Protocol for using antibiotics to treat infected anemones ~Added to 7/30/14

[OrionN]

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 equipments 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.

I will link most of the threads here on RC about the antibiotic treatment of a sick anemone, to this thread. Please feel free to add a link of you own thread to the list. This way we can learn from each other and hopefully do a better job at keeping these beautiful animals alive. I am sure I overlooked a few threads. Please add any other threads as you see fit.
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Amoo's Sick Nem Treatment Protocol:
Let me start by saying most of my research wouldn't exist without what OrionN (Mihn) started on Reefcentral.com years ago. Most all of my treatments have been done on H. Mag and BTAs so my experience applies in different areas. For the sake of this treatment I am only going to go over how I treat H. Mags from the time they arrive until they hopefully go into a DT. I've had good luck with not bleaching my nems and getting most of them to survive.

Medications:
While I am experimenting with other medications, the only drugs I am comfortable recommending at this point are the same basic ones Mihn uses. I get 500mg Ciprofloxacin (Cipro) tablets and 400mg/80mg Sulfamethoxazole and Trimethoprim (SMZ & TP) tablets. Individual dosing will be explained below.

Arrival:
Upon arrival of the Nem I immediately float the Nem bag, to acclimate it to tank temperature. This is done for 30 minutes. A clean 5 gallon bucket is then used and the contents of the bag are placed in the bucket. At this point I visually inspect the Nem for signs of damage and immediately give it a condition score. (I will explain the scoring system at the end of this article.) 9 times out of 10 I will drip acclimate the Nem for about 30-45 minutes before placing it in quarantine tank (QT). There have been times I have had a Nem arrive in such bad shape and water that I have immediately moved it to QT without drip acclimation. Note: This is not the preferred method, but as I buy almost all of my specimen from the same vendor I know what water params to setup my QT for (I still double check to ensure).

QT Setup:
My QT setup is slightly different then Mihn's so I will go into detail about it here. I choose to use a two tank approach. I believe in using two tanks because it allows me to fully clean EVERYTHING in the tank. As I am working with a smaller species I can afford to get away with two 10g tanks. Both tanks are equipped with a divider, heater (79F), power-head, fresh salt water, a coffee mug AND a cycled bio-wheel HOB filter. There is a full spectrum light (Par 38 14000K Full Spectrum Dimmable Reef Light (Coral Compulsion))with a manual dimmer hanging 12" above one tank at a time (I manually move it when I move the nem). Remember this is still a QT tank until we begin treatment.

My first order of business is to slowly begin light acclimating (12 hours with 10 hours of full light) the Nem and observe it. I will not start treatment for a minimum of 6-8 hours on a freshly shipped Nem. I first allow it time to adjust to the new tank conditions and lighting. If it has not shown any signs of improvement (scoring system) I will then begin treatment. Usually there is some improvement and I will give the Nem until the first lights out period to see if it continues to improve. Typically anything above a 5 and I start treatment after 6-8 hours. Anything below I let it ride until "sundown". Once I make the decision to start treatment (Tx), it immediately becomes lights out, I remove the Bio-wheel HOB and dose 250mg/10Gal of Cipro. I then give a strict 12 hours until further action is taken.

Treatment:
IMPORTANT: At the same time I dose the occupied tank with 250mg/10gal of Cipro I dose the second "empty" tank with Cipro as well.

After the first 12 hour, medicated lights out treatment, I immediately move the Nem to the second tank which already had it's HOB removed before dosing. I move the clamp light and begin it's light therapy for the day. At this point I tear down the first tank, take all components outside to clean and dry. Once dry, I bring everything back in and fill the tank with fresh SW and all of it's gadgets. Once it's time for complete lights out, I move the Nem again to this fresh tank and dose 250mg/10gal of Cipro, only to this tank this time.

Note: I feel the 12 hour water changes are important for the first day and a half, beyond that I allow a nem to remain in the same tank for 24 hours unless the tank becomes extremely cloudy.

Once through that first day, I have my second tank setup and ready to go by lights out and move the Nem over for his nightly Cipro dose. Prior to moving him is when I score him for the day. I maintain a 250mg/10gal dose of Cipro for the first 3 lights out periods regardless of score.

