In the dilemma discussed in the May issue of In Practice, you are treating a dog with pyoderma, which has had poor clinical results follow a week of topical antibiotics. You test and find meticillin-resistance Staphylococcus pseudintermedius. You prescribe oral doxycycline but the client asks why vancomycin has not been prescribed (IP, June 2017, vol 39, pp 294-295). Manuel Magalhães-Sant’Ana argues that relying on third tier antibiotics is strongly discouraged. While one can be tempted to appease the client, the vet has a moral duty not to. Depending on results from sensitivity tests, it may be that first or second tier antibiotics can resolve the pyoderma.