Cipro Treatments - doctors perspective

As a physician, I know about various antibiotics, including cost and activity spectrum, I decided to use ciprofloxacin due to the reasons I mentioned previously, not because of any anecdotal usage by reefers before.
 
I have a few questions that I'm hoping you (or Dr. Nguyen) can answer:


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.

Have you tried force feeding via syringe in cases like these?
 


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.


As a datapoint, I recently treated a gigantea that had been in captivity for at least 2 years prior to me getting it. The bacterial infection seemed to be brought on by stress from the 15 min drive to my house or the acclimation process. I was surprised to see the inflate/deflate cycle begin within 24 hrs of being in my tank.
 
Have you tried force feeding via syringe in cases like these?

I actually did. I tried using Selcon since there isn't anything for the nem to physically process. Unfortunately, I think it was too late when I started. It showed a slight positive response, but quickly went down hill. I also did a water change immediately after to prevent a nutrient overload.

FWIW, my blue gig was doing fine and went into the DT -- quickly turned for the worse. It's back in QT with Septra but its mouth is gaping and I think I might lose it as well. I've never seen a gig come back from the condition its currently in (deflated and floppy).
 
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 work in a hospital (Respiratory Therapist) and my sister is a nurse. I'm constantly hanging out with the doctors and around antibiotic therapy.

This last Gig I lost was dosed with multiple antibiotics. I tried them all seperate at first, and then started to run a couple together.

Whatever that Gig had, it was totally unresponsive to antibiotic therapy. This leads me to believe it may have been a virus or a different strain of bacteria. However, this would seem impossible because he did respond to Cipro the first Two times he went down. He was treated for roughly 7 days and made full recovery and placed back in DT. So I'm assuming that since none of my other 5 mags died from this infection, that maybe the bacterial was not fully dead in the 7 days of treatment and built up a tolerance to the antibiotic.

I gotta tell you, I send cultures to the lab for testing daily and was very close to taking some of the Gig and bringing it to the lab for testing. Sounds crazy, but I'm friends with my lab colleagues. The bacteria or virus that killed that Gig was bouncing in my brain for days. I would have done just about anything to identify and study it.
 
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.

I believe that as well. These people who are collecting the anemones are not thinking from a medical prospective. All they care about is the money. If there were clinicians out collecting, all variables would be considered. Cross contamination, serialization, etc. of course that would never happen. :-)
 
Have you tried force feeding via syringe in cases like these?

I have and it made both my Mag's and Gig worse.

I have inflated a couple of my very sick Mag's with water. I took an Eheim compact pump (smallest they make) and directed the flow from a distance into it's mouth and inflated it. It even inflated the tentacles. IMO this saved the animal. They we too far gone and shortly after, they began to perk up and later that day were starting to inflate a little on their on. Kinda like giving my patients in the ER a 100% oxygen mask. I think it improved their ventilation/oxygenation status. :-)
 
As a datapoint, I recently treated a gigantea that had been in captivity for at least 2 years prior to me getting it. The bacterial infection seemed to be brought on by stress from the 15 min drive to my house or the acclimation process. I was surprised to see the inflate/deflate cycle begin within 24 hrs of being in my tank.

FWIW, I don't doubt that stress alone might cause it, but OTOH, folks with an established gigantea sometimes find that a new addition eventually makes both sick, suggesting it can be a transferable condition.
 
As a datapoint, I recently treated a gigantea that had been in captivity for at least 2 years prior to me getting it. The bacterial infection seemed to be brought on by stress from the 15 min drive to my house or the acclimation process. I was surprised to see the inflate/deflate cycle begin within 24 hrs of being in my tank.

Curious - I had a similar experience. Bought an ostensibly healthy mag from a local reefer. Maybe 1/2 an hour drive, and ended up having to treat it with Cipro otherwise I would have lost it. Perhaps damage from being moved, stress, who knows - very sensitive animals.

I'd echo OrionN about lack of protocol. I first heard of using antibiotics on mags from the chap who used to run the NYC Aquarium - maybe 1995? No specifics though.
 
Curious - I had a similar experience. Bought an ostensibly healthy mag from a local reefer. Maybe 1/2 an hour drive, and ended up having to treat it with Cipro otherwise I would have lost it. Perhaps damage from being moved, stress, who knows - very sensitive animals.

I'd echo OrionN about lack of protocol. I first heard of using antibiotics on mags from the chap who used to run the NYC Aquarium - maybe 1995? No specifics though.

I too had an experience with a gigantea where I picked it up, and after a 30 minute ride home, and by the time I opened the bag, its mesenterial filaments were hanging out. However, I don't think this in itself would cause it to die, as once it settled into its QT tank, the filaments retreated and the nem expanded greatly. I think it's a combination of the stress of travel, as well as the ailment already present within the nem. I actually felt that my gig was healthy enough to enter the DT after no deflation for two weeks. However, once in the DT it quickly slid downhill -- I am now down two gigantea in 3 weeks. I am now wondering if there was something still present in my DT water that caused the downhill spiral of my second gig.

What's interesting to note is that these nems reacted to Cipro and Septra in different ways, but the end result was the same -- and unique in how the nems physically looked -- both became extremely bleached and began eating themselves and the manner in which they did so happened very quickly (over the course of a couple of days). This leads me to believe that they suffered from the same ailment, but that I received both at different stages of the infection.