Increasing Dosage or Changing Medications:
After 3 lights out periods I check my pictures and scores and determine if my current treatment appears to be working. If he has come down 2-3 points from where he started, I continue on the same path. If he has not shown improvement or his score has increased I change my dosage. My first line of action is to increase the daily Cipro dosage to 500mg/10gal. This is again done for 3 lights out periods.

After three lights out periods I assess my pictures and notes and determine where to go from there. If things are improving I back off on my Cipro dose, back down to 250mg. If things are not improving, I still back down on my Cipro dose to 250mg but also add 400mg/80mg of SMZ & TP. Things are again maintained for 3 lights out periods.

If you're still reading, things aren't going well and it's probably decision time. Hopefully by this point your nem is close to a 2-3 at worst, but if it's still above 5 and hasn't shown significant improvement it's time to start really hitting it hard. If things are still bad I will double my dose of both Cipro to 500mg/10gal and SMZ & TP to 800mg/160mg. I do this for 3 lights out periods. Anything beyond this point with the Nem not improving significantly is still experimental and not something I'm ready to recommend yet.

Amoo's Severity Scoring System:

0 - Healthy Nem
1 - Tentacles shortened, still fully inflated, mouth tight, responsive to touch
2 - Tentacles shortened, still fully inflated, mouth slightly droopy, responsive to touch
3 - Tentacles shortened, still fully inflated, mouth slightly open, responsive to touch
4 - Tentacles shortened, still fully inflated, mouth open, responsive to touch
5 - Tentacles shortened, still fully inflated, mouth gaping open with insides exposed, responsive to touch
6 - Tentacles shortened, partially inflates, mouth gaping open with insides exposed, responsive to touch
7 - Tentacles shortened, inflates and deflates multiple times daily, mouth gaping open with insides exposed, responsive to touch
8 - Tentacles shortened, most always deflated, mouth gaping open with insides exposed, responsive to touch
9 - Tentacles shortened, always deflated, mouth gaping open with insides exposed, barely responsive to touch
10 - Tentacles shortened, always deflated, mouth gaping open with insides exposed, non-responsive to touch
11 - Mush (Sorry )
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1) OrionN's H. Mag
http://www.reefcentral.com/forums/showthread.php?t=2220652

2) Reef1589's S. Gigantea
http://www.reefcentral.com/forums/showthread.php?t=2247231

3) Slickcg33's S. Gigantea
http://www.reefcentral.com/forums/showthread.php?t=2252486

4) Teejay77's S. Gigantea
http://www.reefcentral.com/forums/showthread.php?t=2262036

5) PTR13's S. Gigantea
http://www.reefcentral.com/forums/showthread.php?t=2259228

6) Winwood's S. Haddoni
http://www.reefcentral.com/forums/showthread.php?t=2260164

7) OrionN's S. gigantea from Petco
http://www.reefcentral.com/forums/showthread.php?t=2329256

8) Ron Popeil's Anemone's and Antiobiotics
http://www.reefcentral.com/forums/showthread.php?t=2111858

9) Beuchat Pedal Laceration.
http://www.reefcentral.com/forums/showthread.php?t=1942967

10) Winwood's H. Mag
http://www.reefcentral.com/forums/showthread.php?t=2184538

11) illcssd's treating bacterial infections in host anemone's.
http://www.reefcentral.com/forums/showthread.php?t=2156179

12) Amoo's Nem Treatments
http://www.reefcentral.com/forums/sh....php?t=2421087

[benjaminspades]

Thank you I have been following your method for a while now and have saved quite a few but at the same time I do see losses especially after ship out. Conventional shipping has yielded that fast change in water params makes the gigas spew something during shipping taht clouds the water. I suspect that this might be what is causing the fast degradation during ship out. I am unsure why it is this way but I would want to continue improving the methods with you so hopefully we can find a solution together.

[benjaminspades]

I have a few questions also ygpm

[SNAKEMANVET]

Great write up Minh.

[cichlidconvert]

I've been building a tank for a carpet and now with work like this I'm more confident in a h.mag or gig species tank. This is an important thread IMO

[OrionN]

Just a note to Anemone newbies. H. magnifica (Ritteri, Magnifica) and S. Gigantea (Gig, Shaggy Carpet, Gigantea, Giant Carpet) are very difficult anemones to keep. They are among the hardest animal to keep in our reef tank. Please commit yourself before you attempt to keep one of these. Please research their requirement. Please set up their QT tank such that you can keep it there fairly long term if needed (1 month or more). They got to have temp, salinity stability and high light with good circulation in the QT. Water condition got to be keep great even in QT.

