maikaʻi ma mua o nā pilikia, no ka mea, ua kaupalena ʻia ka ʻikepili palekana

E noʻonoʻo pū kāu hui mālama ola i nā lāʻau lapaʻau ʻē aʻe āu e lawe nei, no ka mea, hiki i kekahi mau lāʻau lapaʻau ke launa pū me ka amphotericin B lipid complex. Aia kēia me kekahi mau lāʻau antibiotic, nā lāʻau immunosuppressive, a me nā lāʻau lapaʻau e pili ana i ka hana kīkī.

ʻAʻole maʻamau ka makahiki wale nō he contraindication, akā pono paha nā maʻi ʻelemakule i ka nānā ʻana me ka mālama nui ʻana ma muli o nā loli e pili ana i ka makahiki i ka hana kīkī a me ka hoʻonui ʻia o ka naʻau i nā hopena lāʻau.

Nā inoa inoa Amphotericin B Lipid Complex

Loaʻa ka amphotericin B lipid complex ma lalo o ka inoa inoa ʻo Abelcet ma ʻAmelika Hui Pū ʻIa a me nā ʻāina ʻē aʻe he nui. ʻO kēia ka hana kalepa mua o ka amphotericin B lipid complex i loaʻa no ka hoʻohana ʻana i ka lāʻau lapaʻau.

Hana ʻia ʻo Abelcet ma ke ʻano he hoʻokuʻu sterile pono e hoʻoheheʻe ʻia ma mua o ka lawelawe ʻana. Hele mai ka lāʻau lapaʻau i loko o nā vials hoʻohana hoʻokahi a pono e hoʻomākaukau ʻia e nā poʻe loea mālama ola i hoʻomaʻamaʻa ʻia ma nā kūlana sterile. Loaʻa paha nā mana generic o ka amphotericin B lipid complex ma kekahi mau wahi, akā ʻo Abelcet ka inoa inoa i ʻike nui ʻia.

He mea nui e hoʻomaopopo ʻaʻole hiki ke hoʻololi ʻia nā ʻano like ʻole o ka amphotericin B (me ka liposomal amphotericin B a me amphotericin B deoxycholate), ʻoiai aia i loko o lākou ka mea hana like. Loaʻa i kēlā me kēia formulation nā koi dosing like ʻole a me nā ʻaoʻao hopena.

Nā Koho ʻē aʻe o Amphotericin B Lipid Complex

Hiki ke noʻonoʻo ʻia kekahi mau lāʻau antifungal ʻē aʻe ma muli o kāu maʻi kikoʻī a me nā kūlana olakino. E koho kāu kauka i ka lāʻau lapaʻau kūpono loa e pili ana i ke ʻano o ka fungus i pili, ke koʻikoʻi o kāu maʻi, a me kou kūlana olakino holoʻokoʻa.

ʻO nā koho maʻamau e pili ana i nā formulations amphotericin B ʻē aʻe a me nā papa like ʻole o nā lāʻau antifungal. Eia nā koho nui e noʻonoʻo ai kāu hui mālama ola:

• Amphotericin B liposomal (AmBisome): He ʻano hoʻohui ʻia i ka lipid e ʻoluʻolu ana i nā puʻupaʻa
• Voriconazole: He lāʻau lapaʻau antifungal waha a i ʻole IV e hana ana i nā maʻi like
• Caspofungin: He lāʻau lapaʻau antifungal IV mai kahi papa lāʻau ʻē aʻe i kapa ʻia ʻo echinocandins
• Posaconazole: He lāʻau lapaʻau antifungal waha e hiki ke hoʻohana ʻia no kekahi mau maʻi
• Isavuconazole: He lāʻau lapaʻau antifungal waha a i ʻole IV hou me ka hana ākea
• Micafungin: He lāʻau lapaʻau antifungal echinocandin ʻē aʻe i hāʻawi ʻia e IV

Aia ke koho ʻana i nā mea ʻē aʻe i nā mea e like me ke ʻano fungal e hoʻoulu ana i kou maʻi, nā hopena hoʻāʻo ʻana i ka lab, kou hiki ke ʻae i nā lāʻau lapaʻau waha, a me nā kūlana olakino e pili ana i ke koho lāʻau.

I kekahi mau hihia, hiki ke ʻōlelo ʻia ka lāʻau lapaʻau hui pū me nā mea antifungal he nui no nā maʻi koʻikoʻi a paʻakikī paha.

