 for the treatment of pyoderma is not successful, the next step is empirical systemic treatment, according Jason B. Pieper, DVM, MS, DACVD, assistant professor at Iowa State University. According to his lecture 

Updates in pyoderma: diagnosis and treatment

, presented at the 2025 Veterinary Meeting & Expo (VMX) in Orlando, Florida, systemic antibiotics are no longer the recommended first treatment of choice due to the rise in antimicrobial resistance and awareness. However, in cases where topicals have failed or cannot be used to treat a patient’s infection, systemic treatment is the next treatment of choice, followed by bacterial culture and susceptibility.

Recommendations for systemic treatment of pyoderma in 

2014 “Guidelines for the diagnosis and antimicrobial therapy of canine superficial bacterial folliculitis” shows 3 tiers of systemic antimicrobial treatment options for pyoderma in dogs.

The first tier is the primary choice of therapy of known or suspected pyoderma. For this tier, clindamycin or lincomycin is recommended. First generation cephalosporins (such as cefalexin, cefadroxil) and amoxicillin-clavulanate is also suggested, as well as trimethoprim- and ormetoprim-potential sulphonamides.

In the first or second tier, third generation cephalosporins (cefovecin, cefpodoxime) are suggested. “There is insufficient evidence for this working group to reach consensus on categorization of these agents as first or second tier drugs…and concerns about selection of ESBL [extended-spectrum beta-lactamase]-producing 

),” wrote the organization in its guidelines.

In the second tier, doxycycline or minocycline; chloramphenicol; fluoroquinolones (such as enrofloxacin, marbofloxacin, orbifloxacin, pradofloxacin and ciprofloxacin, which should only be used when other options are not available); rifampicin; and aminoglycosides, including gentamicin and amikacin are the suggested antimicrobial drugs.

Additionally, first tier antimicrobial drugs (clindamycin, lincomycin and potentiated sulphonamides) can be “considered when cultures indicate susceptibility,” according to the document.

The third tier, which consists of linezolid, teicoplanin, and vancomycin, is only reserved for when the first 2 tiers are “not appropriate and cultures indicate susceptibility,” wrote the authors of the 2014 guidelines. “Regardless of the fact that most (or all) MRSP [methicillin-resistant 

] are susceptible, the use of these three [antimicrobial drugs] is strongly discouraged. These drugs can be considered ‘reserved for the treatment of serious MRSA infections in humans,’” they continued.

“Realistically, the way I look at for these 3 down here, if you have a superficial pyoderma, you’d never need these,” said Pieper of the drugs in the third tier.

“You can treat it topically and get rid of it otherwise.”

According to Pieper, new updates to the 2014 guidelines, based on a meeting in July 2024, are in the process of being written. The updated document has not been finalized yet.

However, based on what was presented in the July 2024 meeting, the first tier will only involve cephalexin, clindamycin, and clavamox. The second tier will consist of third generation cephalosporins, fluoroquinolones, tetracyclines, and sulfas.

The next group is being called a “Reserved” group, and will comprise rifampin, aminoglycoside, and chloramphenicol. “The important aspect of this though is you [have] to discuss the adverse effects with the owners, prognosis, and implement a plan to address the underlying disease, because the biggest concern is that this infection comes back again and again. If they were only susceptible to this previously, there's a potential it could be resistant to these now, and you're really going to be in trouble, you know, down the line for that,” emphasized Pieper.

“So again, still based off of empirical for first tier; second tier is culture, and then third is culture if you have no other options, more or less, kind of going down those lines,” he continued. “So that's kind of how it's currently broken down, is going to be written and going out soon.”

Following a recheck—which is a crucial step—if the infection is not responsive to empirical systemic treatment, the next step would be to perform a bacterial culture and susceptibility, according to Pieper. This step involves identifying the organism the patient has and finding the appropriate antibiotic to treat it. A culture should be done when

There is less than a 50% reduction in lesions within 2 weeks of appropriate systemic antimicrobial therapy.

New lesions appear 2 weeks or more after beginning the appropriate antimicrobial drug therapy.

There is a presence of residual superficial pyoderma lesions after 6 weeks of antimicrobial therapy along with the presence of cocci on cytology.

Intracellular rod-shaped bacteria are found on cytology. “The reason why we actually state this though here…is because the rods, we can't predict the susceptibility as easily as we can with staph. Staph is pretty repeatable, we kind of have a good idea. And that's why the first tier is what the first tier is, because historically, it's been shown to be relatively effective in a large majority of staph organisms,” said Pieper.