[ezhoops]

How and where do i get cipro?

[OrionN]

You can get a dentist, vet or doctor to prescribed for you. You can also buy it on ebay. Antibiotic for fish without prescription.

[joeyjoe35]

http://www.aquaticpharmacy.com/product-info
I just bought a bottle from here.

[benjaminspades]

Originally Posted by OrionN

Just a note to Anemone newbies. H. magnifica (Ritteri, Magnifica) and S. Gigantea (Gig, Shaggy Carpet, Gigantea, Giant Carpet) are very difficult anemones to keep. They are among the hardest animal to keep in our reef tank. Please commit yourself before you attempt to keep one of these. Please research their requirement. Please set up their QT tank such that you can keep it there fairly long term if needed (1 month or more). They got to have temp, salinity stability and high light with good circulation in the QT. Water condition got to be keep great even in QT.

What temperatures and salinity is best?

[OrionN]

I keep my Gigantea at 83F. I keep gigantea at higher temp than normal because Rod Beuler who had the longest Gigantea in captivity (18+ years) keep his at high temp also, up to 86F, if I remember correctly. Rod stated that if the temp get below 80 his Gigantea would "looks off".
I never have any problem with keep the tank at 83 degree so I have not change. My tank is very stable temp wise with controler.
Salinity, I keep all my tank at 35ppt and have not seen any reason to change that.

[benjaminspades]

35ppt is 1.025? and temperature at 83 degrees?!

[benjaminspades]

wowzers I am at 78 do I raise it overnight??

[OrionN]

salinity stay constant with temp change but SG change with temp. There is a conversion table somewhere but I always use refractometer so I never pay attention to SG.
If you can easy control your temp. I would increase it by a degree or two every day. I do not think that increase ofer several hours would be a problem, but we really don't need to increase it that quick. When I first got my Gigantea, I increase temp of my tank from 80 degree to 84 over several days (4 days I think) but do not think that it is is detrimental for them to increase it quicker.

[benjaminspades]

Do you know the reason to why they need warmer water?

[OrionN]

No I do not

[Reef1589]

Originally Posted by benjaminspades

Do you know the reason to why they need warmer water?

In the wild they are usually in Warmer Water's.. ( S. Gig's that is ) because htey are found on the shallow reef's, where tides come and go and sometimes sit out in the sun for several hours before tide comes back... the shallower water = warmer temperature's .

i keep my S. Gig's are at 81-82..

[Rotknee]

Hey Minh...

First of all, thank you sharing your success with us. I lost a couple of gigs in the past two years and was a little nervous about trying again until I knew I could do something different to increase my chances of success. I think you found that something different that is going to benefit us all.

Are you concerned about ammonia at all? It is my understanding that any measurable amount of ammonia is harmful. When setting up these new hospital tanks are the 50% water changes enough to keep the ammonia levels in check?

[OrionN]

Not feeding plus change 50% of the water and suck out any discharge from the anemone should be enough to keep ammonia level not detectable

[God.]

I believe it would be best to use water from your display for the water in your QT, thus eliminating the typical ammonia spike problems.

As for temp, my tank spiked up to 89 with a problem. My zoas closed and my 24 head frogspawn melted but man was my gig lookin good. I usually keep my tank at 83-84 like minh. Had my big blue for a year now, no problems.

[alprazo]

Just want to note that I had success treating a H. haddoni with 3 consecutive days of 5 hours cipro baths. The anemone was removed from the tank and placed into 3 gallons of cipro treated tank water. It was then returned to the tank after each treatment. It took an additional five days to show improvment.

[ca1ore]

Is it a good idea to use this treatment for all ritteri, etc, or only if worrisome symptoms present themselves?

[OrionN]

I recommend only treat sick anemones. I would not treat healthy anemone "just in case" they are sick. Quarantine and treat if sick.

[ca1ore]

Originally Posted by OrionN

I recommend only treat sick anemones. I would not treat healthy anemone "just in case" they are sick. Quarantine and treat if sick.

That would be my inclination also; I've just read quite a few threads here that lament 'if only I'd started treatment sooner' .....

[OrionN]

I think these are the cases where the reefers were not prepared, Med or equipment needed for treatment. There were never a question of if the anemone need treatment but how soon can the treatment started.