Cipro Treatments - doctors perspective

[MachPilot]

I've read a wealth of information on this site and others regarding Quinalone treatments (Cipro/levaquin/Avelox) for anemones.

I figured as a dually boarded physician in IM/ped ER - I might be able to shed some light on this medication.

Its quite effective against a number of pathogens, notable gram(-) organisms - hence its effect on sick gigs/mags.

The normal side effect profile for humans do not correspond to inverts because they involve rashes, myopathies, and potential tendon damage. Because of that it can be dosed with relative ease of mind.

A 250 mg dose is sufficient daily. A human dose would normally be 500 mg 2x a day for 5 days for uncomplicated UTI's maybe 7-10 for diverticulitis or other sick related issues.

Cipro is made by multiple generic manufacturers. The efficacy of the medication can be different depending on the company but I do not think it would matter much here.

In terms of alternative treatment, there is no medical reason to assume that Levaquin (250mg) would not be just as effective but it is more costly. Recent generic availability has made this much more cost effective however.

If there are any medically related questions regarding the medication, I would be glad to help.

 

[cvcoda]

Nice to see a fellow HCP on here. Welcome.

 

[MachPilot]

Thank you great community.

 

[D-Nak]

I have a few questions that I'm hoping you (or Dr. Nguyen) can answer:

1. What are the negative affects of using Cipro or Septra? What do you think an overdose would do to the anemone?

2. Based on my observations from treating a few gigantea with both antibiotics, during the treatment period, the nems tend to bleach quite a bit and expel dead zoox. Do you think this is a process manifested by the infection (the infection kills zoox) or do you think the antibiotic could be wholly or partly responsible? Do you think the zoox was already dead and the antibiotic aided in removal, preventing it from fouling the nem from within?

3. I've had mixed results with the antibiotic treatment. I am treating two gigantea now, and one appears to have recovered while the other will most likely die today. The one that is dying appears to be eating itself, as the waste it expels includes partially digested tentacles (as indicated by purple bits -- the gigantea has purple tentacles and a blue base). It's extremely bleached, which leads me to believe that without zoox to provide energy to the nem and since it's unable to capture prey, not only is the nem trying to rid the bacteria, but it's also starving. Furthermore, the nems that have died all started very large and fully inflated, then gradually got smaller and smaller, and all began to eat themselves -- where tentacles became non-existent and the oral disk was bald.

4. I feel that we've made quite a bit of progress in the past couple of years, but I think we've now hit a roadblock -- this new crop of gigantea imported appear to not respond to Cipro. Could it be that there is a different bacteria appearing? When Cipro doesn't work, Septra seems to show immediate results, but shortly after, I've seen a more rapid decline. Could it be that "bombing" the nem with Septra is doing more harm than good?


Thanks in advance. I've become very passionate about treating gigantea and am pulling my hair out trying to figure this out. I realize that there are quite a few variables, but my biggest challenge is that I don't have a medical background which I feel would aid in not only treatment options, but analyzing what I see in terms of how the nems respond to the antibiotics.

 

[Randy Holmes-Farley]

Could it be that there is a different bacteria appearing?

I presume that no one has actually cultured the bacteria in a sick gigantea relative to a healthy one (although I could be wrong), so it is certainly plausible that there are a variety of different bacteria that can infect them, and gigantea from different locations/times of the year/etc. may well have different strains naturally in them.

In a human we'd culture to see what was there in a complex infection in order to determine the optimal antibiotic, but that is probably not presently tenable for anemones without even knowing which bacteria are pathogenic and which are not.

 

[DasCamel]

Could it be that there is a different bacteria appearing?

I presume that no one has actually cultured the bacteria in a sick gigantea relative to a healthy one (although I could be wrong), so it is certainly plausible that there are a variety of different bacteria that can infect them, and gigantea from different locations/times of the year/etc. may well have different strains naturally in them.

In a human we'd culture to see what was there in a complex infection in order to determine the optimal antibiotic, but that is probably not presently tenable for anemones without even knowing which bacteria are pathogenic and which are not.

I'm going to laugh when someone bites the bullet and send in a culture for sensitivity testing and it comes back ok with Penn VK. Cipro is already on an extreme end, for a fresh anemone from the ocean/lfs would be surprised if it's resistant to Cipro.

There seems to be another variable we're missing in caring for the nems, more than just antibiotics. It would be nice though if a few people would culture their Nems when sick to see what the real antibiotic sensitivities are. Considering the cost of the high end Nems, I imagine the sensitivity cultures cost far less.

 

[OrionN]

As we all know, sea water is full of living organism and a lot of bacterial, most of which are benign and non pathogenic.
In order to culture the true pathogen we got to have someway to differentiate contaminant from true pathogen. IMO, this require culture to normal anemone and sick anemones. Most of us, even doctors do not really have any mean to do that. If we have a reefer who is also work in a lab, then he may have the mean to help us ID these bacterials.