The canine patient or a pet from the same household as the affected patient has a history of multi-drug resistance infection. “These dogs can actually be be positive carriers for this resistant organism up to a year afterwards,” explained Pieper. “And actually, even dogs that were not even affected, you know, household dogs, they have actually been shown to be positive for carriers afterwards, too, in two-thirds of the dogs”

When topical treatments for pyoderma fail, empirical systemic therapy should follow. If the infection continues to be unresponsive to empirical systemic therapy, bacterial culture and susceptibility testing should be performed to identify the specific pathogen and guide the choice of antibiotics.

Pieper JB. Updates in pyoderma: Diagnosis and treatment. Presented at: Veterinary Meeting & Expo; Orlando, FL. January 25-29, 2025.

Hillier A, Lloyd DH, Weese JS, et al. Guidelines for the diagnosis and antimicrobial therapy of canine superficial bacterial folliculitis (Antimicrobial Guidelines Working Group of the International Society for Companion Animal Infectious Diseases). 

Articles

In a lecture at VMX, Jason B. Pieper, DVM, MS, DACVD, outlined the next steps in the treatment of pyoderma in dogs when the infection is non-responsive to topical therapy

When topical treatment for pyoderma fails

blendVET's Believe and Belong in Veterinary Medicine at VMX 2025

Dozens of middle and high school students joined industry professionals in a day-long workshop at the 2025 Veterinary Meeting & Expo (VMX), presented by the North American Veterinary Community (NAVC), in Orlando, Florida. The event, “Believe and Belong in Veterinary Medicine,” was created by blendVET to encourage underrepresented students to pursue careers in veterinary medicine and provide support to get them started.

For the third year, the blendVET event was presented in partnership with NAVC as a hands-on experience to introduce pre-college students to the veterinary profession. "At NAVC, we are committed to creating pathways for young people from all backgrounds to discover and thrive in the field of veterinary medicine," Gene O'Neill, CEO of NAVC, said in a release. "Our partnership with blendVET enables us to provide students with hands-on learning experiences and mentorship in an industry that they may have never considered otherwise. Together, we are actively working to shape a more open and inclusive veterinary profession, and we're thrilled to offer these opportunities for the third year in a row at VMX, where we connect students directly with mentors and hands-on learning experiences."

Niccole Bruno, DVM, founder and CEO of blendVET, said she was thrilled to collaborate at VMX for a third year. "This year, we are proud to expand our offerings, providing tailored experiences for both new participants and returning blendVET students. It's particularly rewarding to see some of our scholars who have been with us throughout all 4 of our Florida events excitedly return to deepen their knowledge of the profession and strengthen their skills," Bruno said in a release.

In one room at VMX, first-time program participants received lessons in veterinary care as they rotated through stations. “It’s a baseline introduction into veterinary medicine,” Genine Ervin, DVM, chief operating officer of blendVET, said in a 

General practice, emergency medicine, zoological medicine, nutrition, dentistry, and surgery were among the covered topics. Activities included nail trimming, wound wrapping, and suturing. They students also got experience putting on personal protection equipment.

Returning student Catalina traveled from Puerto Rico to participate in this year’s event. She said her science teacher first informed her about the event, knowing that she was interested in becoming a veterinarian. Each of the few events she has attended offered different content, she noted. “It’s really fun, and I get to socialize and also learn new things,” Catalina said in a 

This year, a second room offered lessons in ophthalmology, clinical pathology, large animal medicine and forensic veterinary medicine to students returning to the program. At a more advanced level than the activities for first-time students, this experience provided various simulations including heartworm testing, cytology, rectal exams, phlebotomy, and bone identification.

The ophthalmology station also offered students an opportunity to view live eyes under a microscope, according to Ervin. “Through the use of the ophthalmoscope, they’re actually able to look at the lens and determine where the retina is and see what the defects are in the cornea or the iris,” Ervin added.

With the creation of a second track for more in-depth exploration of veterinary medicine, Ervin said BlendVET is working to keep middle and high school students interested in the profession. “The goal is to expose them to what we do on the veterinary side, diversify the profession as a whole, and keep them engaged along the way by also providing mentorship. Students are asking questions and developing relationships that help to make those local connections and potentially visit hospitals within their surrounding area,” Ervin said.

Bruno said it was inspiring to see young students' personal and professional growth as they began their veterinary medicine journey. "Our commitment to nurturing the next generation of veterinary professionals remains unwavering. We are deeply grateful for the opportunity to contribute to this vital mission and look forward to another successful year of empowering aspiring veterinarians," she added.

