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Treatment for Hole in the Head

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  • Treatment for Hole in the Head

    Hi, I'm new to the forum and have a question regarding my earth eater.
    He is a five year old male pearl scale earth eater (geophagus brasiliensis) and around February this year he started developing hole in the head (head and lateral line erosion) I live on a little island at the bottom of Australia, and veterinary care is hard to find, especially for fish. I managed to contact a vet who would come to me and he diagnosed it as Hole In The Head, and prescribed metronidazole to help fight the infection. I have been getting one week supplies (this is the most they can give me at any one time) for over eight months now and it costs me $45 a week just to treat him, I've spent what seems like thousands of dollars over the past eight months. And i was wondering if Seachem have any products that could help me treat him, without costing me $180 a month? Products containing large amounts of metronidazole are not allowed to be imported by "average Joes" as it is a prescription only medication here, however i have been told by my local customs office that small amounts of metronidazole may be let through, as long as the packaging doesn't have "METRONIDAZOLE" plastered all over the container.

    Any advice would be wonderfully appreciated. I am willing to try anything to help my big man. ⌒.⌒

  • #2
    Re: Treatment for Hole in the Head

    Hi Kittiee,

    There are several potential causes for hole in the head. With large cichlids, it is commonly associated with an infection by Hexamita which can be treated with Metronidazole. We do make a fish medication MetroPlex (formerly called Metronidazole) which can be used to dose directly into the water or mixed with moistened food to make a medicated food paste. Mixed with food is usually the most cost effective way to administer Metronidazole. Unfortunately, strict regulations keep us from being able to export many of our meds to some other countries.

    Have you seen improvement while treating with metro? If you haven't seen improvement at this point, I would discontinue treating with this medication.

    Because the exact cause of hole-in-the-head isn't known and might not have a single cause, it can be difficult to pinpoint. It is thought that Hexamita infections in the gut cause malnutrition or some vitamin deficiencies which cause the external symptoms we see. If the fish hasn't responded to treating for Hexamita, then it could be some kind of deficiency that could be improved with a more varied diet or by using a nutritious food soak like Vitality or Nourish. It is also hypothesized that the age of the fish and declining immune function could play a part as it usually is only seen in older fish. Poor water conditions are another potential cause, so if conditions are poor, improving the water quality could help.

    In marine tanks, there have been studies indicating that marine hole-in-the-head/lateral-line-erosion is sometimes connected to carbon dust in the water from certain activated carbons. This connection hasn't been looked at in fresh water as far as I know, but if you've ruled out other causes, making sure your carbon is prewashed well wouldn't hurt. There have also been some cases that improved after stray electrical current was removed from the tank, so check any old heaters or cords which touch the water.


    • #3

      I am also new to the forum and I have the same problem in a Discus tank. Today I had the second dead fish for a hole in the head in three weeks. I treated both of them with stress guard to try to heal the wound with no results. I did not know that MetroPlex could be the right medication but I have this question: Do I have to treat all of the fish tank as a pandemia or what will it be your recommendation?

      I also have read that it is not necessary to remove the activated carbon with this medication, correct? What will it be the right way to treat the problem?

      Thanks in advance.


      • #4
        Hello Antonio,

        I believe we answered your question on email, but I will post the same reply here as well for others that may find it to be helpful.
        Thank you for your email. Typically external treatments that go into the tank are not as effective with this type of infection. I would recommend the use of any food source you wish (frozen foods do work best) and to use MetroPlex and Focus to create a medicated food that will help to treat parasitic infections that cause hole-in-the-head as well as secondary bacterial infections.
        Here is the "recipe" to create the medicated food:
        1 tablespoon frozen food
        1 scoop MetroPlex (
        1 scoops Focus (

        This can be fed daily to treat infection. I hope this helps. Have a nice day!
        You can feed this for up to 3 weeks as needed and it is fine to feed t any and all fish in the tank. I hope this helps.