Fish Antibiotic Update 2016

Staphylococcus aureus - Antibiotics Test plate

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As of 2016 most preppers are well aware of OTC “fish antibiotics” intended for aquarium use.  If the concept is new to you, please search this site for earlier articles, including yearly updates.

In reviewing several fish antibiotic web sites, I see certain retailers continue to offer ketoconazole, which is not an antibiotic, but rather an antifungal.  Ketoconazole is sold right along with common antibiotics such as penicillin, likely leading the uninformed reader to wrongly conclude that they are equally safe and effective for bacterial illnesses such as pneumonia and strep throat, which ketoconazole is not.

I have also previously warned against the use of this drug for common fungal infections, due to rare but potentially fatal liver failure.  As of this week the FDA has re-issued a warning against the use of this drug, except for serious infections if no safer treatment is available.

The drug should only be used when the risk of death from an overwhelming yeast or fungal infection is deemed greater than the risk of possible death from the treatment.  This would likely only be in an immuno-compromised person, such as someone with HIV disease.  For the average layperson, I say do NOT stockpile ketoconazole – spend your limited prepping dollars on something with a greater potential benefit.

Below are selected excerpts from the FDA’s recent announcement.

FDA Safety Announcement

[05-19-2016] The U.S. Food and Drug Administration (FDA) is warning health care professionals to avoid prescribing the antifungal medicine ketoconazole oral tablets to treat skin and nail fungal infections. Use of this medication carries the risk of serious liver damage, adrenal gland problems, and harmful interactions with other medicines that outweigh its benefit in treating these conditions, which are not approved uses of the drug.

Since the 2013 labeling change, one patient death has been reported to the FDA due to liver failure associated with oral ketoconazole prescribed to treat a fungal infection of the nails.

Health care professionals should use ketoconazole tablets only to treat serious fungal infections when no other antifungal therapies are available.

Patients taking ketoconazole tablets should seek medical attention right away if they experience any of these signs and symptoms of liver problems, which include loss of appetite, nausea, vomiting, or abdominal discomfort; yellowing of the skin or the whites of the eyes (jaundice); unusual darkening of the urine or lightening of the stools; or pain and discomfort in the right upper abdomen where the liver is located.

Ketoconazole in tablet form is indicated to treat serious infections caused by fungi and should be used only when other effective therapy is not available or tolerated.

The topical forms of ketoconazole that are applied to the skin or nails have not been associated with liver damage, adrenal problems, or drug interactions.


About Cynthia J. Koelker, MD

CYNTHIA J KOELKER , MD is a board-certified family physician with over twenty years of clinical experience. A member of American Mensa, Dr. Koelker holds degrees in biology, humanities, medicine, and music from M.I.T., Case Western Reserve University School of Medicine, and the University of Akron. She served in the National Health Service Corps to finance her medical education.
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