This article has information about different aquarium and pond treatments. A gram negative or gram positive application is given where they apply.
It is also noteworthy that not all human medications or veterinary are practical in aquarium or pond applications. A good example is Penicillin and Ampicillin (Please reference each of the sub articles above for more in depth information about different treatments).
Most bacteria which infect fish are gram-negative, including Aeromonas salmonicida, Flavobacterium columnare (Columnaris) Vibrio, and Pseudomonas species. The major group of gram-positive bacteria which cause disease in fish are Streptococcus.
When you have fish that are sick (bacterial, fungal, or parasites), you want to try and isolate the fish in a hospital aquarium whenever possible. Of course, this should not be done if the infection is systemic. This is often seen with Ich or Gram positive infections such as Streptococcus. Regular water changes before each treatment allows for a more effective treatment, especially when treated in the main display aquarium. These water changes will lower dissolved organics, which could be a result of a previous treatment and not only absorb your latest medication dose (rendering it less effective), but can increase the toxic side effects of the treatment. The bottom line is that water changes need to be done before each treatment dose for the best results!
Sponge Filters work great in hospital aquariums. Remember to remove any carbon, as carbon will remove many medications. Also note that silicone in the aquarium will absorb Malachite Green, Methylene Blue, and Copper Sulfate (because they are a dye). Most corals crushed or otherwise, and ceramic decorations will also absorb medications.
Please see more on quarantine/hospital tanks in the Aquarium Disease Prevention Article: “Aquarium Disease Prevention; Hospital and Quarantine Aquariums”
Correct calcium content (positively charged calcium ions) levels are important (newer research shows this more than ever), as calcium helps in healing and stress. Without proper calcium levels healing may be difficult or impossible. The addition of antibiotics, such as Tetracycline, will lower calcium absorption. The opposite is also true, calcium in an aquarium will lower the effectiveness of any antibiotic in the Tetracycline family such as Minocycline.
Initial steps that MUST be followed for best results
- Know and Correct your Water Parameters!
WITHOUT maintaining these parameters, your treatment is unlikely to succeed:
- a stable pH
- an established and maintained KH (usually 80 ppm or higher depending upon fish kept)
- positive mineral ions (Cal/Mag) in CONSTANT supply, which can only be present if GH is maintained (although a GH reading does not guarantee positive mineral ions/electrolytes)
- 0 (or near 0) ammonia and nitrites
- 50 ppm nitrate or less
Aquarium Chemistry; GH, pH, KH
Aquarium Nitrogen Cycle
- Utilize a Fish Bath, Swab, or Dip whenever practical.
These are proven effective. Experiments with different medications/chemicals can help discern the best "In Tank" treatment.
An example: Potassium Permanganate and Nitrofurazone in a bath & swabbing of effected areas of the fish with Aeromonas. Another example is the effectiveness of Methylene Blue ONLY with red reddened gills which indicates exposure to high ammonia. This parameter needs to be watched and further in tank treatment likely will do more harm if water parameters are not in check!
- Identify your disease or ailment as best possible.
Keep in mind you may be dealing with multiple ailments such as Ich with secondary infections such as fin rot or even Ich with fungus, AND even dangerous water parameters.
Please note the tools available to the average fish keeper, all we can do is make an educated guess. Even most primary care human doctors only make educated guesses until blood tests, biopsies, etc. are performed.
Please read on for further elaboration.
Important, Finish Treatment!
Make sure that when you do treat with antibiotics, you follow the recommended course, especially when fish improve. This is a point that many aquarists do not follow. Well meaning aquarist will purchase just enough medication for one or two doses when three or four are the minimum required. Then, the fish may improve somewhat and the aquarist assumes all is good, but the fish goes “downhill”. Subsequent treatments with the same antibiotic are now not as effective due to the disease pathogen building up an immunity to this antibiotic.
I've had aquarists confront me stating “I thought you said this medication would work, the fish got better, but then they got sick again and now they're worse than before”. When I dug deeper I found that only one or two treatments had been used and this is the common result when one treats with most antibiotics this way.
An exception is Triple Sulfa (or any Sulfa) which are not true antibiotics, rather Sulfas are antimicrobials. That said about Sulfas, they too are much more effective when the full course is followed.
