What is the standard treatment for acute pericarditis?

• A. Antibiotics
• B. Steroids
• C. Colchicine
• D. NSAIDs

Answer: (D)

Acute pericarditis is an inflammatory process of the pericardial sac, and the main goal of treatment is to reduce inflammation and relieve chest pain. Nonsteroidal anti-inflammatory drugs are the standard initial therapy because they directly address the inflammatory process by inhibiting prostaglandin synthesis, which lowers pericardial inflammation and alleviates pain. They’re effective in most uncomplicated cases and have a favorable safety profile when used appropriately.

In practice, many clinicians also add colchicine to decrease the risk of recurrence and speed recovery, but the foundational treatment in most guidelines is NSAIDs. Antibiotics aren’t routinely used because bacterial pericarditis is less common and would only be chosen if there’s clear evidence or high suspicion of an infectious cause. Steroids are typically reserved for specific situations (such as autoimmune etiologies or NSAID-refractory cases) because they can increase the risk of recurrence. So, starting with NSAIDs aligns with treating the underlying inflammation and providing prompt symptom relief.