Antimicrobial stewardship is often framed as a global health issue, but for podiatrists it plays out in everyday practice – in prescribing decisions, how treatment is explained, and how care is reviewed over time. In this conversation, pharmacist Danni Miatke reframes stewardship in a way that builds on the strengths already embedded in podiatry practice.
Pharmacist Danni Miatke has led the Antimicrobial Stewardship service at Northern Health in Victoria and contributed specialist care as the senior Infectious Disease Pharmacist.
On the topic of antimicrobial resistance she says, “This is an ongoing worldwide problem that everybody needs to be part of.”
Danni is clear that antimicrobial stewardship (AMS) is often framed too narrowly, which can limit how clinicians engage with it and overlook its practical value.
“I think when people hear me talk about AMS, they assume I’m going to focus on strategies to reduce antimicrobial resistance. But what’s really important is that antimicrobial stewardship isn’t just about resistance. It’s about improving how these drugs work. So how do we prescribe them in a way that makes them more effective? And just as importantly, how do we make them safer for our patients? That means thinking about how we avoid toxicities, how we minimise drug interactions, and how we manage interactions with comorbid conditions.”
Danni shares more in-depth advice in the webinar Bacterial Battles: Optimising Antibacterial Therapy.
“Ultimately, every medicine is just a poison at therapeutic doses,” Danni says. “So, we need to be engaging in that thought process of how do I, as an individual practitioner and for each patient that comes in, improve my practice so that we have longevity with these drugs?”
One of the most important clarifications in Danni’s advice is where antimicrobial resistance sits in relation to clinical care. For podiatrists, this is not a departure from current practice but an extension of it.
“Most of the time, podiatrists are treating skin organisms, which are mainly Gram-positive cocci such as streptococci or MSSA. These are actually covered effectively by narrower options like amoxicillin or flucloxacillin. But people will often add in Augmentin, thinking they are just broadening things slightly, without realising they are covering a large group of Gram-negative organisms as well.”
Danni highlights the broader impact of each prescribing decision beyond the immediate infection.
“Every time an antimicrobial is given, it doesn’t just expose the organism being treated – it exposes every bacterial organism in the body to that drug. That means each time it’s prescribed, it gives other organisms the opportunity to develop resistance. So let’s be more diligent, more proactive, and more considered in how we practice so that we’re contributing less to this problem down the road.”
Danni reinforces that antimicrobial stewardship isn’t tied to where you work – it applies equally across all care settings, including podiatry practice.
“Sometimes people may think, ‘Oh, that’s not my problem because I don’t work in a hospital and I don’t work with those very broad-spectrum antimicrobials.’ Then it becomes this thing that feels far off, like it sits with infectious disease teams. Yet antimicrobial stewardship doesn’t change depending on your healthcare designation. It is relevant to everybody.”
Danni emphasises that podiatrists are central to where real impact happens. “The majority of our issues around antimicrobial resistance start in the community – with opportunities to make a difference existing within everyday prescribing by primary healthcare providers such as podiatrists.”
Danni emphasises that effective medication counselling is not about delivering information – it’s about creating two-way engagement and checking that the patient is taking the information in.
“There isn’t one secret way of counselling your patient, but with experience, the thing that works most effectively is that it should feel like a dialogue between the two of you. When patients are not engaging back, that is how you know they’re not listening or not hearing what you’re saying. So counselling needs to be interactive – not just telling them, but making sure they are actually taking it in.”
She points out that strong counselling starts with clarity. “Making sure the patient understands why they have to take the medicine is key,” Danni says. “A lot of patients say they don’t know why they’re taking something, or they think they do but it hasn’t been explained in a way that is memorable enough for them to use that information later. If a patient can’t understand why they’re taking a medicine, then they also can’t understand what to do if something goes wrong – for example, if they’re having a reaction and knowing whether it’s safe to stop.”
This comes down to simplicity. “Practical details matter,” Danni says. “How many to take, how to take it, how long to take it for – it becomes really important, especially where treatment needs to continue beyond when it looks like the infection has cleared. Patients also need to understand what they should expect and when to act. When should they come back? At what point are they thinking this isn’t working? If that’s not explained, they can continue incorrectly or not return when they need further review.”
Therapy outcomes need to be factored into this conversation. “It’s also about making sure they understand the aim of therapy,” she emphasises. “Is the goal to clear the infection completely, or to suppress it and keep it at bay?”
While discussing side effects is important, Danni explains that it needs to be done in a way that informs without discouraging treatment.
“There’s a real tact to teaching a patient about potential side effects without scaring them away from taking the medicine. It’s about explaining that there are some potential side effects, but they’re not expected, and if they do happen, the patient knows what to do. For more common effects, you can explain that they’re uncomfortable but not usually something to worry about, and share how to manage them.”
Danni also reinforces that counselling is not a one-off interaction and should not be left solely to another professional.
“A lot of podiatrists might think this is the pharmacist’s job – and it is part of our job – but patients need to hear something multiple times before they remember it. That’s why repeating key information, and supporting it with written information, makes a difference. The more times patients hear it, the more likely they are to remember and act on it appropriately.”
At its core, antimicrobial stewardship isn’t a separate task – it’s part of how podiatrists already think about safe, effective care. The opportunity is to be more deliberate about it.
Danni Miatke’s webinar is available to members of the Australian Podiatry Association. The webinar expands on these ideas, sharing detailed clinical examples, patient scenarios and podiatry‑specific applications. An in-depth look at the Antimicrobial Stewardship Clinical Care Standard is also included, with a dedicated focus on the separate guideline specifically for podiatrists.
Members of the Australian Podiatry Association can also access a separate webinar, also presented by Danni: Fungal Focus | Understanding and using antimycotics in practice.
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