Besivance vs Other Ophthalmic Antibiotics: Besifloxacin Comparison
Besivance vs Other Ophthalmic Antibiotics Comparison Tool
Class: Fourth-generation fluoroquinolone
Indications: Bacterial conjunctivitis and acute bacterial keratitis
Dosing: 1 drop three times daily for 5 days
Key Benefit: Broad spectrum with excellent coverage against resistant strains
UK Approximate Cost: £45 per treatment (single-dose vial)
Generic Alternatives: Ciprofloxacin (~£5-£8), Tobramycin (~£12)
Cost-Effectiveness: Higher upfront cost but potentially better outcomes for resistant infections
| Drug | Generation | Dosing | Cost |
|---|---|---|---|
| Besivance | 4th-gen fluoroquinolone | 1 drop TID × 5 days | £45 |
| Ciprofloxacin | 2nd-gen fluoroquinolone | 1 drop QID × 7 days | £5-£8 |
| Moxifloxacin | 4th-gen fluoroquinolone | 1 drop BID × 5 days | £30 |
| Gatifloxacin | 3rd-gen fluoroquinolone | 1 drop QID × 7 days | £20 |
| Tobramycin | Aminoglycoside | 1 drop QID × 7-10 days | £12 |
| Polymyxin B/Trimethoprim | Combination | 1 drop QID × 7 days | £8 |
Key Differences Summary
- Besivance offers broad spectrum coverage including resistant strains, ideal for complex cases
- Ciprofloxacin is the most affordable generic option but has lower efficacy against resistant Gram-positive bacteria
- Moxifloxacin provides similar spectrum but with twice-daily dosing
- Tobramycin excels against Gram-negative bacteria, especially Pseudomonas, but limited Gram-positive coverage
- Polymyxin B/Trimethoprim offers moderate coverage but faces increasing resistance risks
Pros of Besivance
- Broad spectrum including resistant strains
- Convenient 3x daily dosing for 5 days
- Preservative-free formulation
- Low systemic exposure - safer for pregnant/lactating women
Cons of Besivance
- Higher cost compared to generics
- Requires prescription
- Rare allergic reactions reported
Got an eye infection and wondering whether Besivance is the right choice or if another eye drop might work better? You’re not alone. Patients and clinicians constantly weigh effectiveness, safety, dosing convenience, and cost when picking an ophthalmic antibiotic. Below you’ll find a no‑fluff rundown of Besivance, the most common alternatives, and a side‑by‑side comparison that lets you see which option fits your situation.
TL;DR - Quick Takeaways
- Besivance (besifloxacin) is a fourth‑generation fluoroquinolone with strong activity against both Gram‑positive and Gram‑negative eye pathogens.
- It’s dosed three times daily for five days, a regimen that many patients find manageable.
- Top alternatives - ciprofloxacin, moxifloxacin, gatifloxacin, tobramycin - differ in spectrum, resistance risk, and price.
- Safety profile for Besivance is similar to other fluoroquinolones: mild burning, transient vision blur; serious adverse events are rare.
- When cost is a primary concern, generic ciprofloxacin often wins; for resistant infections, Besivance may have the edge.
What is Besivance?
Besivance is a prescription ophthalmic solution that contains the fluoroquinolone antibiotic besifloxacin. It received FDA approval in 2009 and is marketed mainly for bacterial conjunctivitis and acute bacterial keratitis. The 0.6% solution comes in a single‑dose vial, eliminating the need for preservatives that can irritate sensitive eyes.
How Besifloxacin Works
Besifloxacin belongs to the fourth‑generation fluoroquinolones. It blocks bacterial DNA gyrase and topoisomerase IV, enzymes essential for DNA replication. This dual‑target action gives it a broader and more potent spectrum than older fluoroquinolones, covering common culprits like Staphylococcus aureus, Streptococcus pneumoniae, Pseudomonas aeruginosa, and Haemophilus influenzae. Because the drug is delivered directly to the eye, systemic exposure is minimal, reducing the risk of systemic side effects.
Common Alternatives to Besivance
Below are the five most frequently prescribed ophthalmic antibiotics that clinicians compare with Besivance.
- Ciprofloxacin Ophthalmic Solution is a second‑generation fluoroquinolone approved in 1990. It’s widely available as a generic, making it the least expensive option.
