SCTLD last resort treatment

sculpin01

Well-Known Member
View Badges
Joined
Sep 20, 2020
Messages
835
Reaction score
663
Location
Greenville
Rating - 0%
0   0   0
Disclaimer: Try at your own risk. Treatment of this sort is inherently dangerous to both you and your tank. As noted above, this is a last resort option. Wear PPD when handling any antibiotics.

I have a 40 breeder SPS tank that I started with Florida live rock in 2021. At first it did well, but over the past 6-12 months I started seeing widespread STN-type symptoms in otherwise healthy corals and slow growth. Corals would lose colors, brown out (particularly at the tips), then start receding from the base and tips. ICP did not demonstrate anything unusual and nutrients were in the range I like (nitrate ~5-10, phosphate 0.10-0.15). I began to suspect SCTLD (Stony Coral Tissue Loss Disease) brought in on the live rock. I ran across this post:


which demonstrated very similar appearing symptoms which improved with ciprofloxacin treatment. I decided to try the methods they used and treated the tank empirically with ciprofloxacin (one 400 mg tablet crushed in RODI and added daily for three days). (Unfortunately, I did not think to do an Aquabiomics test prior to this.) On day 4, I started passive carbon filtration. The only issue related to this treatment was a forktail blenny that developed swim bladder issues after treatment and eventually succumbed. Everything else was fine. Within about a month, approximately 50% of my corals were showing mild improvement, although the remainder continued to show STN/SCTLD-type symptoms with ongoing tissue recession and subsequent death.


Treatment of SCTLD in wild corals is through the use of a paste form of amoxicillin (I suspect the original form was amoxicillin mixed with zinc-free denture cream, but that is only a guess) applied at the margin of SCTLD:


This has been very effective at stopping progression of the disease but doesn't prevent reinfection. Probiotic treatment of SCTLD is being developed and is effective, but isn't available yet. In addition, SCTLD has been shown to be present in sediment not just on corals, so for aquarists like myself, total tank treatment was clearly indicated.


Given that and the continued loss of corals in the tank, I purchased "pet grade" amoxicillin and decided to follow the dosing recommendations of 500 mg per 20 gallons of tank water (for lack of a better starting point). With a system volume of roughly 40 gallons, this would equate to two 500 mg capsules per day. My initial plan was to treat for 5 days and then start activated carbon, similar to how I treated with ciprofloxacin. Dosing entailed opening the capsules (unscrew/separate the capsule halves gently) and dumping their contents into 200 ml of RODI to make a milky solution that got dumped into the tank all at once. Please note that I wore an N95/gloves while handling the amoxicillin and would recommend the same to anyone attempting this. By day 5, the tank was looking very unhappy with loss of colors in all SPS, so only 4 days of treatment were administered and I started passive carbon filtration on day 5. By day 7, things were not improving and I lost an ORA subulata frag to RTN. I suspected that amoxicillin has a longer half life in aquaria than ciprofloxacin, so I resorted to a 95% water change (much to the displeasure of my fish). I left the passive carbon filtration going and crossed my fingers. Several corals browned out, two exquisita started losing small amounts of tissue, and one valida partially RTNed. The two exquisita got moved to my main tank (which is SCTLD/STN free) but I left the poor valida in the 40 breeder tank to see what would happen. In addition, I moved a few small pieces of live rock from my big tank into the 40 breeder to hopefully reseed the microbiome.

Two weeks later and things have vastly improved. The RTNed valida is regrowing tissue at a rapid rate and is colored up again. Several corals that languished for more than a year are suddenly branching. Colors are appearing that I had not seen before. Tissue recession appears to have stopped for all affected corals, although the most severely affected remain browned-out. Overall, a shocking response to a near lethal treatment.