Ua ʻoi aku ka maikaʻi o ka Amphotericin B Lipid Complex ma mua o ka Amphotericin B maʻamau?

Manaʻo ʻia ka Amphotericin B lipid complex e ʻoi aku ka maikaʻi ma mua o ka amphotericin B deoxycholate maʻamau, ʻoi aku hoʻi i ka palekana o nā puʻupaʻa. Ua hoʻomohala ʻia ka hoʻohui lipid e hōʻemi i ka nephrotoxicity (pōʻino o nā puʻupaʻa) e pili ana me ka amphotericin B maʻamau me ka mālama ʻana i kāna mau hopena antifungal ikaika.

Ua hōʻike nā haʻawina i ka amphotericin B lipid complex e hoʻoulu i ka pōʻino o nā puʻupaʻa a me nā hopena infusion koʻikoʻi liʻiliʻi i hoʻohālikelike ʻia me ka amphotericin B maʻamau. Eia naʻe, ua like ka maikaʻi o nā lāʻau lapaʻau ʻelua i ka hapanui o nā maʻi fungal, no laila, pinepine ka koho ʻana i nā mea palekana a me nā mea maʻi.

Hiki i ka hoʻohui ʻana o ka lipid ke ʻae i nā lāʻau lapaʻau kiʻekiʻe e hāʻawi ʻia me ka palekana, he mea nui loa ia i ka mālama ʻana i nā maʻi koʻikoʻi. Eia kekahi, ʻoi aku ka maikaʻi o ka poʻe maʻi i nā infusions, me ka liʻiliʻi o nā hoʻopau ʻana ma muli o nā hopena ʻaoʻao.

Eia naʻe, ʻoi aku ka pipiʻi o ka amphotericin B lipid complex ma mua o ka amphotericin B maʻamau, he mea e noʻonoʻo ʻia i kekahi mau wahi mālama ola. E loiloi kāu kauka i kēia mau mea a pau i ka wā e hoʻoholo ai i ke ala lapaʻau maikaʻi loa no kou kūlana.

Nā Nīnau i Nīnau pinepine ʻia e pili ana i ka Amphotericin B Lipid Complex

Q1. Palekana anei ka Amphotericin B Lipid Complex no ka poʻe me ka maʻi kīkī?

ʻOi aku ka palekana o ka amphotericin B lipid complex no ka poʻe me nā pilikia kīkī i hoʻohālikelike ʻia me ka amphotericin B maʻamau, akā pono nō ia i ka nānā pono ʻana. Hoʻemi nui ka hoʻohui ʻana o ka lipid i ka pilikia o ka pōʻino o ke kīkī, e lilo ia i koho maikaʻi no nā maʻi me nā pilikia kīkī a i ʻole ka poʻe i ka pilikia nui o nā pilikia kīkī.

E nānā pono kāu hui mālama ola i kāu hana kīkī ma o nā hoʻokolohua koko maʻamau, e nānā ana i nā pae creatinine a me nā mea hōʻailona ʻē aʻe o ke olakino kīkī. Hiki iā lākou ke hoʻoponopono i ka papa hana dosing a i ʻole e hāʻawi i ka mālama kākoʻo hou e pale i kou mau kīkī i ka wā o ka mālama ʻana. Inā loaʻa iā ʻoe ka maʻi kīkī koʻikoʻi, hiki i kāu kauka ke noʻonoʻo i nā lāʻau lapaʻau ʻē aʻe a i ʻole e mālama i nā hana hou i ka wā o ka lāʻau.

Q2. He aha kaʻu e hana ai inā loaʻa iaʻu nā hopena koʻikoʻi i ka wā o ka infusion?

Inā loaʻa iā ʻoe nā hopena koʻikoʻi i ka wā o kāu amphotericin B lipid complex infusion, e makaʻala i kāu hui mālama ola i ka manawa koke. ʻO nā hopena koʻikoʻi maʻamau e pili ana i ka pilikia o ka hanu ʻana, nā anu nui, ke kuni kiʻekiʻe, ka ʻeha o ka umauma, a i ʻole nā ​​hōʻailona o ka hopena maʻi e like me ka pehu ʻana a i ʻole ka ʻulaʻula ākea.

