Best Medication To Treat Hexamita?

Discussion in 'Freshwater Fish Disease' started by Bhuij, Apr 22, 2017.

  1. BhuijValued MemberMember

    My betta has been displaying signs of Hexamita for several days (I didn't know what it was until I did a whole bunch of research and reading today).

    Because I have had a couple of unexplainable fish deaths (two neons) in the past week or so, I suspect the whole tank has some parasites, so even though it's 55g, I think I'll do a 90% water change and treat the whole tank.

    In addition to what is almost definitely Hexamita in the betta, many of my tetras show a tiny amount of mouth fungus.

    I've done some reading, and I think my best bet for the Hexamita is Metronidazole and/or Nitrofurazone. Can anyone weigh in on these medications and confirm that they will work? My betta has stopped eating, so food-based anti-protozoans are out at this point. Will either of these chemicals also treat the mouth fungus in my smaller fish?

    All knowledge and input is welcome; I'm not real experienced with fish diseases more exotic than Ich, and it's been several years since I even had to battle that.
  2. AllieStenFishlore VIPMember

    So Hexamita is also called "Hole in the Head disease" or HITH. It should be treated with metronidazole or nitrofurazone. (I have been reading up on fish diseases lately). I would put the betta in his own hospital tank for any treatment. Because he is clearly the sickest, it is easier to treat and monitor him if he is separated from your community tank. Plus sick fish tend to do better on their own and get better quicker.

    I believe that you will need to do medicated baths to treat him. So take him from the hospital tank to a smaller container that is going to be used for tank water and meds (it doesn't have to be large, but it has to be dosed correctly) and you put the fish into it for an allotted time as a treatment, then placed back into the hospital tank. Does this make sense? I am super new at this, so I am not good at specific doses. @CindiL is the dosing expert.

    I would treat the rest of your tank for the other parasites or fungus. I know that prazipro is a good parasite cure, but I haven't done too much research on it yet. It just depends on what sort of parasite you suspect.

    What are your water parameters?

  3. BhuijValued MemberMember

    Water is pristine. Ammonia 0/Nitrite 0/Nitrate 5, and only because I dose ferts do I have nitrates above 0. Water is somewhat hard and has a pH of about 7.9 out of the tap, I've had these fish for close to three years though and they've never had trouble with the water here.

    I don't have a hospital or QT tank unfortunately, but I can find another container to do temporary dips/baths with metro or nitro. Thanks!

  4. BeanFishWell Known MemberMember

    For hexamita:Metronidazole, the one designed for humans in pill forms. Super cheap and at least where I live super easy to get.
    250 mg for 10 gal, you chop the pills to little pieces add them into a glass with tank water add a lil bit of lemon (helps disolve it better) mix it and add it to the tank.
    After 3 days you do a 50% water change. You can repeat this up to 3 times.
    You can also give it on food but I have never tried that.
    And I don't think Hexamita is HITH, as far as I know it is an internal parasites associated with the disease.
    A commercial med would also help, I don't know if PraziPro treats for HITH but I know that Seachem has something called MetroPlex which is basically metronidazole in a fancy box, the only reason I would get MetroPlex is to have an easier time with the dosages as they would all come at the back of the package.

  5. WhitewolfWell Known MemberMember

    Ive never heard of using lemon beanfish. OFC focus or whatever it is to bind it to the food is expensive, and also betas dont eat alot at once.
    I have seen my own betas, guppies, and fancy goldfish get heximita from my brother in laws chiclids, when i had to take his tank for him. So i do believe a fish besides a chiclid can get it.....
    They cant pass stool, and eventually get bloated and sit on the bottom and die.
    Metronidazole is practially useless in the water as its one of the worst antibiotics to dissolve, especially in hard water.
    It would be best to mix it in a small cup with some thawed out frozen bloodworms, and just a touch of garlic. Starve the beta for a day or feed at the end of a long day, so that it eats vigoursly and its bowels are empty.
    Its important to make sure the metronidazole actually gets absorbed into the food, let it soak room temp for 30-45 mins, so bloodworms always work best for treating fish like this, for any type of oral med.
    They sell premade medicated flake food of all kinds for cheap at But it needs to beat eaten fast or the medication will just dissapate into the water, even with flake food.
  6. CindiLFishlore LegendMember

    Hi, can you post a pic of your betta? What specifically makes you think its HITH?

