In an era of increasing use of immunomodulator (IM) therapy, opportunistic infections have emerged as a pivotal safety issue in patients with inflammatory bowel disease (IBD). Today's challenge to the physician is not only to manage IBD, but also to recognise, prevent and treat common and uncommon infections. The recent European ECCO guidelines on the management and prevention of opportunistic infections in patients with IBD provide clinicians with guidance on the prevention, detection and management of opportunistic infections in patients with IBD. Proposals may appear radical, potentially changing current practice, but we believe that the recommendations will help optimise patient outcomes by reducing morbidity and mortality related to opportunistic infections in patients with IBD. In this ongoing process, prevention is far the first and most important step. Prevention of opportunistic infections relies on recognition of risk factors for infection, the use of primary or secondary chemoprophylaxis, careful monitoring (clinical and laboratory work-up) before and during the use of immunomodulators, vaccination and education of the patient. Special recommendations should also be given to patients before travel. Additionally, this paper discusses how the ECCO guidelines can be implemented in Belgium according to reimbursement legislation.