- Moxifloxacin Ophthalmic Solution is a fourth‑generation fluoroquinolone introduced in 2005. It offers a similar spectrum to besifloxacin but often requires a twice‑daily dosing schedule.
- Gatifloxacin Ophthalmic Suspension is a third‑generation fluoroquinolone launched in 2002. Its suspension form can cause more blurred vision immediately after dosing.
- Tobramycin Ophthalmic Solution is an aminoglycoside that targets Gram‑negative bacteria, especially Pseudomonas. It’s often combined with dexamethasone for inflammation control.
- Polymyxin B/Trimethoprim Ophthalmic Solution couples a membrane‑active antibiotic with a folate‑pathway inhibitor, offering a broad‑spectrum but lower potency against resistant strains.
Side‑by‑Side Comparison
| Drug | Generation / Class | Typical Dosing | Gram‑Positive Coverage | Gram‑Negative Coverage | Resistance Concerns | Approx. UK Cost (per treatment) |
|---|---|---|---|---|---|---|
| Besivance | 4th‑gen fluoroquinolone | 1 drop TID for 5days | Excellent (MRSA‑type strains) | Excellent (incl. Pseudomonas) | Low - retains activity vs many resistant isolates | ≈£45 (single‑dose vial) |
| Ciprofloxacin | 2nd‑gen fluoroquinolone | 1 drop QID for 7days | Good (not active vs MRSA) | Good (incl. Pseudomonas) | Moderate - resistance rising in Staph spp. | ≈£5-£8 (generic bottle) |
| Moxifloxacin | 4th‑gen fluoroquinolone | 1 drop BID for 5days | Very good (covers resistant Staph) | Very good (incl. Pseudomonas) | Low - similar to Besivance | ≈£30 (branded) |
| Gatifloxacin | 3rd‑gen fluoroquinolone | 1 drop QID for 7days | Good (some MRSA gaps) | Good (Pseudomonas) | Moderate - some regional resistance | ≈£20 (branded) |
| Tobramycin | Aminoglycoside | 1 drop QID for 7‑10days | Poor (Gram‑positive limited) | Excellent (Pseudomonas) | Low - resistance rare but strain‑specific | ≈£12 (generic) |
| Polymyxin B/Trimethoprim | Combination (membrane + folate) | 1 drop QID for 7days | Moderate | Moderate | Higher - emerging resistance in Gram‑negatives | ≈£8 (generic) |
Pros and Cons - When Besivance Shines
Pros
- Broad Spectrum: Hits both Gram‑positive and Gram‑negative bugs, including many resistant strains.
- Convenient Dosing: Three times a day for five days is shorter than many older regimens.
- Preservative‑Free: Ideal for patients with dry eye or allergy‑related irritation.
- Low Systemic Exposure: Safe for pregnant or lactating women when prescribed by an ophthalmologist.
Cons
- Higher price tag - the single‑dose vial can cost 4‑5× a generic fluoroquinolone.
- Not available as an over‑the‑counter (OTC) product; you need a prescription.
- Rare allergic reactions (e.g., contact dermatitis) reported in <1% of users.
Alternative Choices - Where They Excel
Ciprofloxacin remains the go‑to for cost‑conscious patients and for infections where resistance patterns are favorable. Its twice‑daily dosing options make it a decent choice for children who struggle with frequent drops.
Moxifloxacin offers a dosing schedule of twice daily, which many find easier than three times a day. It’s priced lower than Besivance but still above generic options.
Gatifloxacin can be useful when a suspension form is preferred for patients who dislike clear solutions, though the temporary blur may be annoying.
Tobramycin shines for suspected Pseudomonas keratitis, especially after contact‑lens‑related injuries. It’s often paired with steroids for inflammation control.
Polymyxin B/Trimethoprim provides a cheaper broad‑spectrum choice but should be avoided in regions with high polymyxin resistance.
Safety Snapshot - What to Watch For
All topical fluoroquinolones, including Besivance, can cause mild burning, stinging, or transient visual blur. Serious events (e.g., tendon rupture, systemic QT prolongation) are virtually unheard of when used eye‑only because systemic absorption is negligible.
Allergies are the main reason to switch agents. If a patient develops persistent redness, swelling, or itching beyond the first 24‑48hours, they should discontinue and contact their eye‑care provider.
