Please STOP CIPROFLOXACIN DIPS and other antibiotics

[Manny’s Reef]

I've used ciprofloxacin as a dip along with chemiclean and iodine. It's only as a last resort to save a very expensive coral. But I would never treat the entire system with antibiotics. I've never had any luck saving sps with it. If I see a coral struggling for a long period of time I will make a small antibiotic dip and place the coral in the solution for a few hours. I always wondered if the next time that coral looks unhealthy would it be resistant to antibiotics?

The issue is what you're doing with the treated water afterwards? Pouring down the drain?

 

[Auto-pilot]

Just for the sake of discussion, how do you know that another antibiotic not used in humans would not have done the same thing? Or an antibiotic with less of a broad spectrum? I would make the point that unless you know what you're treating you shouldn't be treating.

Again - the inactivation of the cipro is not really important - since bacteria multipley so quickly IF resistance develops its there. Second - the fact that many types of resistance are transferred by through plasmids/bacteriophages resistance to MANY other antibiotics can also be caused.

Lastly - IF a reefer wants to use an antibiotic - its practically impossible to dose correctly if you are using a tablet because 1) the medication is often not evenly dispersed through the tablet 2)

1) I don't know what other antibiotics would work, I've experimented with others but have found the KFC dip seems to work fantastic with most of the issues I have diagnosed as either a protozoan or bacteria using my microscope. Chloramphenicol has also been effective

2) to say quantity is irrelevant and besides the point is very debatable. 1 mole of Cipro dumped down the drain vs 100 moles of Cipro is going to be drastically different and the lower quantity is at less risk to create a resistant strain in the environment. To say that quantity is irrelevant would mean that any time people use Cipro and pee it out we would be risking creating a resistant bacteria. To some degree we are taking a risk but quantity is so low they deemed it to not be a threat. If you would ask my interpretation of the problem I would argue that it's based on quantity being dumpee as well as individual uses of antibiotics.

3) I was unaware of the uneven distribution of antibiotics in pill form. I think from now on I will crush my antibiotics and use a scale to administer a correct dosage.

There are realistic solutions to this problem that don't include just throwing the idea of treating with antibiotics out the window. For an example if we used bleach and added it to the solution before we dumped it. This would effectively help break the antibiotic down and kill supposed bacteria that could have become resistant in our solution. I could advocate for that. Even though you don't believe it; antibiotics can be a great tool to help our animals. The biggest risk to human health is not what I dump down the drain but the bacteria we create in our bodies that becomes resistant when taking antibiotics incorrectly

 

[JCOLE]

Well looky here. This seems promising! Reef Builders just linked this as well. They use Amoxicillin but have found a probiotic that might be better due to bacterial resistance. I feel they are close to finding the RTN cure.

Chemical and genomic characterization of a potential probiotic treatment for stony coral tissue loss disease - Communications Biology

A multidisciplinary approach identifies broad-spectrum antibacterial activity of Pseudoalteromonas sp. strain McH1-7 against stony coral tissue loss disease, which is threatening Caribbean coral reefs.

www.nature.com

 

[ScottB]

This is not a common antibiotic. This is one of the best medical weapons today.

I keep my Cipro safe like gold. My Doc described it as the "break the glass med" for super bad wreckage when you just cannot recover from a stomach flu type thing. I got the scrip ages ago for a trip to edgy places under edgy circumstances. Is it still effective after 5 years?

I totally agree with your initial points about the dangers of environmental distribution of this valuable antibiotic.

 

[Tony Thompson]

I appreciate you making this post - my thesis for my phd was on treatment resistant infections (both bacterial and fungal) and I am often alarmed at how many reefers use Cipro especially, but also Amoxicillin so casually.

Hi with regards fungal resistant strains in humans, do you have any comment on the arbitrary use of Azoles such as Fluconazole in aquariums.

Cheers Tony.

 

[Rubymoon286]

Hi with regards fungal resistant strains in humans, do you have any comment on the arbitrary use of Azoles such as Fluconazole in aquariums.

Cheers Tony.

