Besivance (Besifloxacin) vs Other Ophthalmic Antibiotics: A Practical Comparison

Besivance (Besifloxacin) vs Other Ophthalmic Antibiotics: A Practical Comparison
Colin Hargrave
by Colin Hargrave on Sep 25, 2025

Ophthalmic Antibiotic Selector

Select infection severity

Patient dosing compliance

Cost sensitivity

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

  1. After instillation, besifloxacin diffuses across the corneal epithelium.
  2. It binds to the bacterial enzymes DNA gyrase and topoisomerase IV, halting DNA replication.
  3. Without DNA synthesis, bacteria cannot multiply, leading to rapid reduction in colony‑forming units.
  4. The drug’s high binding affinity means even resistant strains struggle to survive.

Comparing the Usual Suspects

Key Attributes of Common Ophthalmic Antibiotics
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

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.

Comments: (3)

Vandita Shukla
Vandita Shukla

September 25, 2025 AT 07:23

If you’re trying to decide between Besivance and the older fluoroquinolones, the dosing schedule alone can tip the scales.
A single drop each morning eliminates the hassle of remembering four daily applications.
That convenience translates into better adherence, especially for pediatric or geriatric patients who struggle with complex regimens.
Clinical data show that adherence rates jump from roughly 60 % with QID dosing to over 85 % when the regimen is once‑daily.
Higher adherence directly improves cure rates, because the drug stays present on the ocular surface for the required duration.
Besivance also boasts a broader gram‑negative coverage, taking on resistant Pseudomonas strains that ciprofloxacin sometimes misses.
The added chlorine atom in its molecular structure increases corneal penetration, which is why it can be used at a lower concentration while still achieving the same microbiologic kill.
On the flip side, the price tag of $70‑90 for a week’s supply can be a barrier for uninsured patients.
Generic ciprofloxacin, at $15‑25, remains an attractive first‑line option when cost is the primary concern.
However, the four‑times‑daily schedule of ciprofloxacin often leads to missed doses and sub‑therapeutic levels.
In real‑world practice, I’ve seen cases where patients on generic drops relapsed because they stopped after three days.
The safety profile of Besivance is comparable; the incidence of stinging is marginally higher but generally well tolerated.
If the patient can afford the premium, the trade‑off of convenience versus cost usually favors Besivance.
For institutions with tight formularies, negotiating a bulk discount can make the drug more accessible.
Bottom line: match the antibiotic to the patient’s ability to follow the regimen, not just the microbial susceptibility.

Susan Hayes
Susan Hayes

September 26, 2025 AT 11:10

When you compare home‑grown American pharma to imported knock‑offs, Besivance stands out as a domestically developed product that’s been vetted by the FDA for safety and efficacy. The once‑daily dosing aligns perfectly with the busy schedule of the modern American consumer, and the higher price reflects the research investment that our own scientists poured into it. While generic alternatives are cheaper, they often come with a compliance penalty that ultimately harms patients. In short, if you value American innovation and are willing to pay a premium, Besivance is the logical choice.

Jessica Forsen
Jessica Forsen

September 27, 2025 AT 14:57

Sure, everyone’s thrilled about another pricey eye drop, but let’s be real: the convenience factor is the only thing that actually matters to most patients. If you can’t remember to blink, you’ll probably forget a QID regimen before you finish the bottle. Besivance’s single‑daily drop is a modest compromise that saves a few headaches – literally. And if you’re hoping the brand name will magically make the infection disappear faster, the data says it’s only marginally better than the older fluoroquinolones.

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