Change Medications when Ineffective:
Since fish treatment is far from an exact science. It's important to try another antibiotic if after three treatments no results are seen. Also if some results are seen, but the fish goes backwards to remission of symptoms, I would recommend changing antibiotics/antimicrobials as there may be bacterial resistance (weaker treatments such as Melafix or Pimafix may result this way).
As I noted earlier, the majority of aquatic diseases are gram negative which make treatments with antibiotics such as Kanamycin or other gram negative antibiotics a good choice. This is no guarantee that the disease pathogen will respond. Sometimes combinations of Kanamycin and Nitrofurazone give a wide spectrum treatment, other times you may have to try very different antibiotics such as Erythromycin or Metronidazole (Erythromycin is a good choice for usually aerobic gram positive eye infections). Metronidazole is sometimes a better choice than Kanamycin or Minocycline for anaerobic gram positive bacterial infections with the side benefit of mild effectiveness for internal and some external parasites.
The bottom line is to read the other pages of this article such as Aquarium Medications Two, antimicrobials, antibiotics to UNDERSTAND the strengths and weaknesses of each antibiotic used. You need to know whether aerobic, anaerobic, gram negative, or gram positive are what you will need for treatment.
For instance, after finding some success in treatment with subsequent backslide with a mild aerobic gram positive treatment such as Melafix, the next course may be a treatment with a stronger gram positive medication. Kanamycin Sulfate is both aerobic gram positive and negative, although more so as gram negative and may be a good next course of action in THIS example. The addition of Nitrofurazone would increase effectiveness in difficult cases, while Erythromycin would be stronger yet (although it would be much more harsh on your bio filter).
The above example is just that, an example and a case of a less common gram positive infection. The use of Erythromycin for example with no effectiveness would likely indicate a totally wrong medication choice, which would not be too unlikely since gram negative infections such as Aeromonas, Vibrio, Columnaris are much more common in aquariums.
Using Erythromycin as an example again, if it is effective for a suspected case of Columnaris, the facts are your fish did not have Columnaris since Columnaris is gram negative and Erythromycin is almost strictly gram positive.
This general principle does not apply to the use of medicated baths using Methylene Blue or Potassium Permanganate and salt, only the optional antibiotics used in any bath (antibiotics should not be used with Potassium Permanganate).
Also as noted earlier, sometimes combinations will allow for better effectiveness than each medication by itself (I would call this the cocktail effect which is employed in human treatments as well).
See these articles for more about Fish Baths: “Aquarium Disease Prevention; Fish Baths” or Fish Baths, Dips, Swabs
This principle also applies to chemical treatments for suspected protozoan infestations:
One point that I often use for both me and clients when microscopic evaluation is not possible is how the fish responded to a medication often is a determining factor in what the disease actually is.
Three diseases often get confused (for good reason), however treatment effectiveness is often a determining factor, see below;
- COSTIA: Formaldehyde
- VELVET: Copper Sulfate, Acriflavin, Methylene Blue
- SPOROZOA: Nitrofurazone (if anything)
Finally, often diseases are mis-identified, such as Fungus.
A good example is the use of Nitrofurazone which is found in different forms in many brands of Fungus treatment. HOWEVER this is not usually effective for true Fungus/Saprolegnia cases. If your treating for Fungus and switch to a product containing Nitrofurazone, likely your aquarium has Aeromonas and care should be taken to prevent this in the future.
See: Aquarium Aeromonas
Water Conditions when Medications Ineffective;
Often when multiple medications are used, often in strong mixed "cocktails", this can damage the aquarium (or pond) ecosystem/chemistry.
often these problems pre-existed long before any treatments were started due to the noticing of sick fish.
Checking ALL these parameters is a must, often before a treatment regimen, but especially if "nothing seems to work". Check the following parameters:
- Ammonia and/or Nitrites
My experience has often shown:
Ammonia and/or nitrite levels are spiking. Or
Client has an unstable pH due to the lack of adequate KH buffers. Or
Positive mineral ions are missing (GH partly tests for these, although Redox is also part of this equation)
The usual causes of these are lack of established bio filtration, poorly treated tap water, or incorrect use of RO water.
Another cause I have observed over the years is the use of home water softeners for filling aquariums (which should never be done).
