The obvious first step is lowering stressors and improving water parameters (not necessarily just "clean water") as outlined in these sections of this article.
If you have jumped to treatment and not read these other sections; STOP now and please read these sections too!
* Parameters to Consider for Prevention and Treatment of Columnaris
This includes mineral Cations and lowering oxidative stress.
This also includes lowering water temperature to 75F (24C).
HERE ARE SOME QUOTES FOLLOWED BY CORRECTIONS/REFUTATIONS:
* "Maracyn is the most useful anti-biotic"
CORRECTION:
WRONG! Columnaris is a strictly gram negative bacterium while Maracyn (which is Erythromycin) is a gram positive antibiotic.
If the author of this article or anyone had any success with Erythromycin, this is proof that the disease treated was NOT Columnaris, rather a gram positive pathogen.
The Antibiotics that have proven gram negative effectiveness and will
work best is somewhat debatable, whether a combination of Furan
2/Kanaplex (best when used 100% together as in the product AAP Spectrogram)
, Sulfamethazine/Trimethoprim combination, Minocycline, or others, but
you will NOT achieve success with a gram positive antibiotic such as
Erythromycin!
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* "Columnaris is usually more of an ulcer than a white patch"
From "Fish Tank Enablers" (Facebook)
CORRECTION:
NO! In fact quite the opposite. Hence why Columnaris is often called
"Cotton Mouth Disease" & "Saddleback Disease" (for the white saddle
on the fish).
Ulcers are more indicative of an Aeromonas infection which might have
some similar treatments, but often quite different causes and prevention
Flavobacterium columnare gained the nick name “Columnaris” because wet
mounts of Flexibacter prepared from diseased fish appear as column-like,
"haystack" colonies.
Columnaris, which is a gram negative strictly aerobic bacterium, is
often prevalent in systems with poor mineralization, but not so much
water high in tanins and other dissolved organics.
Columnaris is "Ubiquitous", meaning it is found everywhere, however its
presence does not necessarily lead to Columnaris disease.
For these reasons, those who state that low oxygen levels can cause
Columnaris along with the need to euthanize surviving fish (&
sterilize the aquarium) are providing 100% INCORRECT information.
Also reference this article: Aquarium Chemistry; The Importance of Calcium, Electrolytes and more.