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This was a multicenter, retrospective, observational cost analysis study conducted in four private Brazilian hospitals between January 2022 and December 2023. A total of 185 medical records from patients undergoing the sequential therapy protocol were included. Clinical outcomes, length of hospital stay, acceptability among physicians of pharmacist-led interventions for switching the route of administration, and the direct costs related to medications and human resources were assessed according to a microcosting methodology. Among the included patients, 74.6% transitioned to the oral route, and 88.4% showed a positive clinical outcome. Sequential therapy was associated with a significant reduction in mean length of stay (10.1 vs. 14.7 days; p\u2009=\u20090.024) and was associated with 55% lower treatment costs, corresponding to an estimated cost avoidance of US$ 4,529.96. The findings suggest that sequential antimicrobial therapy is an safe and economically advantageous strategy that contributes to the rational use of antimicrobials and the optimization of hospital resources.<\/jats:p>","DOI":"10.1371\/journal.pone.0354476","type":"journal-article","created":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T17:28:21Z","timestamp":1785259701000},"page":"e0354476","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Cost analysis of a sequential antimicrobial therapy protocol in patients with pneumonia: A multicenter study"],"prefix":"10.1371","volume":"21","author":[{"given":"Flaviane","family":"Gecler Parreira","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan Vicente da Cunha","family":"Leal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aline Correa de","family":"Araujo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda Mota","family":"Concei\u00e7\u00e3o","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda Migliorini do","family":"Nascimento","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carolina Serra Cabo","family":"Jogaib","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2026-1510","authenticated-orcid":true,"given":"Sabrina","family":"Calil-Elias","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u00e9ssica Pronestino de Lima","family":"Moreira","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,7,28]]},"reference":[{"issue":"5","key":"pone.0354476.ref001","first-page":"909","article-title":"CAP, HCAP, HAP, VAP: the diachronic linguistics of pneumonia","volume":"152","author":"JP Burnham","year":"2017","journal-title":"Chest"},{"issue":"25","key":"pone.0354476.ref002","article-title":"Pneumonia","volume":"7","author":"A Torres","year":"2021","journal-title":"Nat Rev Dis Primers"},{"issue":"2","key":"pone.0354476.ref003","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1080\/17476348.2019.1562339","article-title":"The burden of community-acquired bacterial pneumonia in the era of antibiotic resistance","volume":"13","author":"P Peyrani","year":"2019","journal-title":"Expert Rev Respir Med"},{"issue":"4","key":"pone.0354476.ref004","doi-asserted-by":"crossref","first-page":"741","DOI":"10.1016\/j.vaccine.2019.10.101","article-title":"Rates of hospitalization for community-acquired pneumonia among US adults: A systematic review","volume":"38","author":"JM McLaughlin","year":"2020","journal-title":"Vaccine"},{"key":"pone.0354476.ref005","unstructured":"World Health Organization. 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