What is first-line medical treatment for acute pericarditis?

• A. Corticosteroids
• B. Aspirin and NSAIDs
• C. Colchicine monotherapy
• D. Antibiotics

Answer: (B)

First-line treatment for acute pericarditis focuses on anti-inflammatory therapy to control inflammation and relieve chest pain. The best initial approach is using aspirin or another NSAID at a high anti-inflammatory dose, because these drugs directly reduce pericardial inflammation. Adding colchicine to this regimen markedly lowers the risk of recurrence and helps shorten the course of symptoms, which is why this combination is favored clinically.

Corticosteroids are not used first-line because, although they reduce inflammation, they’re associated with higher recurrence rates and longer recovery when used initially. Antibiotics are reserved for cases where a bacterial infection is suspected or proven, not for routine idiopathic or viral pericarditis. Colchicine alone isn’t the standard initial strategy, since NSAIDs address the immediate inflammation and pain while colchicine specifically targets recurrence prevention when used with NSAIDs.