For me it falls in a similar category as antibiotics, though there isn't truly an antifungal that's as broad spectrum as something like Cipro is as an antibiotic. I think it's situational with a confirmed diagnosis of specific fungal infections in fish. I would refrain from using it as a way to treat Bryopsis since there are other ways to manage algae than jumping straight into using human grade medication. The fastest way to create treatment resistance is though low dose exposure that isn't enough to completely clear up an infection, and unfortunately, when we dose reef tanks, we are setting up an ideal environment for that.

On a larger public health scale, it's also very hard to remove antibiotics and antifungals during waste water treatment without taking extra steps that many water treatment plants just aren't set up for. So the medicines get into the water at low levels, and that water is used for human consumption, watering yards, etc. and it exposes harmful fungi or bacteria to these low levels, and improve their ability to resist these treatments.

 

[MnFish1]

Look at this issue this way - they are attempting to decide how much covid there is in various cities by looking at their wastewater. Bacteria can divide (double) every 15 minutes more or less - depending on the temperature. (PS- there is no light (which inactivates cipro) - in the sewer

 

[Tony Thompson]

For me it falls in a similar category as antibiotics, though there isn't truly an antifungal that's as broad spectrum as something like Cipro is as an antibiotic. I think it's situational with a confirmed diagnosis of specific fungal infections in fish. I would refrain from using it as a way to treat Bryopsis since there are other ways to manage algae than jumping straight into using human grade medication

Thanks for the reply.

Its a topic I am interested in and appreciate qualified input from persons such as yourself. Scott Oliphant had some very interesting points on the subject also. Interesting to see data on the rise in resistance to Fluconazole in the USA.

With regards the topic of antibiotics, Richard Ross mentioned his proposal to in tank dose oxalinic acid (antibiotic) to treat as far as I could tell, undiagnosed (or at least pre diagnosis) RTN. Do you or any others within our community have any comment on this?

There seems to be a number of papers describing resistant strains of bacterial spp. with regards use of OA in aquaculture.

I am aware of the new quinolines such as Cipro have succeeded OA in some uses. However I find use of such drugs concerning without the input of a veterinarian or more importantly one who belongs to a suitably regulated body.

This concern is increased when the unregulated use is openly discussed on social media platforms and within the hobby in general.

 

[Rubymoon286]

Thanks for the reply.

Its a topic I am interested in and appreciate qualified input from persons such as yourself. Scott Oliphant had some very interesting points on the subject also. Interesting to see data on the rise in resistance to Fluconazole in the USA.

With regards the topic of antibiotics, Richard Ross mentioned his proposal to in tank dose oxalinic acid (antibiotic) to treat as far as I could tell, undiagnosed (or at least pre diagnosis) RTN. Do you or any others within our community have any comment on this?

There seems to be a number of papers describing resistant strains of bacterial spp. with regards use of OA in aquaculture.

I am aware of the new quinolines such as Cipro have succeeded OA in some uses. However I find use of such drugs concerning without the input of a veterinarian or more importantly one who belongs to a suitably regulated body.

This concern is increased when the unregulated use is openly discussed on social media platforms and within the hobby in general.

I think prophylactic antibiotics are too big of a risk personally, especially Cipro or other quinolines. I think in a professional setting it's a more acceptable risk, but the risk goes up when the user is someone who doesn't have all of the data prior to treating. I recently read a peer reviewed study about probiotic use in place of antibiotics in treatment of RTN but I can't seem to find it to link (I'll keep looking for it because it was a very interesting study and I meant to bookmark it.)

I'd love to see what others' thoughts are here too, because I'm by no means an expert on RTN. My expertise lies in public health and the processes that cause infectious germs to evolve, so my opinions are coming more from that standpoint than (what I feel is) my basic to intermediate knowledge about coral diseases. At the end of the day I don't believe we should ever over treat especially without a specific diagnosis, and even then the way we dose should be driven by qualified vets or other professionals in the field. The risks are just too great in an already losing battle unfortunately.

 

[Tony Thompson]

I recently read a peer reviewed study about probiotic use in place of antibiotics in treatment of RTN but I can't seem to find it to link (I'll keep looking for it because it was a very interesting study and I meant to bookmark it.)