In terms of recommending this as a treatment, I would have reservations.
1) Essentially, I caused a "microbiome reset" to everything susceptible to amoxicillin, good and bad. If not for having a healthy microbiome from another tank in the form of live rock and the ability to do a near-total water change, this might have led to cataclysmic loss of the tank. I would highly recommend active carbon filtration rather than passive as amoxicillin does not seem to clear as quickly as ciprofloxacin.
2) In my case, having started with Florida live rock, I assumed that the likelihood of SCTLD was high. If you didn't start with Florida live rock, I would definitely send an Aquabiomics test to verify that you have pathologic SCTLD bacteria prior to attempting this treatment.
3) I have no idea whether my dosing strength (500 mg amoxicillin/20 gallons of water) was appropriate for treatment of SCTLD or not. This will require additional attempts at treatment at varying doses and long term results to determine.
 
Last edited:

MnFish1

10K Club member
View Badges
Joined
Dec 28, 2016
Messages
22,561
Reaction score
21,790
Rating - 100%
1   0   0
Disclaimer: Try at your own risk. Treatment of this sort is inherently dangerous to both you and your tank. As noted above, this is a last resort option. Wear PPD when handling any antibiotics.

I have a 40 breeder SPS tank that I started with Florida live rock in 2021. At first it did well, but over the past 6-12 months I started seeing widespread STN-type symptoms in otherwise healthy corals and slow growth. Corals would lose colors, brown out (particularly at the tips), then start receding from the base and tips. ICP did not demonstrate anything unusual and nutrients were in the range I like (nitrate ~5-10, phosphate 0.10-0.15). I began to suspect SCTLD (Stony Coral Tissue Loss Disease) brought in on the live rock. I ran across this post:


which demonstrated very similar appearing symptoms which improved with ciprofloxacin treatment. I decided to try the methods they used and treated the tank empirically with ciprofloxacin (one 400 mg tablet crushed in RODI and added daily for three days). (Unfortunately, I did not think to do an Aquabiomics test prior to this.) On day 4, I started passive carbon filtration. The only issue related to this treatment was a forktail blenny that developed swim bladder issues after treatment and eventually succumbed. Everything else was fine. Within about a month, approximately 50% of my corals were showing mild improvement, although the remainder continued to show STN/SCTLD-type symptoms with ongoing tissue recession and subsequent death.


Treatment of SCTLD in wild corals is through the use of a paste form of amoxicillin (I suspect the original form was amoxicillin mixed with zinc-free denture cream, but that is only a guess) applied at the margin of SCTLD:


This has been very effective at stopping progression of the disease but doesn't prevent reinfection. Probiotic treatment of SCTLD is being developed and is effective, but isn't available yet. In addition, SCTLD has been shown to be present in sediment not just on corals, so for aquarists like myself, total tank treatment was clearly indicated.


Given that and the continued loss of corals in the tank, I purchased "pet grade" amoxicillin and decided to follow the dosing recommendations of 500 mg per 20 gallons of tank water (for lack of a better starting point). With a system volume of roughly 40 gallons, this would equate to two 500 mg capsules per day. My initial plan was to treat for 5 days and then start activated carbon, similar to how I treated with ciprofloxacin. Dosing entailed opening the capsules (unscrew/separate the capsule halves gently) and dumping their contents into 200 ml of RODI to make a milky solution that got dumped into the tank all at once. Please note that I wore an N95/gloves while handling the amoxicillin and would recommend the same to anyone attempting this. By day 5, the tank was looking very unhappy with loss of colors in all SPS, so only 4 days of treatment were administered and I started passive carbon filtration on day 5. By day 7, things were not improving and I lost an ORA subulata frag to RTN. I suspected that amoxicillin has a longer half life in aquaria than ciprofloxacin, so I resorted to a 95% water change (much to the displeasure of my fish). I left the passive carbon filtration going and crossed my fingers. Several corals browned out, two exquisita started losing small amounts of tissue, and one valida partially RTNed. The two exquisita got moved to my main tank (which is SCTLD/STN free) but I left the poor valida in the 40 breeder tank to see what would happen. In addition, I moved a few small pieces of live rock from my big tank into the 40 breeder to hopefully reseed the microbiome.

