How I Cipro

[Amoo]

Just something to keep in mind, but under dosing and or lack of treatment time are two of the biggest factors for resistance buildup. I would venture a guess we're starting to get to the point with aqua-cultured BTAs that it is something we would need to start thinking about.

Secondly if physicians were doing a very good job of limiting prescriptions we wouldn't be in the Xanax crisis we're currently in where they're about as common as tic-tacs.

The data we have is simply the data we have. I think all of us would love to have a formal study on infectious diseases that affect all of our reef inhabitants. Sadly I think we all know, there's not enough money to be made in that for anybody to take up that mantle. As a result the best information we're going to get is hobbyists with some kind of medical background or knowledge testing to the best of their abilities and sharing their results with the reefing community for others to test. If you think you can get it to work on a lower dose, then by all means knock yourself out. I know in all my tests anything lower then the recommended wasn't sufficient in a statistically significant number of tests compared to my total number of tests. Honestly I had better success with going straight to 500mg then I did starting with 250, but it wasn't a large enough difference for me to change the original protocol. So we can speculate all day about limiting antibiotic and this, that and the other, but the reality is, the information we have is what we have and all we can do is share our information and recommendations with the community and let you guys do with it what you want.

You may also find it worth noting that Cipro pills are available medically in 3 sizes, 250, 500 and 750. It's cheaper to by 500mg followed by 750mg followed by 250mg. It's still cheaper then dirt, but that's direct from manufacturer pricing.

Again though, the minute you start getting into the back in forth about reefers use of antibiotics and the ethics of how we're using what we use, I start to point back at "ripped from the ocean and into glass boxes for our enjoyment" and just kind of start to shake my head and nod.

 

[MnFish1]

Again though, the minute you start getting into the back in forth about reefers use of antibiotics and the ethics of how we're using what we use, I start to point back at "ripped from the ocean and into glass boxes for our enjoyment" and just kind of start to shake my head and nod.

I agree with your post - I would say, though, that if it comes down to choosing to limit antibiotics to non-physicians/veterinarians because of antibiotic resistance, I would gladly give up my reef tank antibiotic needs. Given the way things are going with antibiotic resistance, I wouldn't be surprised to see this happening sooner than later. Besides, you already see government(s) trying to keep people like us from 'ripping animals into glass boxes for our enjoyment'. Many people (wrongly so, I believe) say that zoos are unethical and 'wrong'. And yes, whether I agree with it or not, it may mean that anemones will not do as well - or not be allowed in our tanks if the only way to get them there is via 'cipro'.

 

[Linkfalcon]

How were are y’all ordering this from

 

[rgodoy22]

Also which one of these should I get?

THE OP SAYS 250MG PER 10 GALLONS BUT ON THE SITE THAT SELLS THE FISH FLOX IT SAYS 250MG PER GALLON OR 500MG PER 2 GALLONS, CAN YOU OVERDOSE? AND WILL IT CAUSE DAMAGE TO THE ANEMONE

 

[kennedpa]

Treating your cipro laden water with bleach and then dumping it down the drain would've been the easiest comment to make instead of excessive banter attempting to defend environmental topics that really don't require discussing.

Not stating to offend, just stating for the sake of the saying "choosing your battles"

 

[Jennie]

THE OP SAYS 250MG PER 10 GALLONS BUT ON THE SITE THAT SELLS THE FISH FLOX IT SAYS 250MG PER GALLON OR 500MG PER 2 GALLONS, CAN YOU OVERDOSE? AND WILL IT CAUSE DAMAGE TO THE ANEMONE

I haven’t used it yet. The anemone I had died before I could get the meds. Ask @Amoo

 

[mcarroll]

Treating your cipro laden water with bleach and then dumping it down the drain

Is this a known thing? It's not something I've come across in reading so far, so pls link me if you have anything on it! I would be careful!

These molecules have proven to be pretty resistant to things like UV and ozone....and when they do break down, they break down into other problematic compounds.

Plus I think it might be a little unsafe to mix bleach as proposed as mixing bleach and any kind of organics seems to lead to nasty results in all cases:
Common Household Chemicals - Dangerous Mixtures

I think these byproducts are one of the main reasons that UV and ozone do not seem to be viable solutions for degrading molecules like this for water treatment plants. I'm not sure if bleach is much different in its action, but it's definitely known to generate nasty byproducts too so it seems similar. At the very least, mixing it with the organics in the tank water would have the undesired effects described regardless of antibiotics.

