Preparing a 1st aid kit

Dear Seagazer:

Yes, sir, I would be happy to recommend some must-have medications all seahorse keepers should keep on hand. A basic seahorse First Aid Kit should include the following items:

Methylene Blue (for reversing nitrite poisoning and relieving respiratory distress);
Betadine (as a topical treatment for disinfecting small cuts, scrapes, or minor injuries);
Formalin (for treating ectoparasites and fungal problems);
Antiparasitic for treating internal parasites (i.e., praziquantel or metronidazole);
Small Syringe with Needle and Cannula (pouch flushes, tube feeding, needle aspirations);
Diamox (i.e., acetazolamide for treating Gas Bubble Disease);
Deworming Agent such as Panacur (for hydroids, Aiptasia, nematodes and bristleworms);
Vibrance (includes beta-glucan to boost the immune system and help prevent disease);
Broad-Spectrum Antibiotics (i.e., neomycin sulfate or Neo3 for treating bacterial infections).

It sounds like you’ve already got a pretty good head start on rounding up the necessary medications, Seagazer. Having these items on hand will allow you to address nearly all of the common afflictions of seahorses promptly and effectively, as discussed below in greater detail:

The Seahorse Keeper’s Medicine Chest

Prevention is our first goal but is not always possible to achieve, of course, and when disease problems do crop up, early detection of the problem and prompt treatment are the keys to restoring health. Some diseases are remarkably fast acting, such as pathogens and parasites that multiply by binary fission and can quickly explode to plague proportions when conditions favor them. By the time a health problem becomes apparent, there is often no time to make the rounds of your local fish stores searching for the right medications, much less time to order the meds you need through the mail.

Savvy seahorse keepers avoid such delays by keeping a few of the most useful medications on hand at all times so they’re right there when needed. For the greater seahorses, the following weapons should be in your disease-fighting arsenal at the ready, and I strongly suggest you stock your fish-room medicine chest will the following: first aid preparations such as methylene blue, a pouch kit, and a good topical treatment for wounds such as betadine; potent antiparasitic agents such as formalin and metronidazole; a good antifungal agent; and broad-spectrum antibiotics. And don’t forget the heavy artillery for emergency situations when you’re not sure what you’re dealing with — combination drugs with ingredients that are effective against protozoan parasites, bacteria, and fungal infections alike.

Must-Have Meds

methylene blue

Commonly known as "meth blue" or simply "blue," this is a wonderful medication for reversing the toxic effects of ammonia and nitrite poisoning (commonly known as "new tank syndrome"). Since hospital tanks are usually without biological filtration, and ammonia and nitrite can thus build up rapidly (especially if you are not doing water changes during the treatment period), it’s a good idea to add methylene blue to your hospital ward when treating sick fish.

Methylene blue also transports oxygen and aids breathing. It facilitates oxygen transport, helping fish breathe more easily by converting methemoglobin to hemoglobin — the normal oxygen carrying component of fish blood, thus allowing more oxygen to be carried through the bloodstream. This makes it very useful for treating gill infections, low oxygen levels, or anytime your seahorses are breathing rapidly and experiencing respiratory distress. It is the drug of choice for treating hypoxic emergencies of any kind with your fish.

In addition, methylene blue treats fungus and some bacteria and protozoans. Methylene blue is effective in preventing fungal infections, and it has antiprotozoal and antibacterial properties as well, by virtue of its ability to bind with cytoplasmic structures within the cell and interfere with oxidation-reduction processes. A "must" for your fish-room medicine cabinet. However, be aware that it is not safe to combine methylene blue with some antibiotics, so check your medication labels closely for any possible problems before doing so.

Povidone Iodine (brand name Betadine)

Povidone iodine belongs to a class of antiseptics known as iodophores. These chemicals exert their antiseptic effect by slowly releasing iodine. Antiseptics (sometimes called germicides) are chemicals that kill or prevent the growth of microorganisms such as bacteria, fungi, viruses, protozoa and bacterial spores. Povidone iodine is used for the treatment or prevention of infection in minor cuts and abrasions and small areas of burns. It is also used for the treatment of fungal and bacterial skin infections.

