Ophthalmic Antibiotic Selector
Quick Takeaways
- Besivance is a once‑daily fluoroquinolone eye drop approved for bacterial conjunctivitis.
- It offers a broader gram‑negative coverage than older agents such as ciprofloxacin.
- Price is higher than generic alternatives, but the reduced dosing may improve adherence.
- Safety profile is comparable; rare stinging or hypersensitivity can occur.
- Choose based on infection severity, patient compliance, and cost considerations.
Besivance is a prescription‑only ophthalmic solution that delivers the fluoroquinolone besifloxacin at 0.6% concentration. Launched in 2009 in the United States, it targets acute bacterial conjunctivitis with a convenient once‑daily regimen for seven days.
What Makes Besivance Different?
Besifloxacin belongs to the fluoroquinolone class, a group of antibiotics that inhibit bacterial DNA gyrase and topoisomerase IV. Compared with older fluoroquinolones like ciprofloxacin and ofloxacin, besifloxacin shows stronger activity against resistant strains of Staphylococcus aureus and Pseudomonas aeruginosa. Its chemical structure adds a chlorine atom that improves corneal penetration while reducing the potential for ocular surface irritation.
Clinical Efficacy
Phase III trials enrolled over 600 patients with confirmed bacterial conjunctivitis. The primary endpoint-clinical cure by day7-was achieved in 87% of participants using Besivance versus 73% with vehicle. Microbiologic eradication mirrored these numbers, with a 92% clearance rate for common pathogens. Real‑world studies in Australia and Europe have reported similar outcomes, reinforcing its reliability across diverse patient groups.
How It Works: Mechanism in Plain English
- After instillation, besifloxacin diffuses across the corneal epithelium.
- It binds to the bacterial enzymes DNA gyrase and topoisomerase IV, halting DNA replication.
- Without DNA synthesis, bacteria cannot multiply, leading to rapid reduction in colony‑forming units.
- The drug’s high binding affinity means even resistant strains struggle to survive.
Comparing the Usual Suspects
| Antibiotic | Class | Spectrum (Gram‑) | FDA Status | Dosing Regimen | Typical Cost (US$) for 7‑day course |
|---|---|---|---|---|---|
| Besivance | Fluoroquinolone | Broad (incl. resistant Staph & Pseudomonas) | Approved 2009 | 1 drop daily | 70‑90 |
| Ciprofloxacin (Ciloxan) | Fluoroquinolone | Moderate (good Gram‑negative) | Approved 1990 | 1‑2 drops QID | 15‑25 (generic) |
| Ofloxacin (Ocuflox) | Fluoroquinolone | Moderate‑broad | Approved 1994 | 1‑2 drops QID | 20‑30 |
| Tobramycin (Tobradex) | Aminoglycoside + steroid | Gram‑negative focus | Approved 1992 | 1 drop QID | 10‑18 |
| Moxifloxacin (Vigamox) | Fluoroquinolone | Broad (similar to Besivance) | Approved 2007 | 1 drop BID | 50‑65 |
The table makes a few things clear. Besivance’s once‑daily schedule beats the classic four‑times‑daily routine of ciprofloxacin and ofloxacin, which can be a game‑changer for kids or elderly patients who struggle with frequent dosing. In terms of raw potency, moxifloxacin edges close to Besivance, but the latter still wins on convenience.
Safety and Tolerability
Adverse events reported in trials were mild: transient burning (≈8%), foreign body sensation (≈5%), and rare hypersensitivity (<1%). Compared with tobramycin, which carries a higher risk of corneal epithelial toxicity when combined with steroids, Besivance’s profile is favorable. No systemic absorption has been documented, making it safe for patients with systemic fluoroquinolone contraindications.
Practical Tips for Clinicians
- Confirm bacterial etiology. Viral conjunctivitis does not benefit from any of these drops.
- Assess patient’s ability to follow the dosing schedule. If adherence is doubtful, the once‑daily Besivance may be worth the premium.
- Consider local resistance patterns. In regions with high fluoroquinolone‑resistant Staph, Besivance’s higher potency may reduce treatment failures.
- Check insurance coverage. Many plans list generic ciprofloxacin as a preferred drug, so a prior‑authorization request may be needed for Besivance.
Related Concepts: Resistance & Stewardship
Fluoroquinolone resistance has risen globally, driven by overuse in both ophthalmology and systemic infections. Antibiotic stewardship in eye care means reserving the most potent agents-like Besivance-for cases where first‑line treatment fails or when cultures show resistant organisms. Using a narrower‑spectrum antibiotic, such as trimethoprim‑polymyxin B, may be appropriate for mild infections with known susceptibility.
When to Reach for Alternatives
If a patient reports severe pain, corneal ulceration, or a hypersensitivity reaction to fluoroquinolones, switch to a non‑fluoroquinolone like tobramycin (often combined with a steroid for inflammation control) or a macrolide such as erythromycin ointment. For contact‑lens wearers prone to Pseudomonas, consider fortified antibiotics (e.g., cefazolin) administered under specialist supervision.
Bottom Line
Besivance delivers a potent, broad‑spectrum fluoroquinolone in a user‑friendly once‑daily bottle. Its higher price is offset by better adherence and strong activity against resistant bacteria. For uncomplicated bacterial conjunctivitis where cost is a concern, generic ciprofloxacin remains a solid backup. In tougher cases-especially with resistant strains-Besivance or moxifloxacin deserves a spot at the top of the formulary.
Frequently Asked Questions
Can I use Besivance for viral pink eye?
No. Besivance targets bacterial pathogens. Viral conjunctivitis requires supportive care or antiviral therapy, not an antibiotic.
How quickly does Besivance start working?
Patients often notice reduced redness and discharge within 24‑48hours, though the full seven‑day course is needed for complete eradication.
Is Besivance safe for children?
Yes. Clinical trials included children as young as one year, and safety data showed no serious ocular or systemic events.
What should I do if I experience stinging after each drop?
A mild burning sensation is common. If it persists beyond a few minutes or worsens, stop the medication and contact your eye‑care provider.
How does the cost of Besivance compare to generic options?
A 7‑day supply of Besivance typically costs $70‑$90 in the U.S., whereas generic ciprofloxacin or ofloxacin can be $15‑$30. Insurance coverage varies, so check your plan.
Can I use Besivance while wearing contact lenses?
It’s best to remove lenses before instilling the drops and wait at least 15minutes before reinserting them to avoid contamination.
What is the recommended storage for Besivance?
Store at room temperature, 15‑30°C (59‑86°F), and keep the bottle capped tightly. Discard any remaining solution after 28days of opening.