 

[MnFish1]

Regarding the need to do trials to determine the effectiveness of the protocol. It is easy to do but does cost quite a bit. To determine the numbers of animals needed, there will be a few assumptions on how effective the protocol is and the death rate of anemones without treatment. Likely the minimal number of anemones for EACH ARM, antibiotic or no antibiotic would be around 20-50 animals. Let use about 25 each total of 50 animals. I have done clinical trials before and know how to calculate these number but will not go through these here.

I think there might be easier ways to defend what you are doing. How about Koch's postulates? Is this supposed infectious disease that you are treating with Cipro isolatable and transmissible to another similar anemone? Have you looked under a microscope to see if there is overwhelming bacterial infection? Have you gram stained the tissue?

Wouldn't it be possible to just take the next 20 anemones that you get in order - treat every other one with 'the protocol' vs. 'nothing'. (though I can see why you might not want to do this if you believe in your protocol).

Maybe Im not understanding and maybe @Amoo can answer - is this a protocol used for acclimation - for each anemone - or is it a protocol for sick anemones?

Lastly - and this is just a comment not a critique - in the 'severity scale' between healthy and much - several of the 'bullet points' are so close together that it would seem hard for the average person to score it. . For example, the difference between
2 - Tentacles shortened, still fully inflated, mouth slightly droopy, responsive to touch
3 - Tentacles shortened, still fully inflated, mouth slightly open, responsive to touch
would seem to be guesswork.

By the way in developing the protocol, you must have an idea of the survival rate with the protocol and without the protocol - what are the (approximate) numbers?

 

[MnFish1]

Treating your cipro laden water with bleach and then dumping it down the drain would've been the easiest comment to make instead of excessive banter attempting to defend environmental topics that really don't require discussing.

Not stating to offend, just stating for the sake of the saying "choosing your battles"

If you have 10 gallons of tank water - how much bleach is needed to inactivate the cipro? And - in defense of some of the 'excessive banter' - Bacterial resistance to antibiotics is rapidly becoming a severe health problem. In many hospitals, it is standard practice to not use a broad spectrum antibiotic when a narrower spectrum antibiotic would be just as effective. There is no reason that people developing empiric protocols to use antibiotics should not have to be able to defend their proper use. This is not a criticism of this protocol, @Amoo, etc - it is a fact in 2017. Its not an 'environmental topic' - its a public health topic.

 

[Amoo]

I'll pass, like I said before, we've tried narrower spectrum drugs with less success, if that's not a reasonable defense then I don't have an answer for you. I'm honestly tired of arguing about it.

Like I said, we're ripping fish out of the ocean and putting them in glass boxes for our own enjoyment, if you want to play the impact on the environment card please do it elsewhere so I can use this thread for questions that come up regarding help with this treatment.

 

[MnFish1]

False narrative. Answer the questions about your methods. Sorry

 

[Amoo]

False narrative. Answer the questions about your methods. Sorry

I honestly stopped reading about 5/6 posts up, can youi please ask them again or just copy and paste what you're asking.

 

[MnFish1]

I honestly stopped reading about 5/6 posts up, can youi please ask them again or just copy and paste what you're asking.

I think there might be easier ways to defend what you are doing. How about Koch's postulates? Is this supposed infectious disease that you are treating with Cipro isolatable and transmissible to another similar anemone? Have you looked under a microscope to see if there is overwhelming bacterial infection? Have you gram stained the tissue?

Wouldn't it be possible to just take the next 20 anemones that you get in order - treat every other one with 'the protocol' vs. 'nothing'. (though I can see why you might not want to do this if you believe in your protocol).

Maybe Im not understanding and maybe @Amoo can answer - is this a protocol used for acclimation - for each anemone - or is it a protocol for sick anemones?

Lastly - and this is just a comment not a critique - in the 'severity scale' between healthy and much - several of the 'bullet points' are so close together that it would seem hard for the average person to score it. . For example, the difference between
2 - Tentacles shortened, still fully inflated, mouth slightly droopy, responsive to touch
3 - Tentacles shortened, still fully inflated, mouth slightly open, responsive to touch
would seem to be guesswork.

By the way in developing the protocol, you must have an idea of the survival rate with the protocol and without the protocol - what are the (approximate) numbers?

 

[MnFish1]

if you want to play the impact on the environment card please do it elsewhere so I can use this thread for questions that come up regarding help with this treatment.