    You can buy API General Cure at Petsmart which has both metronidazole and praziquantel in it. Ideally I agree the best treatment is if he'll eat food soaked in the medicine if you could get him to eat something. Mix up the medicine in a small container, soak pellets (ideally) for a minute or so until they're just inflated. Pour the medicine into the tank and dry out the food and feed. Its possible his appetite will come back after a day or two of the medicine in the water (hopefully) and then you can feed him the pellets for his meals with the medicine in them.

    As far as the mouth "fungus", actually a bacteria, yeah nitrofurazone is a good choice, found in API Furan-2 or Tetra Fungus Guard, Hikari Bifuran or Jungle Fungus Clear tabs (this one is at Walmart). They all contain the same medicine with different marketing names. I'd do at least 2-four day rounds.
  7. BeanFishWell Known MemberMember

    Well in these forums we can't have a real discussion because all we have are annectodal claims, I am sharing what has worked for me and others near my area. Metronidazole is poor at disolving that is why I use lemon, it disolves relatively well after that and the fish usually respond well to the treatment. Again just like you, all of this are annectodal claims so you can believe me or not.
    And not only is Focus expensive but MetroPlex too...
    I am just stating what has worked for me. Certainly metronidazole in the food is way better, but I have never used that so I cant recommend it nor tell exact instructions.
    Last edited: Apr 22, 2017
  8. AllieStenFishlore VIPMember

    His betta has stopped eating, so suggesting any sort of oral meds won't help. Needs an alternative route of medication administration. So adding lemon or not adding lemon doesn't matter. Neither method will work.
  9. BeanFishWell Known MemberMember

    Then my first post with Metronidazole in the water should help. A lot of people are scared of lemon messing up their pH but I have added it to both of my tanks with good results and no dead fish. The lemon helps the Metronidazole disolve better as it has the fame of not disolving well in water.
  10. AllieStenFishlore VIPMember

    You can't get human metronidazole over the counter here in the US. It has to come from a doctor with a prescription. Buying it for a fish is easier.
  11. BeanFishWell Known MemberMember

    "human metronidazole" sounds funny haha.
    I am afraid to say you also need a recipe here but no one asks for it, they do ask for recipes when you ask for other meds. Maybe the OP has some metronidazole hanging around at his house, I know I had lol.
    Metroplex is basically metronidazole so I guess that would work. Or just finding a "cool" doctor that will make you a favor for the fish lol.
  12. BhuijValued MemberMember

    Picked up some Metro (API General Cure) at my LFS. It says it's enough to do two treatments for 50g, which is just right for my tank. Apparently two treatments is all it will take.

    Tomorrow I'll do a 90%+ water change to minimize protozoans in my water, and start the treatment. Box says to add powder directly to water, wait 48 hours, add again, wait 48 hours, and remove via activated carbon. I think I'll start with that (probably do my best to dissolve in water before adding since my water is very hard here, may try the lemon juice trick as well).

    If betta isn't at least showing a little bit of improvement at that point, I may re-evaluate my diagnosis. But he's showing all the telltale signs of Hexamita and I did just introduce some new fish into the tank a little over a week ago prior to noticing any symptoms. He just sits on the ground all day long and hasn't eaten in 3-4 days. Coloration still looks good, as does body shape, and while I don't see HITH yet, so far all my reading points to Hex. My water parameters are flawless (Ammonia 0, Nitrite 0, Nitrate 5ppm), and it's the same water he's been living in for over 2 years, so I'm sure it's not just a water quality issue.

    Hopefully in two days he'll at least start eating again. If so, before I add the second dose of Metro to the water, I'll soak some freeze dried bloodworms in it; he loves them and it wouldn't hurt the other fish to get some through their system as a preventative measure as well.

    I'll deal with the mouth fungus at a later date; don't want to try treating two diseases simultaneously and this one is certainly the more urgent of the two.

    Fingers crossed, thanks for the help everyone!
  13. CindiLFishlore LegendMember

    I'm still curious what symptoms are actually making you think its HITH? Not eating and sitting on the bottom could also be from the columnaris (the mouth fungus).

    You'll actually want to do two consecutive full rounds (4 total doses) of the general cure for a good parasite treatment. After the first two, do a large water change and repeat another round.
  14. BhuijValued MemberMember

    The betta displays no sign of mouth fungus, nor has he ever. The tetras have had tiny amounts of mouth fungus for months while still displaying normal behavior.

    A couple of weeks ago, I introduced 6 otocinclus cats to the tank without QT (don't have a QT tank). Within two days, I had lost two ottos and one of my neons got really bloated. Around this time, betta got really lethargic, although he was still eating.