I have read the paper I think you are mentioning. Specifically corals in Florida, it may also be on this forum as a link.

 

[Thales]

I just want to point out that I am not willynilly dumpung antibiotics into my tanks as a prophylactic. RTN/STN was moving in my display and after being in contact with some people working up a treatment/best practices and looking into the non human use antibiotic and how it breaks down, dosing seemed like a useful thing to do for the folks working on the treatment, but aHail Mary pass for my corals. I think the important thing to note is that I was willing to risk my entire display on this rather than watch things go downhill like I have watched in the past. Every time I am
In control of the messaging in an article or on social media, I try to be sure that I mention why I think AB’s in general might be problematic, and ver much advocate not using human important drugs like cipro. I think even wrote about that in this thread. If I hadn’t already been discussing the treatment with folks working on it, I wouldn’t have know about it nor done it.
On the topic of confirming diagnosis or talking with a vet, in the states neither of those is practically possible. On the diagnosis front, we have one dna testing company that does Edna for saltwater tanks and getting the results is currently too slow to be actionable for RTN, and I that database is still building. On the vet front, there are almost literally no vets that know anything about treating corals, or even what a coral is - never mind trying to get a script for an expiremental treatment. I would love for there to be fast and affordable diagnostic pathways and accessible vets that know the animals, but right now there aren’t. Heck, getting interceptor, a decades proven treatment, is night impossible in the states at least.
Thanks for listening, and please don’t dump
Stuff in your tank on a whim.

-rich ross

 

[Tony Thompson]

@Thales , Hi Richard, my intention is to explore further the validity of certain statements made in conversations, specifically on social media. As I have been following the conversations for some time now including but also prior to the very interesting conversation you had with Scott Oliphant on the much broader subject.

Statements such as " non human use antibiotic " broadcast recently by not just yourself but others in the hobby media" need clarification.

I stress the word clarification. I personally have absolutely no idea.

Although the World Health Organisation report "Critically Important Antimicrobials for Human Medicine" have Oxalinic Acid listed as:

"Example of drug products used in both human and veterinary medicine"

Comments column both attributed to OA.

"Limited therapy for Campylobacter spp., invasive disease due to Salmonella, and MDR Shigella spp. infections."

" May result from transmission of Campylobacter spp. and Enterobacteriaceae, including E. coli and Salmonella, from nonhuman sources"

I will also stress I am not against the use of antibiotics within the hobby. My concern is the lack of regulation and possible misinformation or more likely, lack of comprehension of the reader or viewer.

On Reading my comment back to myself, I can see how this may have been viewed as singling you out , I apologise for that as the conversation I have been following also included Chris Meckley, Julian Sprung, Charles Delbeek and Dong Zou.

My biggest caveat is, I am personally neither knowledgeable enough or qualified enough to give validated input on the subject.

My citing of the WHO document is an example of my ignorance on the matter, I don't have the tools or knowledge to put that into context. However I don't think it should be discounted as confirmation bias, alternatively I think clarification on the subject is extremely important.

Maybe the fact that I am based in Europe is a factor in forming my opinions. Europe and USA seem to be worlds apart on the subject. This was my reason for using the particular colloquialism "flogging a dead horse".

Recently watching the drama "Dopesick" was illuminating with regards the historical role of the FDA in the USA. On a lighter note, watching you frantically texting your dealer live on air for your supply of OA was entertaining.

In conclusion I sincerely hope you have success with your endeavour to illuminate the problems you are currently witnessing in your impressive reef aquarium.

Tony.

 

[Reef and Dive]

Hi with regards fungal resistant strains in humans, do you have any comment on the arbitrary use of Azoles such as Fluconazole in aquariums.

Cheers Tony.

I’m a lot less worried about fluconazole.

First because it is usually used for in tank treatments and not dips, getting inactive over few days.

Second, because it is a lot less important for medical use and in terms of resistant-resulting microorganisms.

Cipro is more of gold-value for us…

Reason why I was really worried and made this post after people started

 

[Tony Thompson]

I’m a lot less worried about fluconazole.