I also agree with Orion that many people have experimented with antibiotics but were tight-lipped about the process. I think the key driver -- unfortunately -- was finding the cure to ailments that would allow for a monopoly of sorts when it came to the sale of healthy gigs. What we know now is that there isn't the so-called "magic cure" (yet -- and I remain optimistic) and I believe it's because there are multiple ailments. I agree that collection points/export/import play a key role, as I suspect that gigs recently purchased probably came from the same source. I know that three of the four that I know of all died, and we used the same Cipro protocol that proved successful in the past.

In hindsight, I realize that there were crucial mistakes that I made:

1. Do not introduce an otherwise healthy gig into an environment where a gig died a week prior (we'll need to figure out a safe schedule, if there is one). I wonder if the ailment is caused by an agent like ich where it goes through various cycles.

2. Do not introduce a bleached gig to a DT unless it is showing a good feeding response while in QT. I think my clowns were rough on the nem, more so when I attempted to feed it.

Definitely a tough loss. Until we learn more, I don't think we can say we have a "cure" (not that we ever said that, but I think some were learned towards it) because I strongly feel like we've encountered something new with this crop of gigantea.
 
I also agree with Orion that many people have experimented with antibiotics but were tight-lipped about the process.

Some weren't tight lipped at all, but just not active posters on the boards. I give Orion a TON of credit, he made it accessible to the masses!!! I was just responding to the question of how cipro was decided upon. My incorrect assumption was that it was based on community precedence, as back in the old days I clearly recall being told to use cipro and only cipro. I remember trying to hunt some down unsuccessfully, and using another broad spectrum antibiotic. The procedure that I was given was quite different as well, relying on baths of stronger solutions.
 
Curious - I had a similar experience. Bought an ostensibly healthy mag from a local reefer. Maybe 1/2 an hour drive, and ended up having to treat it with Cipro otherwise I would have lost it. Perhaps damage from being moved, stress, who knows - very sensitive animals.

I'd echo OrionN about lack of protocol. I first heard of using antibiotics on mags from the chap who used to run the NYC Aquarium - maybe 1995? No specifics though.

My old gig was very large and with me for a few years. The funny thing is that I moved that one .... I even punctured it during the move .... and there was no treatment needed.

The current gig that I recently treated that did not come from an importer:

5 days into cipro treatment. No deflates for 3 days.
DSC_0001_01_01_zps984e39e5.jpg


2 days after treatment completion, in DT.
DSC_0005_01_zpsb141ba15.jpg


Almost 3 weeks since completion of treatment (36" tank for reference.)

DSC_00051_zps80280b71.jpg


Still no where near as healthy as my last

IMG_2401.jpg
 
Last edited:
Cipro is a viable choice as Minh had mentioned just due ot general gram - coverage which is a viable thought process considering oceanic organisms.

Without culturing the organism, everything is an educated guess. I guess one could put a swab in the oral cavity but the risk of cross contamination is huge. Sterility of the specimin is also suspect and would cloud any chance of a an accurate culture.

Septra or sulfa based meds viable....same thought process - maybe even a little better in some minor gram + coverage.

I will never buy a mag or gig ever again until I have a QT tank set up based on the huge amount of research the people on these forums have done.

Period
 
Cipro is a viable choice as Minh had mentioned just due ot general gram - coverage which is a viable thought process considering oceanic organisms.

Without culturing the organism, everything is an educated guess. I guess one could put a swab in the oral cavity but the risk of cross contamination is huge. Sterility of the specimin is also suspect and would cloud any chance of a an accurate culture.

Septra or sulfa based meds viable....same thought process - maybe even a little better in some minor gram + coverage.

I will never buy a mag or gig ever again until I have a QT tank set up based on the huge amount of research the people on these forums have done.

Period

What are the negative affects of Cipro or Septra with regards to killing beneficial bacteria? Would it make the bleaching process worse? In my recent experience, I would anecdotally say it does, to the point where the nem starts to starve. In other words, even if the infection is cured, other ailments brought upon by treatment could still potentially kill the nem.

I also want to offer a bit of a back story with regards to treatment prior to Cipro:

http://www.reefcentral.com/forums/showthread.php?t=2156179

As TinManX mentioned, the treatment process with antibiotics is not new and there are quite a few threads on this board and others that are similar to the above. Once questions were asked regarding specifics of treatment, the thread would die. I've spoken to a few people working with antibiotics, and while all offered to answer questions, somehow answers to specific questions were left unanswered.
 
I do not think either Cipro or Septra effect the zooathellae at the noraml pharmacologic dose. Everything will have toxic effect once it reach certain level.
In all of my treatment that were sucessful, none of the anemone bleached. They may get a little lighter but not what I consider bleached, and regain their normal zooxanthellae within a week or two. All of the time, they got plenty of light, at least more than 1/2 (interm of wattage) of what they would get in DT.

FWIW, I do not think that bleaching in these anemone is the effect of the antibiotic, rather, it is the anemone that is sick and or light situation that cause bleaching.
 
How long would it take the bacteria to become resistant to Cipro or any antibiotic? The reason I ask is because a LFS told another customer that the gig he purchased, along with the others the store had the time, were treated previously with Cipro. He's found it not to work as effectively when he began treatment at home.
 
One of the problem with Cipro is that registant to it can be easy. Only one mutation is needed for the organism to be come registant. Second generation fluroquinones bacterial need to have two or three mutations, at the same time, to become registant. It is much harder for organism to become resistant to Levaquin in compair to Cipro. About the very specific mechanism of resistant, I must have dozed off when I got to that part because it did not stick to my brain.
How quick depends on how may bacterial and what the exposure were. There are many different factors come into play.
That is the extend of my knowledge regarding the different between Levaquin and Cipro and how bacterial can become resistant to fluroquinones.
 
Back
Top