Two weeks later and things have vastly improved. The RTNed valida is regrowing tissue at a rapid rate and is colored up again. Several corals that languished for more than a year are suddenly branching. Colors are appearing that I had not seen before. Tissue recession appears to have stopped for all affected corals, although the most severely affected remain browned-out. Overall, a shocking response to a near lethal treatment.

In terms of recommending this as a treatment, I would have reservations.
1) Essentially, I caused a "microbiome reset" to everything susceptible to amoxicillin, good and bad. If not for having a healthy microbiome from another tank in the form of live rock and the ability to do a near-total water change, this might have led to cataclysmic loss of the tank. I would highly recommend active carbon filtration rather than passive as amoxicillin does not seem to clear as quickly as ciprofloxacin.
2) In my case, having started with Florida live rock, I assumed that the likelihood of SCTLD was high. If you didn't start with Florida live rock, I would definitely send an Aquabiomics test to verify that you have pathologic SCTLD bacteria prior to attempting this treatment.
3) I have no idea whether my dosing strength (500 mg amoxicillin/20 gallons of water) was appropriate for treatment of SCTLD or not. This will require additional attempts at treatment at varying doses and long term results to determine.
Not a big fan of antibiotics in aquariums especially Cipro - BUT this is a great write up - you should submit it to be used as an article. Thanks for all the references!! Can you explain 'passive carbon filtration' - what and why you used it with this treatment?
 
OP
OP
S

sculpin01

Well-Known Member
View Badges
Joined
Sep 20, 2020
Messages
835
Reaction score
663
Location
Greenville
Rating - 0%
0   0   0
Absolutely.

Passive carbon filtration in my case was simply placing a bag of activated carbon in a high flow area of my sump. Active carbon filtration would entail pumping water through the activated carbon via some form of powerfilter.

Carbon filtration is used as a means of removing the antibiotics (and any breakdown products) from aquarium water. I suspect that the coral toxicity I witnessed was related either to too high a concentration of amoxicillin or the presence of a toxic amoxicillin breakdown product. Following the massive water change, the corals stabilized and improved rapidly.
 

Gatorpa

Well-Known Member
View Badges
Joined
May 28, 2022
Messages
770
Reaction score
666
Location
florida
Rating - 0%
0   0   0
Just curious why do you recommend gloves to handle amoxicillin?

Also Cipro had a longer half life than amoxicillin.
Amoxicillin is like an hour and cipro is like 4.
At least in humans anyway.
 
OP
OP
S

sculpin01

Well-Known Member
View Badges
Joined
Sep 20, 2020
Messages
835
Reaction score
663
Location
Greenville
Rating - 0%
0   0   0
Because some people will be allergic to them. Gloves and N95 go a long way to prevent allergic reaction.

Half life in an aquarium vs half life in a human body are probably not comparable as aquariums lack livers and kidneys for excretion.
 

Gatorpa

Well-Known Member
View Badges
Joined
May 28, 2022
Messages
770
Reaction score
666
Location
florida
Rating - 0%
0   0   0
Because some people will be allergic to them. Gloves and N95 go a long way to prevent allergic reaction.

Half life in an aquarium vs half life in a human body are probably not comparable as aquariums lack livers and kidneys for excretion.
Considering the incidence of allergic reactions to touching amoxicillin is literally infinitesimal it‘s really overkill.

Your far more likely to get some sort of reaction from touching a coral without gloves.
To each his own I suppose.

Antibiotics going into a tank certainly aren’t metabolized by a liver or kidney, although fish will have some effect. Likely they are broke down more by carbon filtration and the bio filtration.

I’ll have to do some research and see if there any papers on the matter.
 
