What is standard initial treatment for acute pericarditis?

• A. Antibiotics
• B. Immunotherapy
• C. Anticoagulation
• D. NSAIDs and colchicine

Answer: (D)

The key idea is that acute pericarditis is treated by reducing inflammation and pain, with a goal of preventing recurrence. The standard initial approach is anti-inflammatory therapy using NSAIDs for symptom relief and inflammation control, paired with colchicine to lower the risk of recurrence. NSAIDs address the pericardial inflammation directly and help relieve chest pain, while colchicine disrupts neutrophil activity and dampens the inflammatory process over time, making recurrences less likely.

Antibiotics would be reserved for cases where there is a clear bacterial infection, which is not the typical cause of most acute pericarditis. Immunotherapy isn’t the first-line treatment for the common presentations and would be considered only for specific autoimmune or immune-mediated etiologies. Anticoagulation, on the other hand, does not treat the inflammatory process and can be risky in pericarditis with effusion or tamponade risk, so it isn’t part of the standard initial treatment unless there is another independent indication for anticoagulation.