Available as topical solution, ointment, or surgical scrub (a detergent version used as a skin disinfectant). Betadine is a dark, reddish-brown liquid used as a topical treatment to promote healing of wounds. It can be applied directly to open wounds on the body of injured fish. (Do not add Betadine to your aquarium water!) Direct contact with this compound disinfects wounds and prevents secondary infections. Infected tissue absorbs the disinfectant and is stained red-brown, making it easy to monitor the healing process. It is especially useful as first aid treatment for mechanical injuries and for treating white tail disease (tail rot) and white patch disease in seahorses. Do not allow this product to contact the eyes, gills, or mouth of the injured fish. It can be dribbled over the affected area, thereby minimizing direct contact with the wound and avoiding any further damage to the fishes slime coat.

formalin

This is basically a 37% solution of formaldehyde and water. It is a potent external fungicide, external protozoacide, and antiparasitic, and seahorse keepers commonly use formalin to cleanse new arrivals of ectoparasites during quarantine. Formalin (HCHO) is thus an effective medication for eradicating external parasites, treating fungal lesions, and reducing the swelling from such infections. It is a wonder drug for treating cases of Popeye caused by trematodes, and also eradicates nematodes as well as bacteria.

Formalin has a limited shelf life and degrades to the highly toxic substance paraformaldehyde (identified as a white precipitate on the bottom of the solution); avoid using any formalin product that has such a precipitate at the bottom of the bottle.

When using formalin, beware that it basically consumes oxygen so vigorous aeration must be provided during treatment. It can be administered as a 1-hour bath at a concentration of 200 ppm (l ml per 5 liters of seawater or about 1/5 teaspoon per 1.33 gallons).

Formalin is guaranteed to knock your biofilter for a loop, so confine its use to the hospital tank only!

Metronidazole (Hexamit/Flagyl)

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 bacteria.

Praziquantel

This is a very effective antiparasitic that works equally well against external and internal parasites alike. Like metronidazole, this is a very safe medication that works best when ingested, hence it is best administered by bioencapsulation — i.e., gutloading live shrimp or injecting them with a solution of the medication.

When treating ectoparasites, it can be added directly to the water in the treatment tank (dose one time and leave in the water for 5-7 days). However, in ordinary to do this, it must first be mixed with ethyl alcohol (e.g., vodka) in order to make it water soluble.

Acriflavine

This is a powerful stain, sometimes known as a tanning agent due to cross-linking of proteins it causes (Burns, 2000). It belongs to a class of drugs known as acridines, which bond to the nucleic acids of disease causing organisms. The resulting cross-linking damage kills microbes (some bacteria, fungus, and especially ectoparasites).

Acriflavine is useful for the treatment of open wounds, external protozoan infections and skin parasites, and the control of Columnaris bacterial infections (Flexibacter sp.). Consider using it when seahorses show the following symptoms: increased respiration, loss of normal body color, scratching themselves with their tails or scratching or on objects; lethargic behavior, randomly distributed powdery or dust-like spots on their body, having a yellowish cast (Oodinium); frayed fins, body lesions with reddish color and diffuse white areas (Flexibacter).

The best thing about Acriflavine is that it is very safe. Fish tolerate it very well and it does not effect biofiltration so it can be used to treat the main tank. Acriflavine can be use with methylene blue to aid respiratory distress and increase its effectiveness against protozoan parasites.

Acriflavine is sensitive to strong light and UV and will decompose in their presence. Treatment tanks should be kept under diffuse light and away from sunlight during treatment.

Fenbendazole (Panacur)

Fenbendazole (brand name of Panacur) is an inexpensive anthelmintic agent (dewormer) used for large animals such as horses, and the de-worming granules can be obtained without a prescription from stores that carry agricultural products (e.g., farm and ranch equipment, farming supplies and products, veterinary supplies, livestock and horse supplies, livestock and horse feed) or via the Internet from places such as KV Vet Supply. The granular form of fenbendazole (horse dewormer granules 22.2%) is preferable to the paste for aquarium use, as the dosage of the granules is easier to regulate (Liisa Coit, pers. com.). It is available in packets of 5.2 grams or 0.18 ounces.

Fenbendazole is very useful for debugging live rock (LR) and eradicating bristleworms, hydroids and Aiptasia rock anemones. Because fenbendazole is essentially a de-worming agent, it will destroy any bristleworms, flat worms, spaghetti worms or the like. The FBZ or Panacur treatments are thus best administered to the live rock in a bucket or hospital tank before the LR is introduced in the main tank. Otherwise, the massive die-off of the worm population in the aquarium may require large water changes in order to prevent a dangerous ammonia spike!

Fenbendazole does not have any adverse effects on biological filtration, but be aware that it is death to many Cnidarians besides hydroids and Aiptasia. Mushrooms and related corals are generally not affected, but expect it to have dire effects on other corals (e.g., sinularias), polyps, gorgonians, and anemones. In general, any Cnidarians with polyps that resemble the stalked family of Hydrozoans are likely to be hit hard by fenbendazole, so don’t use this treatment in a reef tank!