OP
OP
S

sculpin01

Well-Known Member
View Badges
Joined
Sep 20, 2020
Messages
835
Reaction score
663
Location
Greenville
Rating - 0%
0   0   0
Having done this therapy, I can tell you that powdered antibiotics aerosolize. Anaphylaxis to antibiotics is fairly common and people unconsciously touch their mouths on the regular. Given this, basic safety precautions are not unreasonable.

I tried to find sources on ciprofloxacin and amoxicillin breakdown in the environment but didn't get far. Cipro seems to be sensitive to UV. Amoxicillin appears to be less so, although I could not find a direct comparison.

I purposely did not utilize carbon filtration during treatment as I did not want to remove the antibiotic from the water.
 

Gatorpa

Well-Known Member
View Badges
Joined
May 28, 2022
Messages
770
Reaction score
666
Location
florida
Rating - 0%
0   0   0
Having done this therapy, I can tell you that powdered antibiotics aerosolize. Anaphylaxis to antibiotics is fairly common and people unconsciously touch their mouths on the regular. Given this, basic safety precautions are not unreasonable.

I tried to find sources on ciprofloxacin and amoxicillin breakdown in the environment but didn't get far. Cipro seems to be sensitive to UV. Amoxicillin appears to be less so, although I could not find a direct comparison.

I purposely did not utilize carbon filtration during treatment as I did not want to remove the antibiotic from the water.
Sorry man 25 years of Emergency medicine in a very busy ER (100k patients a year) and we rarely see antibiotic induced anaphylaxis perhaps 1-2 cases a year.

The occasional rash affect oral antibiotics yes but not anaphylaxsis.

But like I said to each his own.
 

LimestoneCowboy

Community Member
View Badges
Joined
Sep 9, 2018
Messages
58
Reaction score
49
Location
ReefNation
Rating - 0%
0   0   0
@sculpin01 just checking back to see how things are progressing and if you are seeing any unintended results post treatment. Any lessons learned or things you would try differently? Any coral pics of the recovered ones? Trying to learn from your experience. Thx!
 
OP
OP
S

sculpin01

Well-Known Member
View Badges
Joined
Sep 20, 2020
Messages
835
Reaction score
663
Location
Greenville
Rating - 0%
0   0   0
Past the actual week of treatment, I have had no issues with any of the corals, fish, or invertebrates. I’m at work currently but will try to post pics when I get a chance.
 
OP
OP
S

sculpin01

Well-Known Member
View Badges
Joined
Sep 20, 2020
Messages
835
Reaction score
663
Location
Greenville
Rating - 0%
0   0   0
Here's one example of the sudden growth. This guy encrusted for 10 months with minimal growth (purchase date 4/18/21). Post antibiotic treatment, growth has been absolutely stellar. First pic is 2/13/22, second is from today.


IMG_5743.jpeg

IMG_6818.jpeg
 

92Miata

Valuable Member
View Badges
Joined
Feb 26, 2020
Messages
1,523
Reaction score
2,485
Location
Richmond, VA
Rating - 0%
0   0   0
I appreciate your experience. I have seen antibiotic anaphylaxis (under general anesthesia, to boot) and it's not something I would recommend.
The fact that you have to deal with this is frustrating.

Very few things are less helpful than telling people not to use PPE, especially when handling medications or pesticides. People's immune systems can do weird things - especially when you're dealing with concurrent exposures with things like coral toxins. And when you're dealing with powder and the drastically increased surfaced area that entails rather than a whole capsule risks go up.

"Very few people have anaphylactic reactions" is poor solace when you end up being one of those people. It's really easy to be safe here. The gloves and N95 recommendation is a prudent one.
 
OP
OP
S

sculpin01

Well-Known Member
View Badges
Joined
Sep 20, 2020
Messages
835
Reaction score
663
Location
Greenville
Rating - 0%
0   0   0
Fairly spectacular, actually. I’m continuing to see new growth and branching from multiple previously stalled corals, most recently an ORA rosaria and an ORA turquoise stag, both of which sat in the tank doing nothing for months prior to the amoxicillin treatment. Whatever it was slowing growth appears resolved at this time.
 

