 This 64-year-old woman presented with persistent vomiting and loss of balance of two weeks after starting streptomycin and rifampicin. These symptoms are likely to be related to streptomycin. Streptomycin is known to cause other side effects that include nephrotoxicity, hypersensitivity reactions and parasitias of the mouth have been also documented. Side effects of streptomycin are common in the elderly and they are dose related. In this patient what needs to be done is to take a good history and then to evaluate the patient if available with an audiogram. When it's not available you may count on the history and your examination findings. Renal function tests are also indicated in the form of a simple urea and creatinine result from the biochemistry will be helpful. Rifampicin cannot be left on its own because of development of resistance strains so with Borulea also combination therapy is always the indication. Other potential options of treatment include clarithromycin and moxifloxacin which could be an option when patients develop side effects. In this case moxifloxacin was combined with rifampicin and the patient responded to this treatment but I must say that these are not the current guidelines. There is evidence also that clarithromycin when combined with rifampicin is a valuable choice but this has to be used only when you don't have any options.