Also be aware that fenbendazole seems to soak into the porous live rock and be absorbed indefinitely. I know one hobbyist who transferred a small piece of live rock that had been treated with fenbendazole (Panacur) months earlier into a reef tank, where it killed the resident starfish and Astrea snails. So enough of the medication may be retained within treated live rock to impact sensitive animals months after the fenbendazole was administered. Don’t treat live rock intended for reef systems with fenbendazole (Panacur)!

At the lower dosage recommended for nursery tanks (1/16 tsp. Per 10 gallons), fenbendazole normally does not harm cleaner shrimp and decorative shrimp. With the exception of Astrids (Astrea), Coit and Worden have found it does not usually affect the types of snails typically used as cleanup crews (e.g., Nassarius, Ceriths, and Nerites). It will kill starfish but copepods, hermit crabs, and shrimp are normally not affected.

Macroalgae such as the feathery or long-bladed varieties of Caulerpa or Hawaiian Ogo (Gracilaria) are not harmed by exposure to fenbendazole at even triple the normal dose. In fact, if you will be using Caulerpa in your nursery tanks to provide hitching posts for the fry and serve as a form of natural filtration, it’s a very wise precaution indeed to treat them with a regimen of fenbendazole beforehand.

So fenbendazole (FBZ) or Panacur is primarily useful for ridding bare-bottomed nursery tanks and dwarf seahorses setups of hydroids and Aiptasia anemones, ridding Caulerpa and other macroalge of hydroids or Aiptasia before its goes into the aquarium, and cleansing live rock of bristleworms, hydroids, and Aiptasia rock anemones before it is introduced to the aquarium. If you are serious about raising seahorse fry, fenbendazole is must-have med for keeping your nurseries hydroid free.

It can also be used to eradicate bristleworms, hydroids, an Aiptasia from an established aquarium if it does not house sensitive animals such as live corals and gorgonians, starfish, Astrea snails, or tubeworms and other desirable worms that may be harmed by FBZ, providing you monitor the ammonia levels closely and are prepared to deal with the ammonia spike that may result from the sudden death of the worm population.

Diamox (acetazolamide)

This prescription drug is an effective carbonic anhydrase inhibitor that is commonly used to treat glaucoma, hydrocephaly, and altitude sickness in human. In tablet form (125 mg or 250 mg), it is the only practical treatment for Gas Bubble Syndrome (GBS) in seahorses available to the home hobbyist. Depending on the form of GBS you are treating, it can be administered orally, as a series of baths, or as a pouch wash. Few medications have saved more seahorses’ lives than acetazolamide and it needs to be in your fish room.

Kanamycin

This is a potent broad-spectrum, gram+/gram- aminogylcoside antibiotic. It is wonderfully effective for aquarium use because it is one of the few antibiotics that dissolves well in saltwater and that is readily absorbed through the skin of the fish. That makes it the treatment of choice for treating many bacterial infections in seahorses. Kanamycin can be combined safely with neomycin (as well as metronidazole) to further increase its efficacy. Like other gram-negative antibiotics, it will destroy your biofiltration and should be used in a hospital tank only.

nifurpirinol (Furanase)

Nifurpirinol is a nitrofuran antibiotic that is the active ingredient in many commercial preparations designed for use in the aquarium. It is stable in saltwater and rapidly absorbed by fish, making it the preferred treatment for fungal infections in seahorses (Burns, 2002). Nifurpirinol is photosensitive and may be inactivated in bright light, so use this medication only in a darkened hospital tank. A must-have medication for fungal problems.

Nifurpirinol may be combined with neomycin (see below) to produce a potent broad-spectrum medication that’s effective against both fungus and bacteria. Nifurpirinol/neomycin is therefore a great combination to use when you’re not certain whether the infection you are treating is fungal or bacterial in nature.

neomycin sulfate

Neomycin is a very potent gram-negative aminoglycoside antibiotic. Most of infections that plague marine fish are gram-negative, so neomycin sulfate can be a wonder drug for seahorses (Burns, 2002). As mentioned above, it can even be combined with other medications such as kanamycin, nifurpirinol or sulfa compounds for increased efficacy. For example, kanamycin/neomycin is tremendous for treating bacterial infections, while nifurpirinol/neomycin makes a combination that packs a heckuva wallop for treating mixed bacterial/fungal infections or problems of unknown nature. Keep it on hand at all times.

Neomycin will destroy beneficial bacteria and disrupt your biological filtration, so be sure to administer the drug in a hospital tank.