    I assumed the bloat was constipation and fed some blanched pea. The next day that neon died. The next day after that I lost another unexpectedly. A few days later, betta stopped eating. Two days ago, I lost a third neon out of the blue.

    All tetras (I have some neons left as well as 8 gold tetras) still have none or the same tiny amount of mouth fungus. I don't think it's that causing my unexplained deaths or betta'a symptoms. All fish other than betta show normal behavior and coloring. All are eating except betta. Several have stringy white poo however.

    All this can be traced back to the new ottos I added. I believe it to be a tank wide parasite.

    This morning I did a 90% water change and added 250mg/10gal to the tank of API general cure. I have temporarily suspended adding ferts or Excel while I treat this. I dissolved the powder in tank water as best as I could in a small separate container before adding, and soaked some freeze dried blood worms in it. I also raised tank temp from 80 deg to 86.

    The other fish all ate some of the medicated blood worms. Within 15 minutes, betta was showing more activity than I've seen in weeks. He seems to be having a hard time breathing still, and isn't acting particularly healthy, but he's moving somewhat more and even ate for the first time in 5 or 6 days.

    I have high hopes that I'll continue to see improvement over the next two days. If it becomes apparent that the Metro is not making anything better, I'll remove it and try treating with Nitrofurazone instead.
  15. CindiLFishlore LegendMember

    They can definitely die of columnaris even though you only see small amounts of mouth fungus. Some fish with columnaris never show the mouth fungus and its very contagious. There are four strains and one of them kills with 24-48 hours so if you brought any fish if with the disease it can spread rapidly.
    Its fine to use GC first of course, just want you to be aware that it could be something else. By the time you know see signs of HITH (the pits along the lateral line and head) its fairly hard to treat and doesn't have many symptoms before that. Stringy white poo can be a sign of internal parasites though so I do agree is a good treatment to start with.

    Columnaris Symptoms and Treatments: What is it? Columnaris is a gram negative aerobic bacterial...
  16. BhuijValued MemberMember

    Here's hoping. Whether it's columnaris, Hexamita, both, or neither, it almost certainly came in with the otos. Thanks for all the information, I'll keep everyone posted on this thread. Fingers crossed for significant improvement in Neptune's health over the next 48 hours before I dose again.

    Since I am positive that some of my tetras are showing some mouth fungus, I think I will follow up my API General Cure treatment with some Furan-2 regardless of the outcome.
  17. BhuijValued MemberMember

    Update: Neptune had a pretty rough day yesterday. He was mostly lying in the corner having a hard time breathing. Occasionally he would swim up to the surface erratically and get some air there before sinking back down to the bottom. However, he ate a few flakes, which is more than I can say for the past about week.

    I was worried he wasn't going to make it through the night, but this morning when I checked, he's still lying on the ground under natural "archway" of driftwood, still breathing. His breathing seems to have actually improved a bit since yesterday. I'm hopeful he's making a good recovery.

    Tomorrow afternoon I will be adding the second treatment (should I do a water change before adding the second installment of treatment? I believe the box says to do a 50% WC I think) This time I will soak some flakes in the Metro concentrate before adding it. Hopefully we can get a few medicated flakes into Neptune's system to flush out the parasites more directly. I'll also be picking up a second box of this stuff so I can do two more treatments.

    All other fish in the tank seem to be doing great.
  18. CindiLFishlore LegendMember

    If the box says to, then I would.
  19. WhitewolfWell Known MemberMember

    There is no surefire way to treat every disease. We do not know it all, even tho we are very good at helping newcomers, and intermediates to the hobby.
    Internal problems can be a nitmare, or sometimes a fish will just get old and sit on the bottom, or get skinny and bent tail when it gets old. Its not always gut parasites...........
  20. BhuijValued MemberMember

    Well Neptune is still fighting. I re-read the box and it actually didn't mention anything about water changes between rounds of treatment, so I just added the second dose today, this time soaking some flakes in the concentrated water before pouring it in. He tried eating some flakes (a good sign!) and may have gotten one or two down, but he seems to have almost no energy, and couldn't swallow his third flake, it just fell back out of his mouth.

    Now that I've seen him eat the flakes, if I see no further improvement in 48 more hours, I will start considering clove oil. He's quite an old fish and he's had a good life. He's been suffering for over week now. Unless there's a compelling reason to try some kind of alternative treatment, it might be more humane to just put him out of his misery instead of letting him waste away.

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