Ua aʻo ʻia kāu hui lapaʻau e mālama i kēia mau kūlana a e hoʻolohi paha a hoʻōki paha i ka hoʻokomo ʻana i ka wā e hāʻawi ana i ka mālama kākoʻo. Hiki iā lākou ke hāʻawi iā ʻoe i nā lāʻau lapaʻau e kūʻē i ka hopena, e like me nā antihistamines, corticosteroids, a i ʻole nā lāʻau lapaʻau e kākoʻo i kou koko a me ka hana o ka naʻau. Hiki ke mālama maikaʻi ʻia ka hapa nui o nā hopena, a hiki ke hoʻomau pinepine ʻia ka mālama ʻana ke paʻa ʻoe.

Q3. He aha kaʻu e hana ai inā e hala wau i kahi mahele i hoʻonohonoho ʻia?

Inā e hala ʻoe i kahi mahele i hoʻonohonoho ʻia o amphotericin B lipid complex, e hoʻokaʻaʻike i kāu hui mālama ola i ka hiki wawe e hoʻonohonoho hou. Ma muli o ka hāʻawi ʻia ʻana o kēia lāʻau lapaʻau i loko o kahi keʻena lapaʻau, ʻo ka hala ʻana o nā mahele ma muli o nā paio hoʻonohonoho a i ʻole nā kumu lapaʻau ma mua o ka hewa o ka mea maʻi.

Na kāu hui mālama ola e hoʻoholo i ke ala maikaʻi loa e hoʻoponopono ai i kāu papa hana lapaʻau. Hiki iā lākou ke hoʻonohonoho hou i ka mahele i hala no ka manawa i loaʻa aʻe a i ʻole e hoʻoponopono i ka manawa o nā mahele ma hope. He mea nui ʻaʻole e lele i nā mahele me ka ʻole o ke alakaʻi lapaʻau, no ka mea, hiki i kēia ke hoʻopilikia i ka pono o kāu lapaʻau e kūʻē i ka maʻi fungal.

Q4. I ka manawa hea e hiki ai iaʻu ke hooki i ka lawe ʻana i ka Amphotericin B Lipid Complex?

Pono ʻoe e hooki i ka lawe ʻana i ka amphotericin B lipid complex ke hoʻoholo kāu kauka he palekana ke hana pēlā ma muli o kāu pane ʻana i ka lapaʻau a me ka hoʻāʻo ʻana. Hana ʻia kēia hoʻoholo ma hope o ka hōʻike ʻana o nā hoʻokolohua laboratory ua hoʻomaʻemaʻe ʻia ka maʻi fungal a ua hoʻoponopono ʻia nā hōʻailona lapaʻau.

E hoʻohana kāu hui mālama ola i nā ʻano hana like ʻole e loiloi i kāu holomua, me nā hoʻokolohua koko, nā haʻawina kiʻi, a me nā loiloi lapaʻau. Hiki iā lākou ke hana i nā moʻomeheu a i ʻole nā hoʻokolohua kūikawā ʻē aʻe e hōʻoia i ka hoʻopau ʻia ʻana o ka maʻi. ʻO ka hooki ʻana i ka lapaʻau ma mua loa hiki ke ʻae i ka maʻi e hoʻi mai a lilo paha i mea paʻakikī ke mālama.

Q5. Hiki iaʻu ke loaʻa i nā lāʻau lapaʻau ʻē aʻe i ka wā e lawe ana i ka Amphotericin B Lipid Complex?

Hiki ke hāʻawi palekana ʻia nā lāʻau lapaʻau he nui me ka amphotericin B lipid complex, akā pono kekahi e nānā pono a i ʻole e hoʻoponopono i ka mahele. E nānā kāu hui mālama ola i nā lāʻau lapaʻau a pau e ʻike i nā pilina kūpono a e hana i nā hoʻololi kūpono i kāu hoʻolālā lapaʻau.

Pono paha kekahi mau lāʻau lapaʻau e pili ana i ka hana o nā puʻupaʻa, e like me kekahi mau lāʻau antibiotic a i ʻole nā lāʻau immunosuppressive, e nānā pono ʻia ke hoʻohana ʻia me ka amphotericin B lipid complex. E hoʻonohonoho kāu hui lapaʻau i nā mea a pau o kāu mālama ʻana e hōʻoia i ke ala lapaʻau palekana a maikaʻi loa. E hōʻike mau i kāu poʻe mālama ola e pili ana i nā lāʻau lapaʻau a pau, nā mea hoʻohui, a me nā huahana lāʻau lapaʻau āu e lawe nei.