The blendVET program is supported by sponsorship from Boehringer Ingelheim Animal Health, Hill's Pet Nutrition, Merck Animal Health, and VCA Animal Hospitals. Veterinarians and other industry professionals also lent support to the program by volunteering their time to instruct students and provide mentorship.

Local students scrub in as veterinarians for a day, gaining hands-on experience and immersive training at the world’s largest veterinary conference. News release. North American Veterinary Community. December 17, 2024. Accessed January 29, 2025. 

https://www.prnewswire.com/news-releases/local-students-scrub-in-as-veterinarians-for-a-day-gaining-hands-on-experience-and-immersive-training-at-the-worlds-largest-veterinary-conference-302334015.html

blendVET presented the hands-on workshop to nearly 70 middle and high school students during the 2025 Veterinary Meeting & Expo.







Program encourages students to believe they belong in veterinary medicine

Otitis can be a challenging condition to manage in canine patients, so recognizing common compliance challenges can help ensure each patient is getting the proper care. Making it a team effort between veterinary teams and clients can make it easier to understand the challenges each client faces when it comes to treating pets.

Missing links In the medical management of chronic otitis—

at the Veterinary Meeting & Expo conference in Orlando, Florida, Elizabeth R. Drake, DVM, DACVD, shared some of the obstacles she has encountered with clients when treating otitis patients, how she gets around them, and the crucial aspect of understanding client expectations and lifestyles.

Drake told attendees it is better to say "treatment obstacles" instead of "compliance obstacles" because owners want to do the right thing, but they may struggle to do so without a maintenance plan. For patients with otitis, it can be challenging for clients to apply topical medications because of how painful the ears can be, making them wish for a “magic pill” of some kind. Although this magic solution is not available, understanding the challenges clients could face with treatment can help teams design a therapeutic plan for each client.

Drake, for example, stated if the pain is preventing clients from treating the otitis with topical solutions, an oral steroid could be considered for a few days to decrease the pain and swelling for the patient to be more comfortable. Veterinary teams can also choose products that can be administered in measured-dose syringes rather than a predetermined number of drops. Because owners have to count the number of drops to make sure the patient is getting the correct amount, this can take longer, making it harder for the patient to get the full dose if they are in pain.

Besides pain, the sizing of the ear canal can also present an issue for administering the medications needed. Drake shared findings from some of her research conducted with students at Iowa State University, and 

“What we were able to show, using CT scan and measurements by the radiologist, is that body weight is directly a linear relationship to the volume of the ear canal. And that seems very logical, but that means some of the medications that are labeled for 8 drops or 4 drops, or what have you, have no chance of being successful in a dog with a large, large, large ear canal," she explained.

“And so the body weight is linear, except for the brachiocephalic breed, it's where you really can't tell, just like when you're trying to use an endotracheal tube, it's hard to predict the size. So the larger the dog, a big Hound Dog 2, mils of medication is a lot more than the label allows for,” Drake continued.

Veterinary teams may also need to consider the client's lifestyle when it comes to designing a plan for them. For example, with organisms like 

 spp, which is likely to develop resistance, it can be important to utilize a chelating agent like tris-EDTA, especially when the veterinarian is prescribing enrofloxacin to minimize the resistance. When prescribed together, owners are likely to administer these products separately as a ”flush” and “ear drop,” which mean the owner may abandon the flush portion of the regimen or it will occur less often than necessary, which can be more common in a busy household. Drake explained this is why the chances of success will improve if veterinary teams are looking for “one-stop” treatment.

Drake also explained that sometimes, when it comes to administering treatment, sometimes veterinary teams need an alternative or creative approach to make sure the patient is getting the medication they need, and the owner has success administering it. 

For expectations with treatment, the desired outcomes for the patient can differ between clients and veterinary teams. Drake explained most clinicians will wish for their patients to be comfortable at a minimum, and everyone wants to discuss the origin of the problem. This may not be possible for those patients suffering from chronic conditions, but making an improvement in a pet's quality of life is always a welcomed occurrence with treatment, Drake stated in her provided proceedings.

Clients tend to want to treat the condition once and then never again. It is common for clients to ask for surgical intervention when presented with this mentality. However, if the primary problem is allergic disease, inflammation, pruritus, and lichenification of the ear tissue that remains post surgery will continue, despite if whether a total ear canal ablation and bulla osteotomy are performed.

