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 Overview
This article (which will continue to grow with information) has information about different aquarium (and pond) treatments. I give the gram negative or gram positive applications where they apply.
It is also noteworthy that not all human medications (or veterinary medications meant for cat or dog disease treatment) are practical in most 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).
When you have fish that are sick (bacterial, fungal, protozoan, or other parasites), you want to try and isolate them in a hospital aquarium whenever possible. Regular water changes before each treatment allow for a more effective treatment, especially when treated in the display aquarium.
Sponge Filters work well in hospital aquariums. Remember to remove carbon, as carbon will remove many medications. Also note that silicone in the aquarium will absorb malachite green, methylene blue, and copper sulfate. Most corals (crushed and otherwise), and ceramic decorations will also absorb medications such as malachite green, methylene blue, and copper sulfate.
Please see the section on quarantine/hospital tanks in this Aquarium Disease Prevention Article: “Aquarium Disease Prevention; Hospital and Quarantine Aquariums”
Correct calcium levels are important (newer research shows this more than ever), as calcium also helps in healing and stress, and without proper calcium levels healing may be difficult or impossible. The addition of antibiotics (such as Tetracycline) will lower calcium absorption (also the opposite is true that calcium in an aquarium will lower the effectiveness of any antibiotic in the Tetracycline Family such as Minocycline).
Important, Finish Treatment! Make sure that when you do treat with antibiotics, that you follow the recommended coarse, especially when fish improve. This is a point that many aquarists do not follow based on conversations and feedback over the years, as often a well meaning aquarist will purchase just enough medication for one dose or two when three or four are the minimum required. Then what will happen is the fish may improve somewhat and the aquarist assumes all is good, but then the fish go “downhill” and subsequent treatments with the same antibiotic are not as effective if at all as the disease pathogen have built an immunity to this antibiotic.
I have 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 are 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.
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 ones posted on the internet or elsewhere are way over simplified and can mislead an average aquarist into miss-diagnosis often resulting in frustration. I will admit I have seen a few that have better flow charts than others, however even these do not take variables into account (which may often include water conditions/parameters that can effect correct diagnosis of disease pathogen).
My point is understanding each medication and how it works, where and where not it works as well as knowing more about the possible disease pathogens is far more important in my opinion than a “one chart fits all” diagnostic chart.
An example would be a fish with a Red Sore; first one needs to determine whether this was caused by another fish, then if not one should find out water parameters, tank conditions and similar. If this tank has poor circulation with a high bio load/DOC (dissolved organic compounds) this is likely caused by Aeromonas or similar since this is an Anaerobic bacteria that thrives in these kinds o water conditions. Columnaris can also cause similar symptoms and is also an opportunistic bacteria where improving electrolytes such as calcium would also help, however 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 used the wrong medication when in fact the medication could not help the fish over come perfect conditions for this bacteria.
This is an important point, as 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 for the problem.
For example you cannot use Neomycin for a severe Aeromonas infection along with 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 that 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” as many medications such as Malachite Green are not only more effective in water with pH above 7.2 and a GH over 150 ppm, it is less stressful to the fish and the necessary electrolytes such as Calcium further buffer and aid in osmoregulation that further helps a fish resist the infestation.
To further summarize why diagnostic charts are generally to be avoided in my opinion is just that, these are opinions that are often vague and even true medical doctors (as per many of my friends in the Medical Profession) often make educated guesses based on a lot more information at hand than the average aquarist has at their disposal (myself included), not to mention 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 web site to be nay more accurate when they have less tools and vastly less money at their disposal?
Effect of Water Parameters
So, please make sure all your water parameters are where they should be, if for example your ammonia levels are high, all the medication in the world will not help, in fact they will only exasperate the problem. Make sure you have proper water circulation and even more importantly enough dissolved oxygen and low waste particulates, otherwise your Redox Potential can be adversely affected (this is not to say Redox Potential needs to be worried about for the average aquarist). Adequate calcium levels (which can be partially measured by kH) are very important to proper osmotic proper osmotic function. For more information here 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.
And above, proper efficient water changes (with proper electrolytes; salt magnesium, calcium) can do wonders without medication, so use ALL medications sparingly!!
Medication misinformation
Finally, I would like to address the common anecdotal comments made by many about the harmful side effects of medications. While almost every medication has a side effect that can harm or kill your fish, applying over use or misuse as a reason to not use a medication is poor aquarium husbandry and even in human treatments what can cure can also harm.
An anecdotal comment often stated is that use of antibiotics will kill your nitrifying bacteria, while this is true it is ONLY true for gram positive antibiotics or over use of others. Most true nitrifying bacteria (Autotrophic bacteria) are gram positive while the majority of aquarium infections (especially in marine aquaria) are gram negative. So the use of gram positive antibiotics such as Erythromycin has a greater risk of a nitrifying bacteria die-off than Kanamycin (which is both gram negative and gram positive, however this antibiotic is more effective against gram negative). 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 is 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)
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:
-Aeromonas (anaerobic)
-Furunculosis; Aeromonas-salmonicida (anaerobic)
-Vibrio (anaerobic)
-Flavobacterium (Columnaris) (aerobic)
-Pseudomonas (aerobic)
-Streptobacillus (anaerobic)
-Salmonella (anaerobic)
*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 bacteria that retain a crystal violet dye during the Gram stain process.
Here are some Gram Positive Bacteria:
-Mycobacterium
-Pseudonocardia (anaerobic)
-Staphylococcus (aerobic)
- Cyanobacteria (Oxygenic Phototrophic)
Aerobic Chemolithotrophic Bacteria:
Nitrifying bacteria
-Nitrobacteraceae (aerobic)
-Nitrobacter (aerobic)
-Nitrococcus (aerobic)
-Nitrospina (aerobic)
-Nitrospira (aerobic)
-Nitrosococcus (aerobic)
-Nitrosolobus (aerobic)
-Nitrosomonas (aerobic)
Anaerobic Chemotrophic Bacteria
-Erythrobacter (anaerobic)
*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 that Aeromonas and Vibrio are 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.
*Another important note is that the bacteria responsible for removal of ammonia, nitrites, & nitrates are gram positive as is Cyanobacteria (also known as Blue Green algae), which brings up the point of misinformation as to what medications do and do not destroy filter beds. Erythromycin and Ampicillin are effect on gram positive bacteria and can be harmful to beneficial bacteria (often called bio bacteria) necessary for a healthy aquarium with low ammonia/nitrites (Erythromycin is also effective for Cyanobacteria). However primarily gram negative medications such as Kanamycin are not harmful to these bacteria unless abused (Kanamycin also has gram positive attributes as well).
I have sited much of the information for this section from this source:
Bergey's Classification of Bacteria
Also: Bacteria
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 Bloodworms or Brine Shrimp (sometimes FD Brine Shrimp), I soak these foods in a few tablespoons of water for about 10-15 minutes then add everything to the aquarium (or pond). These are the foods I find work best in FW for internal infections when soaked; Metronidazole, Neomycin, Oxytetracycline, Piperazine, and Levamisol.
FOR EACH MEDICATION ARTICLE, PLEASE CLICK THE TOP LINKS, OR BELOW:
ANTIBIOTICS/ ANTIMICROBIALS
PARASITE & CHEMICAL TREATMENTS
ORGANIC TREATMENTS
QUICK SUMMARY:
I have stated this in other articles as well that I personally have resisted adding disease charts as these proliferate 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 a 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”
This site (not associated with this article) has some really good medication ingredients lists: The Turquoise Aquarium; "Medicine Ingredients"
For more aquarium information and articles (pond too), please visit this site:
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Summary (Below); reference links below for specific treatments/types