INTRODUCTION: Anti tumour necrosis factor (anti-TNF) is highly effective in inflammatory bowel disease (IBD) but has been associated with a risk of infectious complications, particularly in patients with advanced age. AIMS: To determine the risk of infectious complications in our elderly patients exposed to anti-TNF therapy. METHODS: This is a retrospective study carried out in the University of Malaya Medical Centre, Kuala Lumpur where all patients diagnosed with IBD on anti-TNF were recruited. Dose and duration of anti-TNF, concomitant medications and infectious complications (non IBD related) were recorded. RESULTS: 349 patients with confirmed IBD who were actively under follow up as from January 2014-2015 were identified. Of all patients who received anti-TNF, 71 were <60 years, 3 were 60 years. There was no significant difference in the use of concomitant immunomodulators in the two age groups. Infectious complications were seen in of 9(12.7%) in the younger group and 3(100%) in the elderly group. In the young age group, only one (1.4%) died from nosocomial pneumonia following an iatrogenic pneumothorax. 2 patients developed pneumonia (successfully treated) and 6 patients developed shingles. In contrast, all three (100%) of the elderly patients had significant infectious complications; one had disseminated Tuberculosis, one died following nosocomial pneumonia and one developed multiple opportunistic infections (pneumocystis pneumonia, cryptococcal meningitis). CONCLUSIONS: Anti-TNF has to be used with extreme caution and ideally avoided in elderly patients with IBD.