Please read these articles for some overview of these problems:
Back up Bio-Filtration:
As noted earlier, water changes before each dose are important to the effectiveness of treatment. The other aspect which may be important is the use of backup bio filtration. This is especially important when using medications such as Erythromycin which is hard on aerobic gram positive bacteria and nitrifying bacteria.
Having on hand separate sponge filter, bio media, even gravel in a healthy tank that can be added as needed to the tank under treatment, can go a long way in making a treatment effective. A soaring ammonia level in an aquarium can cancel the benefits of any treatment. I recommend testing ammonia during a treatment, especially with Erythromycin and Tetracyclines. Then add this bio media at the first sign of an ammonia increase.
If this is not possible or in addition the above suggestion, the use of SeaChem Stability or similar facultative bacterial aids should be added approximately 12 hours after each medication treatment dosing to aid in maintaining your bio filter
Remove Carbon (& other chemical filter media)
Although most experienced keepers are aware of this, many “newbies” are not. The use of activated carbon in filters can and will remove most aquarium treatment medications. If the carbon in your filter has not been changed in over 8 weeks, it likely will not be too effective at removing the medication from your aquarium or pond.
If you use filter cartridges, the answer is simple in most instances. Simply & carefully slit the back of the cartridge and pour out the carbon so that the mechanical part of your filter cartridge can still be used.
Also note that some other types of chemical filter media such as Boyd’s Chemi-Pure or Bio-Chem Zorb can also remove medications and should be temporarily discontinued during use of aquarium medication treatments.
Carbon or other similar chemical filter media can be replaced after treatment is finished or added to the filter temporarily for 2 hours prior to each subsequent treatment, then removed again.
SeaChem Purigen is another good product to use during treatment intervals or after treatment. This product can be used with Carbon and compliments carbon in that Purigen removes many organic compounds carbon cannot remove which are toxic and often interfere with treatments.
The purpose of this is to remove any residual toxins that may have built up during each treatment dose. However, this is not required and is only an option to improve water conditions during treatment.
Mineral treatments (such as Regular Wonder Shells), buffers, or similar water chemistry additives can safely be used during aquarium medication treatments.
If bio filtration additives, such as SeaChem Stabilityare required due to ammonia or nitrite issues, these can be added about 50% of the time between each treatment dose.
Changing water immediately prior to each treatment can improve effectiveness and lower the possible toxicity of treatment.
A 20% water change can cut back on organics in the water column that can often absorb many medications, thus lowering effectiveness.
As well some medications break down after 24-48 hours and can leave mildly to moderately toxic chemicals behind which a water change prior to the next treatment can help lower or remove completely. Placing carbon or similar products such as SeaChem Purigen in a filter for an hour or two prior to a treatment can help remove ineffective or exhausted medications.
Tetracycline and Malachite Green are two examples of treatment medications that can be both more effective and less toxic if water changes (and/or carbon filtration) are performed immediately prior to a new or follow up treatment.
Be aware that many chemical dyes such as Malachite Green can be at least partially removed by most water conditioners such as Prime, Start Right, Amquel+, etc.
I suggest using the water conditioners after a water change, then waiting 15-30 minutes prior to adding a chemical dye medication treatment such as ParaGuard or Quick Cure.
See: Aquarium Water Conditioner Use and Information.
Why I do not use Diagnostic Charts:
Readers of my Aquarium Information sites might also note that I do not use diagnostic charts. The reason is simple. Most of the diagnostic charts that are posted on the internet or elsewhere are way over simplified and can mislead an average aquarist into miss-diagnosis. This often results in frustration. I will admit I've seen a few charts that have better flow than others, however even these do not take other variables into account. This often included water conditions/parameters that can effect correct diagnosis of disease pathogen.
My point is simple understanding each medication and how it works. Know when and when it wont work. Knowing more about the possible disease pathogens is far more important than a “one chart fits all” diagnostic chart.
For example: A fish with a Red Sore. First one needs to determine whether this was caused by another fish. If not one should find out water parameters and note tank conditions. If this tank has poor circulation with a high bio load/DOC (dissolved organic compounds) it is likely caused by Aeromonas or similar since this is an anaerobic bacteria that thrives in these kinds of water conditions. Columnaris can also cause similar symptoms. It is also an opportunistic bacteria where improving electrolytes (Cal/Mag)would also help.