Sulfathiazole Sodium

This is a wide spectrum antibiotic that is also helpful in controlling protozoa. It uses sulfur as a keratolytic agent, promoting sloughing of dead skin cells and excess mucous production to assist fish in shedding parasites and pathogens. It is the most soluble of all the sulfa drugs and may be combined with neomycin to produce a more effective broad-spectrum antibiotic with potent synergistic effects.

Trimethoprim and Sulfathiazole Sodium (TMP-Sulfa)

A potent combination of medications that’s effective in treating both gram-positive and gram-negative bacterial infections. It exerts its anti-microbial effect by blocking two consecutive steps in the biosynthesis of nucleic acids and proteins essential to many bacteria, making it very difficult for bacteria to develop resistance to the medications. TMP-Sulfa may be combined with other sulfa compounds to further increase its efficacy and decrease the chance of resistant strains developing.

TMP-Sulfa will knock your biofilter for a loop, so be sure to use it in the hospital tank only.

furazolidone

This is an antibacterial agent, possessing both bacteriostatic and bactericidal properties. It is active against various gram-negative and gram-positive bacteria. It is indicated for the control of marine ulcer disease, and may be given orally (via gut-loaded shrimp) to treat systemic infections such as Vibrio.

Furazolidone can be administered as a bath to treat minor external skin infections, using a concentration of from 5 to 25 ppm (mg/L), depending on the severity of infection. Repeat the dosage every 24 hours with a partial water change before re-treatment, and continue the treatments for a minimum of 5 to 7 days (Furazolidone, 2004). An easy way to achieve the recommended dosage level is to add one level teaspoon for each 36 to 180 gallons (18.9 to 94.6 mg/gal). This medication will impair your biofilter, so use it in your hospital tank only.

Combination Drugs (Paragon 2, Furan2, etc.)

That is how hobbyists refer to the drug cocktails that combine antiparasitic, antifungal and antibacterial agents in one commercial preparation. Look for a product that combines the following ingredients in one potent mixture: antiparasitics such as nitrofurazone and metronidazole, effective antibiotics like neomycin, and kanamycin, and antifungals such as nifurpirinol. The result is a powerful combination drug that’s effective against protozoans, fungus, and many kinds of bacteria. When combined together, these medications cover all the bases and the formulation acts as a particularly strong broad-spectrum antibiotic.

A good combination drug is the ultimate weapon in your medicine cabinet. It is effective against a wide range of diseases, making it a versatile shotgun for restoring order when trouble breaks out in your tank. When you suspect an infection is at work, but don’t know whether you’re dealing with fungus, bacteria, protozoan parasites or a mixed infection, don’t hold back — break out the heavy artillery and give the bugs both barrels! Use them with caution in a hospital tank only.

Some examples of combo meds that are commonly available in pet shops and fish stores are Furan2, Paragon II, and Maracyn 2 (be sure you get the saltwater version).

Pouch Kit

Bloated pouch is the most common ailment of seahorses and every seahorse keeper should have the equipment needed to treat the condition on hand. This includes a small syringe with catheter, suitable eyedropper, pipette or the like for rinsing the pouch, as well as a medicated pouch-flush solution. (The small syringe and catheter are also useful for tube feeding seahorses that are on a hunger strike.) Ready-made kits consisting of special antibiotic solution, flushing apparatus and instructions are available from the Ocean Rider seahorse farm in Hawaii, or you can easily assemble your own kit from the necessary components. Acetazolamide combined with nifurpirinol and neomycin makes a superior pouch wash for cleansing the marsupium and stopping the formation of excess gas.

Small Syringe & cannula

Every fish-room medicine cabinet should include a small, clean syringe with a fine-gauge needle. They are indispensable for flushing pouches, tube feeding seahorses that have gone on a hunger strike, and injecting frozen Mysis or live shrimp with medications when administering them orally. Leslie Leddo finds that a 1/2 cc insulin syringe with a 26-gauge needle is ideal for such purposes. For best results, a small diameter cannula or catheter that will fit on the end of the syringe and place of the needle is especially useful for pouch flushes and tube feeding.

Stocking the Arsenal: the fish-room First Aid Kit

Needless to say, your fish-room medicine cabinet does not need to include all of the items listed above. But it should include all of the basics listed below:

Methylene Blue
Betadine
Formalin
Pouch Kit
Small Syringe with a fine needle and cannula or catheter

Together with freshwater dips, these items comprise the basic first aid measures you will need to deal with heavy breathing and many of the most common problems hobbyists encounter, such as bloated pouch and hunger strikes. They are the fish-room Band-Aids, disinfectants, and tools you’ll need for scrapes and abrasions and other minor problems.