The questions I asked were not about environmental impact. They were about using your protocol, i.e. how to use it, how to use your severity score (since it is written somewhat unspecifically as to criteria (IMHO) and also some background on why/when to use it? The other guy was playing the environment card - Im curious from a science perspective what you think you are treating with Cipro and why?

 

[Jhillreef]

If I Cipo. Is it a must to change water daily? Also, is a light required? Can it just be a lamp ?

 

[OrionN]

Jhillreef,
I will post my original write up on Ciprofloxaxin treatment in the next post. If you are interested, read it. If you have any specific question I can try to answer it. Regarding water changes, I find it work best to do water change daily.Initially, I changed 50% of the water, but find that 100% change works better as long as you use"good water" and keep the condition, salinity and temperature the same. The best way to remove pollutants, is water change. How much Cipro remain after light periord is also uncertain. By changing 100% of the water I can control the concentration of the Cipro in the hospital tank.

Light is needed, but the very best of light is not essential. You want to provide reasonable amount of light to keep the anemone from further stress and keep the population of zooxanthellae alive so that the anemone can recover quickly once treatment is over. You wand adequate light in term of spectrum and intensity. I have use day light, LED with cool white spectrum and florescence light for treatment tank initially but finally settle on a 10K spectrum LED flood light.

 

[OrionN]

............ The other guy was playing the environment card - Im curious from a science perspective what you think you are treating with Cipro and why?

MnFish1,

First, I am not playing any card or have any agenda to push. I just want to help reefers and advance our hobby. Just so that you know, I was the reefer who named Pinched Mantel Disease(PMD) in Clams, and was the person who devised the successful treatment of PMD in clams with fresh water dipped.

I love anemones and tried to keep anemone since 1980. Not very successful in keeping most of them alive though the initial periord. I am a medical doctor. I used and know about antibiotics. I participated in a few online discussions regarding how to care for these animals for a very long time. Reading various people opinions, pay attention to some of their experiences, in addition to my own experiences, I came up with the protocol. Fortunately, this protocol works very well for me. There were a few other antibiotic choices, but I did not investigate extensively because this protocol works so well for me.

Prior to using antibiotic, I have 0% success with getting Magnifica and Gigantea from on line sources. I have keep many Magnifica since 1997. I was the first person who documented asexual reproduction of Magnifica anemones with pictures in 2000. Choosing from local sources in Houston, Austin and San Antonio and Corpus Christi, I have about 50% success rate with Magnifica. The only Gigantea I got to survived without treatment was a Gigantea that was at a LFS here in Corpus for more than 1 month and stay healthy. I paid an arm and a leg for that one.

Using antibiotic I rarely lost a Magnifica due to illness. Gigantea is still a little harder. I estimated that I successfully acclimated at least 80% of Gigantea I obtain with antibiotic.

Prior to 2010, the number of reefers in the US that keep Gigantea anemone (that participate in Reef Central Anemone Forum) less than 5. After 2010 this number exploded. There are TMTC reefers who keep Giganteas. TMTC reefers have multiple Gigantea in their tanks. All most all of these reefers used antibiotic to treat their anemones, or at least have the option of using antibiotic to treat their sick anemones. Many dealers now use antibiotic to treat their anemones so I think a lot of the reefer who does not treat still benefit from the effect of antibiotic because they are getting much healthier anemones.

Regarding what are the cause for anemones demise when first put into our tank, there got to me many causes, from stress, injury, heat, cold, salinity changes, infection from various micro organism and other unknown factors. It would be extremely foolish to think that there is one organism, or one thing that kill these beautiful animals. Bacterial infections got to be fairly high on this list once we rule out obvious cause like trauma or physical injury. It is well known to me, and many reefers who tried to keep anemones that placing a sick anemone in a system with a healthy anemone that have been thriving for years often will result in loosing both. While this does not satisfy the Koch's postulates, it is the best that you can get. I toyed with the idea of culture sick anemones to isolate the infectious agent, communicated with Kevin at Live Aquaria who agreed to send me Gigantea anemones free of charge, but ended up not going through with it. Even with free source of anemones, the cost in term of time and money is prohibitory high for me. This would be a perfect project for marine biology students. I am not wealthy, and need to earn a living for my family (wife, three boys, two of the three are in college).

I will post the original write up I did. In it I gave rationals for choosing the antibiotic and dosage. If you are interested, read this very short write up. If you have any specific question, I will be happy to answer them.