Here in the UK Fluconazole is not a prescription drug, however it can only be issued by a regulated pharmacist after completion of a questionnaire. There has also been a detailed discussion around the possible misuse of azoles in the wider community of reef keeping.

There is data and research that mentions the sleeping threat of human fungal infections. There is also data that suggests a growing resistance to Fluconazole including the USA. Due to my limited knowledge I can not put that data into context, so thanks for your qualified input.

Also in Europe we have products based on Bio Algicides that are specifically marketed and readily available of the shelf in reef aquarium stores. Unlike some of the USA algal (one in particular) products the products in Europe have a complete MSDS and state on the bottle which Bio Algicide is contained.

Regulation is the point I would like to amplify within this discussion.

Its not the effluent that I am singularly worried about, its the formation of resistant strains and possible transfer to the wider community of those strains. If we create a resistant strain it could theoretically be passed on through ownership via frag swaps or the trade in general. That is why I stress the point of regulation lays within the source. This is the point at which regulation is most plausible. If we can eradicate possible infections at wholesale level through regulated practice, then the knock on effects and transition of that disease may be mitigated.

Tony.

 

[Tony Thompson]

Is treating the effluent or the biological breakdown of the ant biotic the only consideration here?

Or is the most significant threat the evolution through unregulated supply and dosage or protocols and transmission of a resistant strain?

IMO/ IME, neither the trade or the hobby can be trusted with self regulation.

 

[immo]

Anybody that questions whether or not antibiotic resistant bacteria are real, and/or dangerous check out MRSA. Just got out of the hospital from a cellulitis infection in my leg. Evidently they see a lot of MRSA in the same scenario.

 

[amoore311]

A 9 page thread about the efficacy of antibiotics being jeopardized because, maybe, couple hundred people have or may try to save their corals in the future?

the hobby is small, the amount of people who give enough of a crap about the hobby to be browsing the internet researching coral disease treatments is even smaller. the amount of those hobbyists willing to source and try the stuff, after researching even smaller.

Talk about trying to put a wild fire out with a watering can.

Referencing responsible ways and scenarios to use product x, is going to go a lot farther than feeding into the gloom and doom narrative.

 

[workhz]

A 9 page thread about the efficacy of antibiotics being jeopardized because, maybe, couple hundred people have or may try to save their corals in the future?

the hobby is small, the amount of people who give enough of a crap about the hobby to be browsing the internet researching coral disease treatments is even smaller. the amount of those hobbyists willing to source and try the stuff, after researching even smaller.

Talk about trying to put a wild fire out with a watering can.

Referencing responsible ways and scenarios to use product x, is going to go a lot farther than feeding into the gloom and doom narrative.

I may have urinated into the toilet when on Cipro a long time ago (I no longer am ok taking it because it can lead to tendon issues). I am sorry for the harm I have caused humanity. Thoughts and prayers.

 

[Thales]

A 9 page thread about the efficacy of antibiotics being jeopardized because, maybe, couple hundred people have or may try to save their corals in the future?

the hobby is small, the amount of people who give enough of a crap about the hobby to be browsing the internet researching coral disease treatments is even smaller. the amount of those hobbyists willing to source and try the stuff, after researching even smaller.

Talk about trying to put a wild fire out with a watering can.

Referencing responsible ways and scenarios to use product x, is going to go a lot farther than feeding into the gloom and doom narrative.

How many people do you think are in the hobby just in the US? When you searched antibiotic use on this site, how many instances of it being used did you find?

 

[MnFish1]

2) to say quantity is irrelevant and besides the point is very debatable. 1 mole of Cipro dumped down the drain vs 100 moles of Cipro is going to be drastically different and the lower quantity is at less risk to create a resistant strain in the environment. To say that quantity is irrelevant would mean that any time people use Cipro and pee it out we would be risking creating a resistant bacteria.

Actually - it's probably the opposite. The less cipro - the more resistance - to a point. Of course - I do not have a plot to show you - but - its LOW concentrations of antibiotics that promote resistance not high concentrations. So - you're right it's not irrevalant - IMHO- Except for the comment that NONE is best.