The use of medicated foods is the only way to effectively treat internal disease. We recommend using this product as the only food source to ensure the proper amount of medication is taken in. Additionally, treatment may be coupled with elevated temperatures, such as when treating for hemamita. Metronidazole is an anti-protozoan fish medication used to treat hexamita (hole in the head disease or Malawi bloat), body slime (chilodonella), freshwater ich, epistylis in pond fish. Treatment: Feed 1-2 times a day for 7-10 days. May be repeated if necessary. We treat our own tanks by raising the temperature to 86F/30C or higher during treatment. May be used concurrently with Epsom Salt to help clear out the gut more efficiently. Medicated flakes are made to order to ensure medication does not age sitting on our shelves and lose potency.