I believe that the protocol, using as is is responsible use of antibiotic. The total impact of the course of treatment on our sewer system is less than a course of Cipro as used to treat human infection. Regarding the dose, I calculated using volume of distribution, to achieve concentration at approximate the concentration of medication in human body. Culture to ID the organism, then do sensitivity testing is out of the question. I really don't have money to burn.

 

[OrionN]

Here is my original write up:

Protocol for using antibiotics to treat infected anemones
Many anemone keepers know, the collection and shipping process from ocean to local fish store (LFS) is a stressful event. Most host anemones do not survive this process without help, especially H. magnifica and S. gigantea. Other host anemones also have high mortality. Most succumb to infection in the first 4 weeks on arrival to LFS. With help from other anemone keepers at ReefCentral.com Anemones and Clownfish Forum, I have come up with an antibiotic protocol that seems to be successful and drastically improve the initial survival of anemones during this critical time.

The antibiotic choice: Ciprofloxacin (Cipro), a floroquinone antibiotic or Trimethoprim/sulfamethoxazole (Septra) combination antibiotic
There are several reasons I choose these antibiotics. They are broad spectrum antibiotics that should, hopefully, cover most pathogens involved. These antibiotics covered most of the pathogens involved in a saltwater wound infection in humans. This is not to say that pathogen that infected the anemones are the same ones that infected human. However, we have to start somewhere and these two antibiotic are reasonable choices. The other reason for choosing these antibiotic is that they are inexpensive and widely available. Cipro and Septra dissolve well in water and will break down with light exposure in a tank environment. Another antibiotic that can be use is levofloxacin (Levaquin). However, Levaquin is a newer fluroquinone and much more expensive because generic are not available.


Instruction:
The dosage for continuous exposure (not dipping) in a hospital tank is Cipro 250 mg or Septra 160/800 mg per every 10 gal of water. I recommended that anemone be treated in hospital tank. I used a standard 20 gallon (high) tank, power head (PH) , heater, egg crate and possibly an air stone. I also recommended that full light is provide for the anemone to help it recover via photosynthesis. The hospital tank is divide into two compartments by the egg crate. Place the anemone with an inert object (a mug or a medium piece of rock) for it to attach to in one compartment. In the other compartment place the heater, PH and +/-air stone.
Fill the hospital tank half way (10 gal) and added either Septra or Cipro, then added the sick anemone. The hospital tank water needs to be keep stable with respect to temperature and salinity. I recommend that all the water in hospital tank be change daily as the day-time cycle comes to an end. After a water change add antibiotic. The best method to add antibiotic into the hospital tank is to rub the tablet between thumb and index finger in front of the PH until fully dissolved. With reasonable light, it is likely that all or most of the antibiotic will be degraded by the end of the day-time cycle. Adding medication at the begin of the night-time cycle, should give optimal antibiotic exposure for the anemone for most of the 24 hour time period. Adequate circulation, with small PH, is a must. The hospital tank will have a minimal ability to process ammonia, therefore feeding sick anemone is not recommended during treatment process. I do not recommend tapering the dosage of the antibiotic because low level antibiotic treatment is what causes problems and creates resistant strains of bacteria.
Anemones often discharge various substance when they are not well. When the hospital tank water have solid discharge, I recommend removal of these discharge. At any time, if the water of the hospital tank is cloudy, I recommend a 100% water change and new antibiotic added.

Length of treatment:
It is recommended that the anemone is treated for a minimum of 7 days, and at least 3 days after it stops deflating. Early termination of treatment is a mistake that has caused me to loose a few anemones.

Disposal of antibiotic containing water:
There is no special treatment needed for disposing water containing antibiotics. Cipro and Septra will break down quickly with light exposure and will not stay around long in the environment. Short course of antibiotic use like in this protocol should not have significant impact on the environment. It is harmful for the environment if there is a continuous low level antibiotic discharge, but not for short courses like in this protocol . In human usage, these two antibiotics are eliminated unchanged by the kidney, and flushed down the toilet into the sewage system, which is what we are doing with our treatment water. It is unclear if treatment by bleach will do anything to the antibiotic. If you are concerned, store the water and put it under sunlight for a few days then discard.
I clean the hospital tank and all equipment thoroughly include bleaching the full set up in fresh water. Once thoroughly cleaned, the hospital tank can be dry and put into storage until needed.

 

[MnFish1]

Thanks a lot for that explanation

 

[Jhillreef]

So, I’m adding the Nem in this Am. I shouldn’t add the meds yet as it’s daytime? I should wait until tonight Add he meds turn light off? Then keep that cycle. And change the water every night then redose once changed?