Bloody diarrhoea may be a sign of verotoxingenic E coli enteritis (VTEC/0157 disease). Always send a stool sample from children or elderly with acute painful or bloody diarrhoea to exclude E. coli 0157 infection. If unwell consider haemolytic uraemic syndrome (HUS). Antibiotics are generally contraindicated in E. coli 0157 infections/HUS.

Primary care practitioners are recommended to always seek urgent specialist advice whenever a child or elderly are reported to have had a single episode of bloody diarrhoea. Referral is an emergency where, significant dehydration, acute abdominal pain, or signs and symptoms indicating a differential diagnosis that includes the possible need for surgical intervention, are present.

Antibiotic therapy not indicated unless systemically unwell.

Do not use anti-motility agents and assess/treat dehydration in every child or elderly person. See NICE CG84: Diarrhoea and vomiting caused by gastroenteritis in under 5s: diagnosis and management (April 2009), for further guidance