Montagne

Community Member
View Badges
Joined
Sep 23, 2020
Messages
59
Reaction score
14
Location
Michigan
Rating - 0%
0   0   0
@sculpin01 Thanks for sharing your experience and insight. I recently received the below Aquabiomics results indicating that a STCLD associated pathogen is present in my tank:
Screenshot 2023-03-26 at 10.27.50 PM.png


Unfortunately, searches for "Planktotellea" return literally one article hit so I'm not able to select for an appropriate antibiotic for my particular case. I would like to perform a treatment similar to yours and see if subsequent Aquabiomics tests show any improvement. Given your initial experience, could you kindly outline a next iteration/"what you would do differently next time" method and dosage that I could try?
 
OP
OP
S

sculpin01

Well-Known Member
View Badges
Joined
Sep 20, 2020
Messages
835
Reaction score
663
Location
Greenville
Rating - 0%
0   0   0
I recently found Planktotella in my big system on an Aquabiomics test. I suspected something was up given that I had seen weird pseudo-bleaching in several corals. Given that I was dealing with 420 gallons of system volume, amoxicillin for 3-7 days followed by a massive water change was not an option. Instead I decided to treat with ciprofloxacin at 1.25 mg/gallon for 10 days dosing at lights out (cipro is moderately photosensitive). Following completion, everything seems to be doing well. I’m waiting for my new Aquabiomics test to see what effect this has had.
 

Montagne

Community Member
View Badges
Joined
Sep 23, 2020
Messages
59
Reaction score
14
Location
Michigan
Rating - 0%
0   0   0
I recently found Planktotella in my big system on an Aquabiomics test. I suspected something was up given that I had seen weird pseudo-bleaching in several corals. Given that I was dealing with 420 gallons of system volume, amoxicillin for 3-7 days followed by a massive water change was not an option. Instead I decided to treat with ciprofloxacin at 1.25 mg/gallon for 10 days dosing at lights out (cipro is moderately photosensitive). Following completion, everything seems to be doing well. I’m waiting for my new Aquabiomics test to see what effect this has had.
Ok great to hear that you also going the Aquabiomics route and that the cipro has been promising so far. I hope you will consider sharing your results on here when they become available!
 

Kerbash

Active Member
View Badges
Joined
Oct 9, 2019
Messages
220
Reaction score
141
Rating - 0%
0   0   0
Following

My tank has been suffering from the same issue of RTN/STN too, Im pretty I can pin point it too when it started. I brought a macro algea from a Florida vendor, 4 months ago since then my acropora started RTN/STN out of no where, almost 100% sure its pathogenic too. Multiple healthy acro down flow from a sick acro had RTN, multiple proximity cases too.

4 days ago I started a combo, 1mg/L cipro and 1mg/L amoxicillin, some adverse side effect is occurring one of my tenuis is looking pretty unhappy, though all seemed to STN stopped and no new RTN case as of yet.

Im really interested your Aquabiomics, and if wither or not it has a dent in the population. Because I'm really not sure what the optimal dosage is. I picked 1mg/L because that seems to be the upper limit of some marine bacteria according to some paper i saw.
 
OP
OP
S

sculpin01

Well-Known Member
View Badges
Joined
Sep 20, 2020
Messages
835
Reaction score
663
Location
Greenville
Rating - 0%
0   0   0
Amoxicillin is very hard on some corals, although I do not understand why. If you can make it to 7 days, it'll decrease your chances of persistent bacteria. If things look bad, huge water change and cross your fingers.

I'm actually concerned about shrimp, snails, crabs, and hermits coming out of Florida. SCTLD is known to reside in sediment where a lot of these organisms live. One option might be to quarantine and send an Aquabiomics test for new clean up crew.

I got my new Aquabiomics test kit this week, so I should be able to get it in the mail by Monday.
 
Back
Top