Ophthalmic Antibiotic Decision Guide
Select Your Scenario
When you need fast relief from bacterial eye infections, picking the right drop can feel like a gamble. Besivance (besifloxacin) is often touted as a premium option, but how does it really stack up against the other drops on the pharmacy shelf? This guide breaks down the science, cost, side‑effects, and practicalities so you can decide whether Besivance is worth the extra pennies or if a cheaper alternative will do the job just as well.
What is Besivance (Besifloxacin)?
Besivance Ophthalmic Solution is a prescription‑only fluoroquinolone eye drop containing the active ingredient besifloxacin. It was approved by the FDA in 2009 and quickly became popular for treating acute bacterial conjunctivitis and keratitis. The product is sold in a 0.3% (3 mg/mL) suspension, packaged in a single‑use vial to preserve sterility.
How Besivance Works - Mechanism of Action
Besifloxacin belongs to the fourth‑generation fluoroquinolones. It inhibits bacterial DNA gyrase (topoisomerase II) and topoisomerase IV, enzymes crucial for DNA replication and transcription. By blocking both targets, the drug achieves a broad‑spectrum kill against Gram‑positive and Gram‑negative organisms, including resistant strains like Staphylococcus aureus MRSA.
Key Clinical Benefits
- Rapid symptom relief: Clinical trials showed noticeable improvement in redness and discharge within 24 hours.
- High eradication rates: >95% bacterial clearance after a 5‑day course.
- Low resistance development: The dual‑target mechanism reduces the chance of mutant selection.
- Convenient dosing: One drop three times daily (TID) for five days.
Top Alternatives Overview
Several other ophthalmic antibiotics compete with Besivance on efficacy, price, or convenience. Below is a quick snapshot of the most common ones.
| Product | Active Ingredient | Class | Indications | Typical UK Cost (per pack) | Common Side‑effects |
|---|---|---|---|---|---|
| Besivance | Besifloxacin 0.3% | Fluoroquinolone (4th‑gen) | Acute bacterial conjunctivitis, keratitis | £45-£55 | Transient stinging, mild photophobia |
| Moxifloxacin | Moxifloxacin 0.5% | Fluoroquinolone (4th‑gen) | Conjunctivitis, keratitis, post‑surgical prophylaxis | £30-£38 | Burning, temporary blurred vision |
| Ciprofloxacin | Ciprofloxacin 0.3% | Fluoroquinolone (2nd‑gen) | Conjunctivitis, corneal ulcers | £15-£22 | Redness, mild itching |
| Tobramycin | Tobramycin 0.3% | Aminoglycoside | Bacterial conjunctivitis, corneal infections | £10-£14 | Transient discomfort, rare ototoxicity (systemic absorption) |
| Azithromycin | Azithromycin 1% | Macrolide | Chlamydial conjunctivitis, ocular rosacea | £20-£28 | Temporary gritty feeling, mild rash |
Side‑Effect Profile Comparison
All eye drops can irritate the delicate ocular surface, but the frequency and severity differ.
- Stinging or burning: Most patients report this with Besivance (≈30% of users) and moxifloxacin (≈25%). Ciprofloxacin and tobramycin tend to cause less immediate discomfort.
- Photophobia: Besivance can increase light sensitivity in about 5% of cases due to its higher corneal penetration.
- Allergic reactions: Macrolides like azithromycin have a slightly higher risk of hypersensitivity (≈3%). Fluoroquinolones carry a rare risk of tendon inflammation when systemically absorbed, but this is negligible in ophthalmic use.
- Resistance concerns: Overuse of older fluoroquinolones (ciprofloxacin) has led to rising resistance in community settings. Besifloxacin’s dual‑target action keeps resistance rates below 2% in recent UK surveillance data.
Cost and Convenience
Price is a major factor for patients, especially when the NHS covers only a portion of ophthalmic prescriptions. Besivance’s single‑use vials ensure sterility but add to the cost. Moxifloxacin and ciprofloxacin come in multi‑dose bottles, lowering the per‑drop price. However, they may require refrigeration after opening, and the longer shelf‑life can invite contamination if not handled correctly.
From a convenience standpoint, Besivance’s three‑times‑daily schedule is easier than some alternatives that need four to six doses per day (e.g., older fluoroquinolones). Fewer daily drops improve adherence, which directly translates to better outcomes.
Making the Right Choice - Decision Guide
Here’s a quick decision tree to help you line up the best option for a given scenario.
- Severe acute bacterial keratitis - Choose Besivance or moxifloxacin for their high corneal penetration and rapid bacterial kill.
- Cost‑conscious patient with mild conjunctivitis - Ciprofloxacin or tobramycin offer similar efficacy at a fraction of the price.
- History of fluoroquinolone resistance - Opt for a different class such as azithromycin or a combination therapy under specialist advice.
- Patient reports severe stinging with every drop - Consider switching to a gentler agent like tobramycin or a non‑fluoroquinolone macrolide.
Always discuss the choice with a qualified eye‑care professional; they can factor in local resistance patterns, allergies, and the patient’s ability to follow the dosing schedule.
Frequently Asked Questions
Can I use Besivance for viral conjunctivitis?
No. Besivance is an antibiotic and only works against bacterial infections. Viral conjunctivitis usually resolves on its own or may need antiviral therapy.
Do I need to refrigerate Besivance after opening?
No. Besivance comes in a sterile, single‑use vial that can be stored at room temperature until the expiration date printed on the label.
How long does it take for symptoms to improve?
Most patients notice reduced redness and discharge within 24 hours, with full resolution by day 5 when the course is completed.
Is Besivance safe during pregnancy?
The drug falls under FDA Category B, meaning animal studies have not shown risk, but there are no well‑controlled studies in pregnant women. Consult your ophthalmologist before use.
Can I wear contact lenses while using Besivance?
It’s best to remove contacts during treatment and re‑insert them after the infection clears, typically 24‑48 hours after the final dose.
