Most patients with idiopathic pericarditis can be managed
conservatively, with a nonsteroidal anti-inflammatory
drug (NSAID) such as indomethacin, ibuprofen or aspirin.
These agents are believed to be equally effective.8 Colchicine
(administered at a dose of 0.6 mg twice daily) appears to
be effective alone or in combination with ibuprofen in treating
acute pericarditis, although it has not been tested in randomized
trials; it is preferred in patients who have recurrent
pericarditis.3 Patients who do not respond to an NSAID may
need a short course of prednisone (5–10 mg per day for one to
two weeks).8 Rarely, patients do not respond to this therapy or
show evidence of recurrent pericarditis; these patients require
a prolonged corticosteroid course (i.e., several months).
Most patients with acute pericarditis have a brief and
benign course, and can be managed as an outpatient with
NSAIDs. Indicators of a poor prognosis in patients with pericarditis
include temperature above 100.4◦F (38◦C), a subacute
onset, an immunosuppressed state, pericarditis associated
with trauma, a history of oral anticoagulation therapy,
myopericarditis, a large pericardial effusion or cardiac
tamponade.3 Patients with one or more of these criteria are at
increased risk for serious complications and should be admitted
to the hospital.