With Aeromonas you would want to address the water conditions foremost before treatment otherwise your medication results may be poor, leading one to believe that they used the wrong medication when in fact the medication could not help the fish over come the perfect conditions (poor circulation)for this bacteria.
This is an important point. When medications do not work, it is often not a problem with the medications which is often assumed, but with water parameters and the choice of medication that was used for the problem.
For example you cannot use Neomycin for a severe Aeromonas infection also having poor water conditions and then say medications do not work. In this case Aeromonas is a gram negative anaerobic bacteria that is much more resilient in low circulation, low oxygen water which is low in electrolytes. It also requires a gram negative treatment such as Kanamycin, not a primarily gram positive treatment such as Neomycin.
This point also extends to parasitic diseases such as “Ich”. Medications such as Malachite Green are not only more effective in water with pH above 7.2 and a GH over 150 ppm. It's less stressful to the fish and the necessary electrolytes such as Calcium further buffer and aid in osmoregulation which further helps the fish resist an infestation.
To further summarize why diagnostic charts should be avoided is that they are simply people's opinions which are often vague. Even true medical doctors (per my friends in the medical profession) often make educated guesses based on a lot more information on hand than the average aquarist has at their disposal (myself included). Not to mention, medical doctors have a lot more training than most aquarists have. This is important as several studies of online human diagnostic web sites have found the vast majority to be highly inaccurate when put to the test with real subjects where a true medical diagnosis has been confirmed. How can we expect an aquatic diagnostic to be any more accurate when we have less tools and vastly less money for diagnosis at our disposal?
Effect of Water Parameters:
Make sure all your water parameters are where they should be. For example, if your ammonia levels are high and all the medication in the world will not help, make sure you have proper water circulation, dissolved oxygen, and low waste particulates. Otherwise your Redox Balance can be adversely affected (Redox Potential does not need to be worried about for the average aquarist). Adequate calcium levels (which can be partially measured by kH) are very important to proper osmotic function. For more information see this article; CALCIUM, KH, AND MAGNESIUM IN AQUARIUMS; How to maintain a Proper KH, why is calcium important
- If any of the above parameters are out of sorts, you will have trouble affecting a cure, even with proper medication.
- Also important, proper efficient water changes (with proper electrolytes; salt magnesium, calcium) can do wonders without medication, so use ALL medications sparingly!!
I would like to address the common anecdotal comments made by many people about the harmful side effects of medications. While almost every medication has a side effect which can harm or kill a fish, only over use or misuse can result in harm. Even in human treatments, what can cure can also harm.
A comment often stated is the use of antibiotics will kill your nitrifying bacteria. While this is true, it is ONLY true with new bio filters (newly established aquariums). This only can happen with gram positive antibiotics or over use of others.
Although true nitrifying bacteria (Autotrophic bacteria) are gram negative, these bacteria are seriously impacted by gram positive rather than gram negative medications. See Aquarium Nitrogen Cycle; Nitrification.
The majority of aquarium infections (especially in marine aquaria) are gram negative. So the use of gram negative antibiotics such as Kanamycin (which is primarily gram negative) have a lower risk of a nitrifying bacteria die-off than when used properly/carefully in an established aquarium. Some antibiotics are more mixed such as the Tetracycline families which are often equally divided such as Minocycline. However, Tetracycline Hydrochloride is primarily gram positive.
References: What are Bacteria; http://www.dls.ym.edu.tw/ol_biology2/ultranet/Eubacteria.html , Cloudiness in Water.
Another example: Kanamycin Sulfate, this antibiotic can be very harmful on the Kidneys, however this is one of the better kidney disease treatments available over the counter for fish. You just do not want to abuse or over use it.
Another example is Malachite Green. This has been shown in studies to be carcinogenic when used in large quantities yet in studies using this chemical at established therapeutic levels, Malachite Green has not shown to pose this danger (I reference this source in my Malachite Green section)
Here's another of piece medication misinformation or what I consider jumping to conclusions . In this area of two products by API; Melafix and Pimafix have recently fallen victim to well informed aquarists and forums making assumptions based on poor scientific method. I recommend reading page four of this article specifically dealing with these treatments: ORGANIC TREATMENTS.
