Canine heartworm disease wreaks havoc inside canines all throughout the modern world, including the USA. Any region where mosquitoes thrive will provide efficient dog-to-dog transportation for the microfilaria of the infectious nematode Dirofilaria immitis. Veterinary scientists have recently discovered both phylogenetic and biochemical evidence for the obligate symbiosis of D. immitis and the bacteria Wolbachia pipientis. As a result, veterinarians have initiated testing of antibiotic therapies either instead of, or together with, the currently utilized antiparasitic treatments for canine heartworm. The toxicity of melarsomine adulticidal therapies has prompted an abundance of new research involving doxycycline and other antibiotics, which will be addressed in this review. As our knowledge of the Wolbachia endosymbiont expands, so will our abilities to minimize toxicity and maximize efficiency of heartworm treatments.