Objective To investigate the clinical features and treatment strategy of acute drug-induced liver injury (DILI) in elderly Chinese patients. Methods Databases of CBM, VIP, Wanfang and CNKI were searched by retrieving from construction to 2011 with the key words “drug-induced liver injury or drug-induced liver disease, and elderly”. Data from retrieved literatures were summarized and analyzed by SPSS 14.0 software. Results There were 14 studies meeting the inclusion criteria, which included 879 elderly patients with acute DILI (583 males and 296 females). The main clinical manifestations were digestive symptoms (45.41%), jaundice (34.58%), fatigue (25.48%), and anorexia (21.84%), and so on. While, 308 patients (35.04%) were asymptomatic. Clinical classification indicated that hepatocellular type accounted for the largest proportion of acute DILI in the elderly (57.40%). The most common drugs causing acute DILI were antimicrobial agents (18.98%), Chinese traditional medicine (18.26%), cardiovascular drugs (17.90%) and antineoplastics (11.61%) in order. As for the prognosis, 692 of 774 cases (89.41%) were recorded being clinically cured or improved. Conclusion It is of great significance to diagnose and treat acute DILI early and properly, especially for the elderly patients so as to improve the prognosis and decrease mortality.