If we start to truly see anemones with infections, all or most, of which are registant to Cipro, we got to start to think that somewhere in the collection chain someone keep them in holding tanks that have continuous Cipro exposure. In conditions like this, they will select for bacterial that is resistant to Cipro and pass them along. Under these condition, they can keep anemones alive while they are in their custody while make it much harder for us reefers to keep them alive in our tank.

I cannot stress enough that hospital tanks need to be keep essential sterile between treatments. If we treat an anemone early enough but fail, likely that anemone was infected with a resistant bacterial. Without sterilize this tank, we are put new anemones in this tank at high rick for getting resistant infection.

 

[DasCamel]

Tank sterilization

Tank sterilization

As we all know, sea water is full of living organism and a lot of bacterial, most of which are benign and non pathogenic.
In order to culture the true pathogen we got to have someway to differentiate contaminant from true pathogen. IMO, this require culture to normal anemone and sick anemones. Most of us, even doctors do not really have any mean to do that. If we have a reefer who is also work in a lab, then he may have the mean to help us ID these bacterials.

If we start to truly see anemones with infections, all or most, of which are resistant to Cipro, we got to start to think that somewhere in the collection chain someone keep them in holding tanks that have continuous Cipro exposure. In conditions like this, they will select for bacterial that is resistant to Cipro and pass them along. Under these condition, they can keep anemones alive while they are in their custody while make it much harder for us reefers to keep them alive in our tank.

I cannot stress enough that hospital tanks need to be keep essential sterile between treatments. If we treat an anemone early enough but fail, likely that anemone was infected with a resistant bacterial. Without sterilize this tank, we are put new anemones in this tank at high rick for getting resistant infection.

Yeah, no need to create or propagate more resistant strains. Cleaning and preventing cross contamination is key.

Regarding culturing a sick anemone, I'm not sure if it would be that hard to find the bacteria in question. If its sick, close to death, the bacteria in question will be present in far greater numbers. A simple internal mouth swap of dying Nem could be all thats needed. Any bored microbiologists around?

 

[Randy Holmes-Farley]

I'm not sure we need to invoke resistance in normally susceptible strains to see pathogens in anemones that are resistant since we have no idea what they are or whether they are normally susceptible to cipro

Cipro is already on an extreme end, for a fresh anemone from the ocean/lfs would be surprised if it's resistant to Cipro.

Well, since we have no idea what the pathogens are, I'm not sure how we'd conclude they are sensitive to Cipro. It is effective against many that infect humans, but that may have little bearing on anemone pathogens.

For example, Cipro is effective against only a third of the anaerobic organisms tested in this study:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC176292/

"The in vitro activity of ciprofloxacin was assessed against 362 strains of anaerobic bacteria and compared with that of cefoxitin, clindamycin, metronidazole, and mezlocillin. Only 31% of the strains tested were susceptible to ciprofloxacin. "

 

[OrionN]

We can culture a bacterial from or on a sick anemone would would not be able to tell if that bacterial is a normal flora organism or a pathogen.

In human, if we want to culture blood, which should be sterile, we don't use any chemical to pressures bacterial growth. However, if we want to culture stool, we must suppress all the normal flora to isolate that pathogen. If we inoculate stool on to a grow media we just get a bunch of normal flora that overwhelm any pathogen

 

[OrionN]

Randy,
Cipro is not an antibiotic that is been use to treat anaerobic infections. The rest of the antibiotics Cipro been compare to in that study are all used to treat anaerobic infections.

 

[DasCamel]

Good info.

Good info.

I'm not sure we need to invoke resistance in normally susceptible strains to see pathogens in anemones that are resistant since we have no idea what they are or whether they are normally susceptible to cipro

Cipro is already on an extreme end, for a fresh anemone from the ocean/lfs would be surprised if it's resistant to Cipro.

Well, since we have no idea what the pathogens are, I'm not sure how we'd conclude they are sensitive to Cipro. It is effective against many that infect humans, but that may have little bearing on anemone pathogens.

For example, Cipro is effective against only a third of the anaerobic organisms tested in this study:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC176292/

"The in vitro activity of ciprofloxacin was assessed against 362 strains of anaerobic bacteria and compared with that of cefoxitin, clindamycin, metronidazole, and mezlocillin. Only 31% of the strains tested were susceptible to ciprofloxacin. "

I always thought cipro had a wider effective range. My expirience is limited to infections of the oral cavity, never really use Cipro. For severe facial cellulitis we tend to go with Clindamycin.

Anyway, w/o testing we're really just guessing at possible solutions. Minh why did you chose Cipro initially?

