Which trial do we need? Combination treatment of Pneumocystis jirovecii pneumonia in non-HIV infected patients

Pneumocystis jirovecii pneumonia (PJP) is an increasingly prevalent, opportunistic, and life-threatening fungal infection [ [1] Kolbrink B. Scheikholeslami-Sabzewari J. Borzikowsky C. von Samson-Himmelstjerna F.A. Ullmann A.J. Kunzendorf U. et al. Evolving epidemiology of Pneumocystis pneumonia: findings from a longitudinal population-based study and a retrospective multi-center study in Germany. Lancet Reg Health Eur. 2022; 18100400https://doi.org/10.1016/j.lanepe.2022.100400 Abstract Full Text Full Text PDF Scopus (4) Google Scholar ]. In recent years a rising incidence in immunocompromised patients without HIV infection has been described [ [2] Pereira-Díaz E. Moreno-Verdejo F. de la Horra C. Guerrero J.A. Calderón E.J. Medrano F.J. Changing trends in the epidemiology and risk factors of Pneumocystis pneumonia in Spain. Front Public Health. 2019; 7: 275https://doi.org/10.3389/fpubh.2019.00275 Crossref PubMed Scopus (26) Google Scholar ]. Besides steroid therapy, further drugs such as rituximab, cyclophosphamide, calcineurin inhibitors, and methotrexate as well as immunomodulating drugs pose increased risk on patients and their use is steadily increasing [ [3] Hänsel L. Schumacher J. Denis B. Hamane S. Cornely O.A. Koehler P. How to diagnose and treat a non-HIV patient with Pneumocystis jirovecii pneumonia (PCP)?. Clin Microbiol Infect. 2023; (S1198-743X(23)00186-6)https://doi.org/10.1016/j.cmi.2023.04.015 Abstract Full Text Full Text PDF Scopus (0) Google Scholar ].