Drake E. Missing Links In The Medical Management Of Chronic Otitis

 Presented at: Veterinary Meeting & Expo; Orlando, FL. January 25-29, 2025.

Anticipating obstacles can help ensure the successful treatment of dogs suffering from otitis. 

Overcoming client challenges in canine otitis treatment 

The growth and establishment of veterinary facilities and services help improve pet care by providing pet owners with greater access to veterinary services for their pets. As the number of veterinary clinics and facilities grow and existing facilities expand, wait times for veterinary care decrease. Moreover, the offering of more advanced veterinary services gives pet patients a greater opportunity to receive the diagnoses and treatment they need. In turn, patients receive faster diagnoses and treatments.

Below are recent veterinary facility expansions and growth:

UC Davis veterinary hospital Neurosurgery Specialty Service (California)

The University of California, Davis (UC Davis) veterinary hospital recently announced the establishment of a Neurosurgery Specialty Service focused on providing advanced surgical solutions for complex neurological conditions.

According to the university, the service offers neurosurgical interventions and clinical trials such as craniotomies, spinal mass resection, correction of cranio-cervical junction abnormalities and spinal malformations, minimally invasive spine surgery, hydrocephalus treatment, wobbler and lumbosacral stabilization, stereotactic brain biopsy, and more.

“This new specialty at UC Davis will allow our hospital to offer more exclusive surgical offerings previously not available in California, such as intracranial endoscopy for hydrocephalus, minimally invasive spinal surgery, and stereotactic brain biopsies,” Vishal Murthy, DVM, DACVIM (Neurology), assistant professor at the university, said in a university release.

 “Our neurosurgeons take on complex cases, often referred by other neurologists, using the best tools, and regularly push the envelope of veterinary neurosurgery.”

“We are committed to providing cutting-edge surgical solutions for complex neurological conditions in our animal patients,” continued Murthy.

 “With a goal to provide personalized, high quality, collaborative neurosurgical care, we are thrilled to offer these new services to improve outcomes for our patients.”

Terravet Real Estate Solutions veterinary clinic acquisitions (Georgia)

Three veterinary practices have been acquired by Terravet Real Estate Solutions, a real estate group that specializes in veterinary properties. The acquisition of the 3 practices totaled $5.37 million and include Animal Medical Clinic of Peachtree City and Animal Medical Clinic of Fairburn, as well as the pet boarding facility Animal Medical Clinic’s Pet Care Center & Hotel.

 The 3 properties comprise 19,649 sq ft in total, with their locations strategically planned to “support the growing suburban communities southwest of Atlanta,” according to Terravet.

 Their locations improve access to quality veterinary care, said the company.

“This expansion into Atlanta is an exciting step forward for Terravet, reinforcing our mission to support veterinary practices with modern, accessible facilities,” said Daniel Eisenstadt, CEO of Terravet Real Estate Solutions, in a news release.

 “We’re proud to collaborate with…Vince Obsitnik [DVM] and the Animal Medical Clinic team, whose dedication to compassionate, high-quality care aligns perfectly with our values.”

“My business partners and I did an extensive investigation into options available for our veterinary properties and opted to join the Terravet REIT. We value the opportunity to diversify and enhance the value of our investment and to partner with the professional team at Terravet,” said Obsitnik.

Warren R. UC Davis launches Neurosurgery Specialty Service. News release. University of California, Davis. January 28, 2025. Accessed January 29, 2025. 

https://www.vetmed.ucdavis.edu/news/uc-davis-launches-neurosurgery-specialty-service

Terravet Real Estate Solutions expands into Atlanta metro area with $5.37 million acquisition of three veterinary facilities. News release. Terravet Real Estate Solutions. January 27, 2025. Accessed January 29, 2025. 

https://www.businesswire.com/news/home/20250127234300/en/Terravet-Real-Estate-Solutions-Expands-into-Atlanta-Metro-Area-with-5.37-Million-Acquisition-of-Three-Veterinary-Facilities

Take a look at these veterinary centers newly opened or coming soon

Clinic center: Updates on new veterinary centers

Iridociliary cysts in dogs and cats occur when part of the epithelium fills with aqueous humor. It may become separated from the iris, which causes a round mass to form and float within the anterior chamber. In an educational session at the Veterinary Meeting & Expo (VMX) hosted by the North American Veterinary Community (NAVC), Kate Myrna, DVM, DACVO, a professor at the University of Georgia in Athens, also explained that iridociliary cysts (also known as iris or uveal cysts) typically originate in the back of the pigmented epithelium of the iris or ciliary body of the iris.