 

[OrionN]

I choose Cipro intitially because it is cheap, widely available and have very good gram negative coverage.
Most of the bacterial infection in human associated with salt water exposure are Gram negative, maily Aeromonas and Vibrio. We tend to use multiple drugs to treat salt water associated infection but the antibiotic that do most of the lifting is ciprofloxacin or levofloxacin. As I noted in previous thread, bacterial that infect human may not be the same as bacterial that infected anemones, but I have to start somewhere. I decided to used either Cipro or Septra (for the same reason). I initially use Cipro and got great sucess with it so I never look back.

I/We cannot do do any better in antibiotic selection unless we know more about the bacterial, and we don't know anything about the organisms that infect our anemones other than:

1. stressed anemone get infected with bacterial (most likely)
2. there are certainly more than one bacterial species that infect the anemones
3. infected anemone tend to contracted to purge the bacterial from their body. In enclosed space, this does not happen, they purge and retake these bacterial back into their body.
4. these purges exposes non infected anemones to the infectious agent and infect them.
5. some anemone species handle infection better than other

I guess that a lot of these infections are cause by gram negative bacterials similar to human infections.

 

[OrionN]

I always thought cipro had a wider effective range. My expirience is limited to infections of the oral cavity, never really use Cipro. For severe facial cellulitis we tend to go with Clindamycin.

Anyway, w/o testing we're really just guessing at possible solutions. Minh why did you chose Cipro initially?

Oral infection are almost always cause by anaerobe. Clindamycin, Penicillin or Metranidazole works great for these infections.

 

[Randy Holmes-Farley]

1. stressed anemone get infected with bacterial (most likely)
2. there are certainly more than one bacterial species that infect the anemones
3. infected anemone tend to contracted to purge the bacterial from their body. In enclosed space, this does not happen, they purge and retake these bacterial back into their body.
4. these purges exposes non infected anemones to the infectious agent and infect them.
5. some anemone species handle infection better than other

That's a nice summary.

I might also add the possibility that holding tanks along the way from ocean to home may be contaminated with high populations of these pathogens from sick anemones passing through.

 

[DasCamel]

Solid list.

Solid list.

I choose Cipro intitially because it is cheap, widely available and have very good gram negative coverage.
Most of the bacterial infection in human associated with salt water exposure are Gram negative, maily Aeromonas and Vibrio. We tend to use multiple drugs to treat salt water associated infection but the antibiotic that do most of the lifting is ciprofloxacin or levofloxacin. As I noted in previous thread, bacterial that infect human may not be the same as bacterial that infected anemones, but I have to start somewhere. I decided to used either Cipro or Septra (for the same reason). I initially use Cipro and got great sucess with it so I never look back.

I/We cannot do do any better in antibiotic selection unless we know more about the bacterial, and we don't know anything about the organisms that infect our anemones other than:

1. stressed anemone get infected with bacterial (most likely)
2. there are certainly more than one bacterial species that infect the anemones
3. infected anemone tend to contracted to purge the bacterial from their body. In enclosed space, this does not happen, they purge and retake these bacterial back into their body.
4. these purges exposes non infected anemones to the infectious agent and infect them.
5. some anemone species handle infection better than other

I guess that a lot of these infections are cause by gram negative bacterials similar to human infections.

Solid list!

 

[TinManx]

FWIW, people have been using cipro on anemones for at least 7 years. Back in 2007-2008, right before I left the hobby, I was in contact with a local collector who had used it successfully on many mags and was starting to use it on gigantea. I even tried to use another antibiotic, no available cipro, to save a Gig back then. The recent documentation on this board is in no way the first use of cipro.

 

[OrionN]

There have been antibiotic used, but those who used it does not give out any information what so ever. I know because I searched for these information. Here on RC was where dosage, how to use antibiotic, the documentation of success or failure. All the useful stuff was started.
Even in TRA I and II Delbeek and Sprung mention used antibiotic on anemones, however no further information was given. There were no useful information for us reefers.

 

[TinManx]

In terms of developing better treatments for gigantae, I agree with others that culturing and IDing the pathogen would be too difficult for the hobbyist. IMO, our best bet is to try and develop a method to infect aipastia, as it could be a competent model organism. According to the below reference, aipastia is easily infected with cultures of pathogenic vibrio as well as by fluid samples taken from corals infected with CYBD.

http://www.ncbi.nlm.nih.gov/pubmed/24619233

 

[TinManx]

There have been antibiotic used, but those who used it does not give out any information what so ever. I know because I searched for these information. Here on RC was where dosage, how to use antibiotic, the documentation of success or failure. All the useful stuff was started.
Even in TRA I and II Delbeek and Sprung mention used antibiotic on anemones, however no further information was given. There were no useful information for us reefers.

Yes, it is clear that the reason this treatment is available to the reefcentral audience is your effort. Thanks.

However, someone asked why cipro? I just wanted to point out that cipro has been anecdotally utilized for sick anemones for quite some time.