Fifty-five of 294 consecutive patients with acute pericarditis had first attacks of recurrent pericarditis and were evaluated and treated according to a management protocol. Corticosteroids were restricted to aspirin contraindication or failure. Colchicine was added in cases of aspirin and prednisone failure and was the treatment of choice for the second and subsequent recurrences. After logistic regression multivariate analysis, only the previous use of corticosteroids (odds ratio 10.35, 95% confidence interval 4.46 to 23.99, p <0.001) was associated with an increased risk for recurrence. After a mean follow-up of 72 months (range 48 to 108), a similar rate of complications was found in patients with or without recurrences.