Basically I have read aquarists in forums stating Pimafix should not be used due to Clove Oil being in this product, however this is the same as stating a human should never use Tylenol as over use (especially with alcohol) can lead to liver failure. This is not likely used properly with normal water changes between doses (which I recommend with all medications). Melafix has been blamed for the death of Labyrinth/Pencil fish, which I am not doubting the sources (such as Fish Lore) are reputable, but since I and others have conducted tests with Melafix at double dose with Labyrinth fish with no ill effects, I think we have to look scientifically at what the trigger may be (I explore this problem further on page four of the Medications article as noted earlier).
Making False Assumptions when Medicating:
This is similar to the section above, however here I'm referring to aquarium and pond keepers use of medications vs. the previous section dealing with anecdotal advice.
A good example is the use of Erythromycin or Melafix for treating Columnaris which is for Fact gram negative and then assuming your use of Erythromycin cured this ailment when laboratory tests prove this impossible. What likely happened is some other part of your tank maintenance procedure took care of this opportunistic infection OR quite simply your fish did not even have Columnaris, rather Streptococcus or FNT Disease or other gram positive diseases.
Changing water or otherwise improving water conditions can often allow a fish overcome an opportunistic infection (such as Aeromonas). This easily allows the aquarium keeper to assume that a treatment cured his/her fish.
My point is that this hobby is often driven by anecdotal assumptions that I would like readers to avoid by thinking more scientifically. A controlled study of medication use would include control groups, exact maintenance/water change procedures and more to keep different medication tests accurate. Obviously the aquarium or pond keeper when confronted with sick fish does not have time or multiple aquariums/ponds to perform these tests. However by changing water before treatments (even before each additional treatment), keeping water parameters where they should be for the fish kept, and knowing what each treatment method can and cannot effect, as well as proven/known effective treatments for bacterial & parasitic pathogens can allow an aquarist to know when an infection treatment is the best possible.
So please understand the importance of healthy water parameters, and knowing what a medication can and cannot due rather than listening to or making your own anecdotal assumptions.
Best Used By or Expiration Dates:
Despite common belief, 95% of medications are still quite effective well past their expiration/best used by dates printed on packages (generally an antibiotic is at least 90% + effective 6-12 months after said date). The exception is Tetracycline Hydrochloride which can become toxic past its expiration date, although even then it takes well over a year for this to happen (generally years).
Many organic treatments such as Melafix can last for years past their expiration dates (I used some Melafix that was two years past its date with positive and measured results).
These “dates” are in part made by regulations (often under false assumptions) as well as companies which manufacture these products who know when you discard a medication, you will likely purchase a replacement. Either way, neither reason is based on good science which includes many studies, as well as my own multiple controlled tests over the years.
If you doubt this, a quick search on the internet, including medical sites will prove this correct. Don't believe what you read on Yahoo Answers or similar anecdotal sites.
Here is one such site:
Harvard Medical School; Drug Expiration Dates - Do They Mean Anything?
Gram Negative/ Gram Positive Bacteria
Here are a few terms:
*Gram-negative bacteria are pathogenic, as they can cause disease in a host organism and have a thin cell wall. Gram negative bacterial infections are much more common in fish, especially marine. These bacteria that will NOT retain a crystal violet dye during the Gram stain process.
Please click picture to enlarge
Here are some Gram Negative Bacteria:
-Furunculosis; Aeromonas-salmonicida (anaerobic)
-Flavobacterium (Columnaris) (aerobic)
Aerobic Chemolithotrophic Bacteria:
Anaerobic Chemotrophic Bacteria
- Cyanobacteria (Oxygenic Phototrophic)
Gram-positive bacteria do not always cause a disease in the host organism and have a very thick cell wall.
Gram positive infections are less common in fish (or aquaria in general). These are the bacteria that retain a crystal violet dye during the Gram stain process.
Here are some Gram Positive Bacteria:
-Mycobacterium (aquatic tuberculosis)
- Streptococcus (Pyogenic Hemolytic Streptococci, Oral Streptococci,Enterococci, Lactic Acid Streptococci, Anaerobic Streptococci)
Of the above bacteria noted, Flavobacterium (Columnaris), Vibrio, Aeromonas, & Pseudomonas cause the vast majority of diseases in aquariums/ponds AND these are gram negative. It should also be noted that Aeromonas and Vibrio are generally anaerobic, so keeping a well circulated/oxygenated aquarium or pond is important for their prevention and treatment.
