What is the second-line treatment for acute pericarditis if NSAIDs are not effective?

Colchicine is considered the second-line treatment for acute pericarditis when NSAIDs fail to provide adequate relief. It works by inhibiting the migration of inflammatory cells and reducing the production of inflammatory mediators, which ultimately helps to alleviate the symptoms associated with inflammation of the pericardium. Colchicine has been shown in studies to improve outcomes in acute pericarditis and can also reduce the recurrence rate of this condition when utilized either alone or in conjunction with NSAIDs.

The selection of colchicine as an alternative therapy stems from its effectiveness, especially in patients who may not respond to or cannot tolerate NSAIDs. In the context of acute pericarditis, using colchicine can help manage the condition more effectively and reduce the need for steroid therapy, which is typically reserved for more severe cases or when other treatments fail.

Steroids can be effective but are generally considered a third line in uncomplicated cases of acute pericarditis due to their side effect profile and potential to cause dependency or complications if used long-term. IVIG therapy is not indicated for acute pericarditis and is reserved for specific autoimmune disorders or refractory cases of certain conditions. Aspirin is a typical first-line treatment, especially when associated with viral infections or inflammatory