Hello! Thanks for posting your query! Though blood in first spittle is not much serious thing but it needs to be evaluated for underlying cause. Ketoconazol and aceclofenac do not cause bleeding from oral cavity.Aceclofenac if used for long term may cause gastric ulcers and bleeding from gastrointestinal tract which may present as black colored stool or hematemesis. Blood in spittle could be due to:- -bleeding from gum This can occur if there is any abnormality in your blood like low platelet count,functional disorders of platelet,von-wilbrand factor deficiency,etc. It may happen while brushing teeth vigorously. -Bleeding from upper respiratory tract due to infective cause Acute pharyngitis,bronchitis,laryngitis -bleeding from lower respiratory tract -Though it is very rare to get blood in spittle from lower respiratory tract etiology but it may happen in tuberculosis,sarcoidosis,Wegener s granulomatosis,bronchiactasis,etc. To rule out all these things it needs clinical correlation and laboratory tests like Hb,CBC,Platelet count,Chest X-ray and examination by dentist by for dental caries. Hope this will help you. Wish you good health.