HomeAnswersOtolaryngology (E.N.T)oral ulcerI have mouth and throat ulcers with no fever or breathing difficulty. Please suggest treatment.

My mouth and throat ulcers do not improve on medication. Why?

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The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.

Medically reviewed by

Dr. Vinodhini J.

Published At March 29, 2020
Reviewed AtDecember 1, 2023

Patient's Query

Hello doctor,

I have had mouth and throat ulcers lasting for the past nine days. No fever, cough, or difficulty breathing. I consulted a doctor over the phone and took three days of Azithromycin, Dologel, and some pain relief medicine. After no improvement after three days, the doctor changed the medicines to Candid mouth gel and Alusil. I have been taking this for the last three days. Still, there is only minimal improvement.

Hello,

Welcome to icliniq.com.

Please answer the following so that I can better understand your problem. Can you kindly share the pictures of the lesions? Are there any blisters? How did the lesions appear in the first place? If it is not responding, it might be oral herpes. Revert with answers. Kind regards.

Patient's Query

Hello doctor,

Thank you. It is difficult to click a picture as it is in the back of the mouth (near the tonsil) and throat. It does not look like a blister. It happened suddenly. I had beetroot leaf and roti. But not sure about the real reason.

Hello,

Welcome back to icliniq.com.

I understand your concern. There does not seem to be any extensive rash. So, it should heal in a while. I would recommend you add Betnesol gargles (Betamethasone). Two tablets are to be dissolved in a cup of water, and gargling is to be done twice a day. Replace Dologel (Choline salicylate and Lidocaine) with Oraways (Triamcinolone) ointment thrice a day. Analgesics like Zerodol-SP (Aceclofenac, Paracetamol, and Serratiopeptidase) better be avoided. If the pain is unbearable, then use it. Take plenty of fluids. Add a multivitamin like Becosules (multivitamins) once daily. You may also continue antibiotics for a couple more days. Hope this helps. Regards.

Patient's Query

Hello doctor,

Thank you. I will follow this. And will get in touch again. I hope there is nothing to be worried about.

Hello,

Welcome back to icliniq.com.

No, there is absolutely nothing to worry about. It will clear soon, hopefully. Kind regards.

Patient's Query

Hello doctor,

Thanks. And, is any food to be avoided or included?

Hello,

Welcome back to icliniq.com.

I understand your concern. Continue multivitamins and Oraways ointment. One important thing is to cut down on your anxiety and avoid beverages. Eat a lot of fruits and vegetables. Does this happen often, or is it the first time? Also, add a different antibiotic like Cefpodoxime-CV twice a day. Hope this helps. Kind regards.

Patient's Query

Hello doctor,

Thanks again. It happened the first time. Yes, I am quite tense. Because of the lockdown, I cannot visit any doctor personally. I think that is why little more tense. By the way, can it be any allergic reaction?

Hello,

Welcome back to icliniq.com.

I understand your concern. Yes, at times, it can be due to an allergy, but such a rash is most of the time due to an allergy to drugs like pain medications or certain antibiotics. Secondly, it can follow any prolonged illness, particularly a febrile illness. Then it can occur in viral infections of the mouth. Another cause is aphthous ulcers, of which the cause is unknown, and stress and personality types seem to affect its appearance. I hope this helps. Kind regards.

Patient's Query

Hello doctor,

Thanks again. Sure. So should I continue the medications you suggested last time and the antibiotics? How long it usually takes to get better?

Hello,

Welcome back to icliniq.com.

I understand your concern. The response should begin in a couple of days, and you should be fine in five to seven days. Regards.

Patient's Query

Hello doctor,

Thank you.

Hello,

Welcome back to icliniq.com.

Sure. Revert in case of queries.

Patient's Query

Hello doctor,

Thanks. Still, the pain is there, and the rashes are the same. It turned a little blueish, I guess. I have little difficulty speaking in my throat, and it is paining.

Hello,

Welcome back to icliniq.com.

Honestly, I do not see any ulcers there, and the bluish hue is of veins which is normal. Is your throat still sore? Is your tongue sore? I do not find a lesion there. Are you on any other medication? It may be a condition called burning mouth syndrome. Do you have any gastric problems like gastritis, sour eructations, or reflux? There is no specific lesion that can explain your symptoms. Hope this answers your query. Regards.

Patient's Query

Hello doctor,

Thanks for the reply. A sore throat is there but not coming into the picture. I took no other medication, though I have not started the antibiotics you suggested last time. I could not go to the pharmacy. I have no other problem. These sores and throat pain while speaking still exist.

Hello,

Welcome back to icliniq.com.

What are you taking at present? Revert with answers. Kind regards.

Patient's Query

Hello doctor,

Thank you.

I am taking Oraways ointment, Becosules, and Betnesol gargles.

Hello,

Welcome to icliniq.com.

I suggest you take Zerodol-SP twice a day for three days. That shall help in alleviating pain. Hope this helps. Regards.

Patient's Query

Hello doctor,

Thank you. Are the antibiotics which you mentioned last time not required?

Hello,

Welcome to icliniq.com.

Yes, take antibiotics also for three to five days twice a day. Add a PPI (proton-pump inhibitor) like Rabeprazole 20 mg, Pantoprazole 40 mg, or even Aciloc 150 mg on an empty stomach. Discontinue Betnesol gargles after a week. Continue Becosules and ointment. Hope this answers your query. Kind regards.

Patient's Query

Hello doctor,

Thank you for the detailed reply. And why is this not settling down? I am really tired of this pain and uncomfortable feeling. As you mentioned last time, I feel this is some drug allergy or reaction only. I was taking painkillers, antibiotics, and Dologel, and one day I had a headache. So, I took Disprin as well. Even Azithromycin also he told me to take for seven days.

Hello,

Welcome to icliniq.com.

I understand your concern. It could be burning mouth syndrome. In the absence of any congestion or any definite lesion on the tongue, oral cavity, or even pharynx, there does not seem to be a cause for bigger concern. There are certain precipitating factors for such pain. One of them is anxiety and stress. Second, if you are on any medication, then there are conditions like diabetes. Reflux and gastritis can also cause such symptoms. I would suggest you avoid beverages for a while. Take plenty of fluids. Avoid spicy hot foods. Use more of a bland diet. Avoid fried foods. Continue medicines prescribed for three to five days. After that, take only Aciloc 150 mg or Pantoprazole 40 mg once a day. It will be fine. There is no cause to worry. Hope this helps. Kind regards.

Patient's Query

Hello doctor,

Thank you.

Sure. I got the medicine. I will start Zerodol-SP and Cefpodoxime and Pantoprazole. Instead of this, I got Pantocid. I hope that is fine. If there is some drug allergy, I hope all these medicines will not cause any further problems. Please suggest if I have to visit any doctor personally in case I will not get better or get worst. And one request, my subscription will expire today. Hopefully, it will be better with this medication.

Hello,

Welcome to icliniq.com.

No, there is nothing suggestive of any drug allergy. You do not have any rash or eruptions suggestive of drug allergy. Pantocid (Pantoprazole) is fine. One particularly important thing is to cut down on your anxiety. That is an integral part of management. As I said, avoid fried, spicy, hot foods. Use more fruits and raw vegetables. Revert in case of more queries. Regards.

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Syed Peerzada Tehmid Ul Haque
Dr. Syed Peerzada Tehmid Ul Haque

Otolaryngology (E.N.T)

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