Contact‑lens wearers should remove lenses before applying any drops and wait at least 15minutes before reinserting to avoid drug‑lens interactions.
Decision Checklist - Choose the Right Drop for You
- Infection type: Conjunctivitis→Besivance or ciprofloxacin; corneal ulcer→Besivance or tobramycin (if Pseudomonas suspected).
- Resistance profile: Known MRSA→Prefer Besivance or moxifloxacin; low‑risk community strains→Ciprofloxacin may suffice.
- Cost sensitivity: Budget→Generic ciprofloxacin; premium→Besivance for its preservative‑free convenience.
- Patient age & compliance: Children→Simpler dosing (BID) or suspension forms; adults→Any regimen works if they can handle three daily drops.
- Allergy history: Known fluoroquinolone allergy→Switch to tobramycin or polymyxin‑based combo.
Next Steps & Troubleshooting
If you’ve been prescribed Besivance but are unsure about the regimen, follow these steps:
- Read the patient information leaflet - it explains how to shake the vial, avoid contaminating the tip, and store the unused portion (if any).
- Mark your dosing times on a phone reminder; three doses a day often fit morning, noon, and bedtime.
- If you feel burning after each drop, try placing the bottle higher than your eye and gently pulling down the lower lid to create a pocket.
- Monitor symptoms - redness should start to improve within 48hours. If it worsens or you notice increased pain, call your ophthalmologist.
- Should side effects become intolerable, discuss switching to an alternative on the comparison table with your doctor.
Frequently Asked Questions
How long does Besivance take to work?
Most patients notice reduced redness and discharge within 2‑3days. Full resolution of bacterial conjunctivitis usually occurs by day5, which matches the treatment course.
Can I use Besivance if I wear contact lenses?
Yes, but remove the lenses before each drop and wait at least 15minutes before putting them back. This prevents the drug from binding to the lens material and reduces irritation.
Is Besivance safe during pregnancy?
Topical use delivers minimal systemic absorption, and there are no documented adverse pregnancy outcomes. Nonetheless, it should only be used when the benefits outweigh any theoretical risk, under a doctor’s guidance.
Why is Besivance more expensive than generic drops?
The higher price reflects its preservative‑free single‑dose packaging, newer patent‑protected formulation, and the broader spectrum that covers resistant strains. Generic fluoroquinolones lack these specific features.
When should I consider switching from Besivance to another antibiotic?
If you develop persistent burning, an allergic rash, or worsening infection after 48hours, contact your eye‑care professional. They may swap you to tobramycin (if Pseudomonas is a concern) or a different fluoroquinolone based on culture results.
Darlene Young
October 3, 2025 AT 03:43Besivance really shines when you’re battling a stubborn infection that won’t quit – its fourth‑generation fluoroquinolone backbone punches through resistant strains like a seasoned detective cracking a cold case. The preservative‑free vial means less irritation for patients prone to dry eye, and the three‑times‑daily schedule for five days is surprisingly manageable compared to the week‑long grind of older drops. While the price tag looks steep at £45, think of it as an investment in a quicker, more reliable cure rather than a cheap band‑aid that may fail. In my experience, the broad‑spectrum coverage can be a game‑changer when cultures show mixed flora. So, if you’re wrestling with a tough bacterial conjunctivitis, Besivance is worth the extra pennies.
Steve Kazandjian
October 10, 2025 AT 16:16Just a quick heads‑up: the dosing for Besivance is three drops a day for five days, which isn’t too bad. If you’re watching your wallet, ciprofloxacin is a lot cheaper, but it might not hit the hard‑to‑kill bugs.
Roger Münger
October 18, 2025 AT 04:49To add precision, the pharmacodynamics of besifloxacin include dual inhibition of DNA gyrase and topoisomerase IV, thereby reducing the probability of resistance development. Comparative MIC data consistently show lower values for Besivance against MRSA‑type isolates than ciprofloxacin. Moreover, the single‑dose vial eliminates the need for preservatives, which have been implicated in epithelial toxicity.
Gerald Bangero
October 25, 2025 AT 17:23i think the best part is that the eye dont feel like its on fire after using it. many times i tried other drops and i got that stinging feeling but besivance was kinda smooth. also it only takes a week which is good cuz i dont have time to keep messing with my schedule.