“They’re little, fluid-filled sacs. They are usually incidental, but there are a couple of exceptions to this,” Myrna told VMX attendees.

In some cases, an iridociliary cyst can obstruct a patient’s vision. If needed, these benign cysts can be ruptured with a diode laser.

“In dogs, because of gravity, these balls will usually float to the bottom of the anterior chamber, and when you light them from the side, you'll be able to see through them. There can be one, there can be multiple. You can start with one and end up with more later. And sometimes they can sneak back behind the pupil. So you maybe saw [a cyst] one day and the next day you didn’t see one at all. They do float,” Myrna said. “Feline iris cysts more typically extend from the pupillary margin and are much darker.”

Myrna emphasized that smoothness and shape are key to identifying a cyst associated with the iris, and they often transilluminate with a bright light. “They look like an emulated balloon, and tumors just don't grow like that. You can't see the light pass through the tumor,” she said.

During her talk, sponsored by Domes Pharma, Myrna verbally walked attendees through a series of close-up images of iridociliary cysts in patients. One image of a canine patient served as an example of a cyst that was almost fully translucent. “This was a gold star day because a student spotted this on their exam, and I about lost it,” Myrna said. “I was so excited, because it is virtually invisible, and that's just because the iris tissue is so light.”

According to Myrna, iridociliary cysts are associated with an inflammatory condition that is sometimes referred to as 

 The disease occurs exclusively in golden retrievers, golden and labrador retriever cross bred dogs and golden retriever and poodle cross bred dogs.

“Those cysts stay behind the iris, and they are exfoliating pigment. So, you can imagine, as the pupil constricts, the cysts rub on the lens, and they leave these streaking pigment lines,” Myrna said. “Now we call it 

because frequently it has this big, bloody cyst that juices out a bunch of gross fluid.”

Golden retriever uveitis disease is progressive with cysts continuing to grow and darken, and, in more serious cases, secondary glaucoma may develop, which can lead to eye loss. “It does not act like uveitis in that anti-inflammatories don’t seem to change the course of the disease,” Myrna said.

Most dogs diagnosed with golden retriever uveitis are older than 5 years, and the average age at the time of diagnosis is 8-10 years.

 The disease prevalence in North America is estimated to be between 5% and 10%, according to Myrna.

 “This is much more common in the northeast and the Midwest,” she added.

Iridociliary cysts can cause vision interference, but are benign in nature. However, Myrna noted that their primary importance in identifying an iridociliary cyst lies in “differential diagnosis” from iris melanoma.

Myrna K. I’m seeing spots! What to do with brown spots in the eye. Presented at: Veterinary Meeting & Expo; Orlando, FL. January 25-29, 2025.

Golden retriever uveitis—what dog owners need to know. Veterinary Vision Center. October 1, 2021. Accessed January 29, 2025. 

https://veterinaryvisioncenter.com/golden-retriever-uveitis-what-dog-owners-need-to-know/

Kate Myrna, DVM, DACVO, discussed the ophthalmologic condition during a session at the 2025 Veterinary Meeting & Expo.

Looking at iridociliary cysts

In this interview with dvm360, Alex Sigmund, DVM, DACVO, shares when he treats corneal ulcers with medical management and when he treats them with corneal debridement

Interview with Alex Sigmund, DVM, DACVO

During an interview with Alex Sigmund, DVM, DACVO, ahead of his lectures at Veterinary Meeting & Expo (VMX), he shared with dvm360 when veterinary professionals should be treating ulcers with medical management and when cases call for corneal debridement. Through the interview, Sigmund explains the steps he takes to determine whether or not an ulcer is indolent, which determines if a debridement is necessary or not. 

The only time that I'm doing a corneal debridement is that, if I am sure that it is an indolent or non healing ulcer. You can also hear them called SCCED ulcers, Boxer ulcers. These are all the same thing where these are superficial ulcers that just are really frustrating from the get go, and they just do not want to heal without kind of stimulating them to heal. So we want to look at features of those ulcers that would indicate to us that it's indolent. So number 1, it's superficial. They are always superficial. Number 2 is that it's an ulcer that's been lasting too long, and it's still superficial. And 3, we want to look for that loose tissue hanging out around the edges of the ulcer. 

Videos

Alex Sigmund, DVM, DACVO, shares when veterinary professionals should manage corneal ulcers with medical management vs. corneal debridement