Along with your basic First Aid Kit, the seahorse keeper’s medicine chest should also include the following categories of must-have meds so that you are prepared to deal with any major disease problems that may arise:

Antiparasitic Agents: Praziquantel or metronidazole (pick one and keep it on hand at all times).

Antifungals: Nifurpirinol (Furanase) is recommended.

Broad Spectrum Antibiotics: if you can only keep one antibiotic in your fish-room medicine cabinet, make it neomycin sulfate due to efficacy and the ability to combine with the other antibiotics mentioned above. For example, it can be used together with nifurpirinol to create a potent combination that’s effective in combating both fungal and bacterial infections. Or another good choice would be Neo3 by Aquabiotics, which is a concentrated formulation of neomycin sulfate combined with sulfa compounds to produce a potent rot-spectrum antibiotic with synergistic effects.

If you can afford to keep more than one antibiotic on hand, build on that approach and add others that can be safely combined with the neomycin to further increase their potency, such as Kanamycin and Sulfathiazole or other sulfa compounds (e.g., Triple Sulfa).

CAUTION! Antibiotics can become toxic in the presence of copper sulfate, so it is important never to combine antibiotic therapy with copper treatments.

Combo Medications: When it comes to the heavy artillery, Paragon II and Furan2 are my favorite big guns (pick one and keep it at the ready in your arsenal). They can save the day when you’re not sure whether you’re dealing with a fungal problem, a parasite infestation or a bacterial infection. But remember, they are weapons of mass destruction that will nuke your biofilter, so use them with discretion and only in a hospital tank.

Diamox (Acetazolamide): in all its different forms, Gas Bubble Syndrome is one of the most common problems that plagues seahorses, and Diamox is your primary weapon for defeating this affliction. But as a prescription drug, it can be difficult to obtain.

Many of the medications mentioned above can be obtained from your local fish store (LFS). Those that are not available locally can be obtained online through National Fish Pharmaceuticals, aka the Fishy Farmacy: http://www.fishyfarmacy.com/products.html

Having the items above in your medicine chest, ready to use, will enable you to respond to almost any emergency or disease problem that may arise quickly and efficiently.

Best of luck with all your seahorses, guys!

Happy Trails!
Pete Giwojna

Dear Seagazer:

Yes, sir, I can suggest some sources for most all of the most-have meds we’ve been discussing.

Methylene blue, formalin, and metronidazole should be available from any well-stocked fish store.

Pouch Kits and beta-glucan (a primary ingredient in Vibrance) can be obtained directly from Ocean Rider (http://www.seahorse.com/).

Betadine or something equivalent should be available from any drug store or pharmacy.

You can obtain the right kind of Panacur (i.e., fenbendazole) online from the following web site:

Click here: KV Vet Supply / KV HealthLinks – Pet, equine & livestock supplies / Quality nutrition for you!
http://www.kvvet.com/KVVet/product_family.asp?family%5Fid=250&gift=False&0=dept%2Easp%2Cdept%5Fid%3D197%26Tree%3D%2CMost%20Popular&1=dept%2Easp%2Cdept%5Fid%3D980%26menu%5Fid%3D%26Tree%3D0%2CEquine%20Dewormers&mscssid=C531CF573E8C412EB1AD293E86E9A7C6

(Get the 22.2% granules of Panacur/fenbendazole rather than the paste.)

Neo3, a concentrated formulation of neomycin combined with sulfa compounds, is available online from AquaBiotics at the following web site:
http://www.aquabiotics.net/neo3.html

You can get a wide range of antiparasitics, anti-fungals, and antibiotics, including pretty much all the medications on my list from National Fish Pharmaceuticals (aka the Fishy Farmacy) at the following URL:
Click here: Fish Medications
http://www.fishyfarmacy.com/products.html

However, many of the meds from National Fish Pharmaceuticals are only available in relatively large quantities — sometimes more than the average seahorse keeper needs for his fish room Medicine Chest or First Aid Kit. So assembling First Aid Kits for seahorses might make a good project for aquarium clubs or aquarium societies to work on. Members could pool their resources, by the medications in bulk, and then divvy them up for their individual kits…

Diamox (the tablet form of acetazolamide) will be the toughest of the most-have medications to obtain, since it’s a prescription drug. Most hobbyists will need to obtain it via their family physician or local veterinarian.

Best of luck lining up the medications that are important for the seahorse keeper to keep on hand, Seagazer!

Happy Trails!
Pete Giwojna