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This medication was originally developed to combat the parasites that cause amoebiasis and giardiasis in man and wreak havoc on the human GI tract (Kaptur, 2004), and it remains the treatment of choice for eradicating internal parasites (intestinal flagellates, digenetic trematodes, etc.) in seahorses. It is extremely effective in treating wasting disease (weight loss despite eating well) and loss of appetite when they are due to such intestinal parasites (Kaptur, 2004).
Metronidazole is most effective when ingested (Kaptur, 2004), and is best administered orally via gut-loaded shrimp. If administered in a hospital tank, it will be absorbed from the water through the gills, but is most effective at elevated temperature (80-90 degrees F), which means this method of treatment is only practical for tropical seahorses.
Metronidazole is only active against anaerobic bacteria, so it is one drug that can be used safely in your main tank without impairing the biofiltration (Kaptur, 2004). This is a very safe with medication with little to no danger of overdosing.
Metronidazole can be combined safely with aminoglycoside antibiotics such as Kanamycin and neomycin to create a potent synergistic treatment that's effective against both aerobic and anaerobic bacteri