Mycobacterium is an occasional problem that is gram positive.
I have cited much of the information for this section from this source:
Classification of Bacteria
Contraindications (& Medication Mixing):
What are "Contraindication"?
From Wikipedia: http://en.wikipedia.org/wiki/Contraindication
"In medicine, a contraindication is a condition or factor that serves as a reason to withhold a certain medical treatment
Some contraindications are absolute, meaning that there are no reasonable circumstances for undertaking a course of action
Other contraindications are relative, meaning that the patient is at higher risk of complications"
With this in mind I have added a "Contradindications" section under many explanations of each medication treatment on page 2 and page 3 of this article.
Knowing some of these conrindications will help determine whether it is advisable or at all safe to mix certain medications or chemical treatments.
As well, the mix of medication and volume depends on the disease you are trying to treat and the inhabitants of your tank.
Here are some examples of medications that can or cannot be mixed:
, NEVER mix Tetracyclene with any other medication. The reason for this is that it is a very harsh treatment and lowers the red blood cell count in your aquarium fish.
can be mixed with salt, and is used to aid in the treatment of external parasites such as Anchor Worms.
can be mixed with Paraguard
as it aids with secondary infections and lowers the ricks of infections caused by the irritation of malachite green with certain sensitive fish such as Cory Catfish or Clown Loaches.
Paraguard, Furan 2
, and Kanaplex
can be mixed and this combination aids in the treatment of a wider spectrum of diseases.
Food Delivery of Medications:
For many internal infections soaking medications in food or the use of prepared medicated food is the best coarse of action (in freshwater, marine fish do not usually require delivery of medication via food due to their constant drinking of water around them). I prefer to use frozen foods such as Blood worms or Brine Shrimp (sometimes FD Brine Shrimp), I soak these foods in a few tablespoons of water with the medication for about 10-15 minutes then add everything to the aquarium (or pond).
These are the foods I find work best for internal infections when soaked; Metronidazole, Neomycin, Oxytetracycline, Piperazine, and Levamisol. Generally a dose intended for 2 gallons of water treatment will work for a 15 minute fish food soak
For instance with Neomycin, this would mean .10 grams (or one measure) of the brand "SeaChem Neoplex" per each fish food soak twice per day (usually for 7-10 days)
FOR EACH MEDICATION ARTICLE, PLEASE CLICK THE TOP LINKS, OR BELOW:
PARASITE & CHEMICAL TREATMENTS
How to Make a Percent-% Solution:
Sometimes it is necessary to mix your own chemical solutions such as Methylene Blue, Malachite Green, Potassium Permanganate, etc.
Simply put- to make a 1% Malachite Green aqueous solution, use a 100 ml bottle. Then add 1 gram of Malachite Green to your bottle and bring the volume up to 100 ml.
As another example, to make a 2.30% Methylene Blue aqueous solution, use a 100 ml bottle, then add 2.3 grams of Methylene Blue to your bottle and bring the volume up to 100 ml.
See this equation:
% solution = (dry mass in grams / volume in ml) * 100
I have stated this in other articles as well.nI personally have resisted adding disease charts as these just show up all over the internet, many are very “cookie cutter” in their descriptions. I feel first understanding prevention methods followed then by a knowledge of antibiotics, chemical treatments, and organic treatments will go much further in treatment and disease prevention than any disease chart that has a one size fits all approach.
I recommend reading this companion article about Aquarium Disease Prevention for more information that will help you make an educated choice when treatment of fish is required, rather than a “dart on the wall” approach.
“Aquarium Disease Prevention”
Also I recommend reading some of the specific disease articles such as “Columnaris/ Saprolegnia”, Ichthyophonus, and many others founds here: “Aquatic Information, Resources”, “Aquarium & Pond Answers” or other disease specific articles found on the internet or elsewhere.
For some pictures of fish anatomy that may be useful in disease recognition, please visit this article: “Aquarium Answers; Fish Anatomy”
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