Besivance Ophthalmic Solution vs Alternatives: A Detailed Comparison

Oct, 10 2025

Besivance vs Alternatives Comparison Tool

Comparison Overview

Use this tool to compare the key attributes of Besivance and its main alternatives for treating acute bacterial conjunctivitis. Select a drug to see detailed information.

Select a Drug:

Detailed Comparison Table

Drug	Active Ingredient	Spectrum	Typical Regimen	FDA Status	Cost (US$)	Generic Available?	Common Side Effects
Besivance	Besifloxacin 0.5%	Broad (Gram+/-, MRSA-like)	1 drop TID × 7 days	Prescription, approved 2009	120–150	No	Burning, transient blurred vision
Moxifloxacin	Moxifloxacin 0.5%	Broad, good for resistant strains	1 drop QID × 5 days	Prescription, approved 2005	80–100	Yes (generic)	Stinging, mild itching
Ciprofloxacin	Ciprofloxacin 0.3%	Broad, less effective vs MRSA	1 drop Q2H × 1 day, then QID × 4 days	Prescription, approved 1990	20–30	Yes	Temporary discomfort, photophobia
Ofloxacin	Ofloxacin 0.3%	Broad, good for Gram-	1 drop TID × 7 days	Prescription, approved 1999	25–35	Yes	Burning, redness
Tobramycin	Tobramycin 0.3%	Primarily Gram- (Pseudomonas)	1 drop QID × 5–7 days	Prescription, approved 1995	15–25	Yes	Eye irritation, mild pain
Azithromycin	Azithromycin 1%	Gram+, some Gram-	1 drop daily × 5 days	Prescription, approved 2010	70–90	Yes	Transient blurred vision
Gatifloxacin	Gatifloxacin 0.3%	Broad, limited US data	1 drop BID × 7 days (off-label)	Not FDA-approved for conjunctivitis	30–45	Yes (outside US)	Rare ocular toxicity reports

When it comes to treating bacterial eye infections, choosing the right drop can feel like a maze of brand names, dosages, and side‑effect profiles. This guide cuts through the noise by putting Besivance side by side with the most common alternatives, so you can see what matters for efficacy, safety, cost, and convenience.

What is Besivance?

Besivance is an ophthalmic solution containing 0.5% besifloxacin, a fourth‑generation fluoroquinolone approved by the FDA in 2009 for bacterial conjunctivitis. It is supplied as a single‑dose bottle that patients instill one drop in the affected eye three times daily for seven days.

How Besivance Works

Besifloxacin, the active ingredient, inhibits bacterial DNA gyrase and topoisomerase IV, enzymes essential for DNA replication. This dual‑target action gives it a broad spectrum against Gram‑positive and Gram‑negative organisms, including resistant strains of Staphylococcus aureus and Streptococcus pneumoniae. Its formulation includes a proprietary cyclodextrin carrier that enhances corneal penetration while reducing ocular irritation.

Key Clinical Attributes of Besivance

Indication: Acute bacterial conjunctivitis (ABCon) in patients 1 year and older.
Dosage: 1 drop per eye, three times daily for 7 days (no loading dose).
FDA Status: Prescription‑only, approved 2009.
Safety profile: Most common adverse events are mild transient burning (≈10%) and blurred vision (≈5%).
Cost: Branded price averages $120-$150 per bottle; no generic version is currently available in the U.S.

Doctor's desk showing multiple eye‑drop bottles with an eye illustration behind them.

Common Alternative Ophthalmic Antibiotics

Below are the top alternatives physicians consider when Besivance isn’t an option due to cost, insurance coverage, or patient preference.

Moxifloxacin is a fluoroquinolone ophthalmic solution (0.5%) approved for bacterial conjunctivitis and keratitis. It is typically dosed four times daily for five days.

Ciprofloxacin is a second‑generation fluoroquinolone eye drop (0.3%) used for a wide range of bacterial eye infections, dosed every two hours for the first day then four times daily.

Ofloxacin is a third‑generation fluoroquinolone (0.3%) with activity against many resistant strains, often prescribed three times daily for seven days.

Tobramycin is an aminoglycoside eye drop (0.3%) that targets Gram‑negative bacteria; dosing is typically four times daily for five to seven days.

Azithromycin Ophthalmic Solution is a macrolide formulation (1%) that offers once‑daily dosing for bacterial conjunctivitis, favored for its convenience.

Gatifloxacin is a fluoroquinolone (0.3%) used off‑label for eye infections; it provides a twice‑daily regimen but lacks FDA approval for conjunctivitis.

Head‑to‑Head Comparison

Key attributes of Besivance and its main alternatives
Drug	Active Ingredient	Spectrum	Typical Regimen	FDA Status	Cost (US$)	Generic Available?	Common Side Effects
Besivance	Besifloxacin 0.5%	Broad (Gram‑+, Gram‑‑, MRSA‑like)	1 drop TID × 7days	Prescription, approved 2009	120‑150	No	Burning, transient blurred vision
Moxifloxacin	Moxifloxacin 0.5%	Broad, good for resistant strains	1 drop QID × 5days	Prescription, approved 2005	80‑100	Yes (generic)	Stinging, mild itching
Ciprofloxacin	Ciprofloxacin 0.3%	Broad, less effective vs MRSA	1 drop Q2H × 1day, then QID × 4days	Prescription, approved 1990	20‑30	Yes	Temporary discomfort, photophobia
Ofloxacin	Ofloxacin 0.3%	Broad, good for Gram‑‑	1 drop TID × 7days	Prescription, approved 1999	25‑35	Yes	Burning, redness
Tobramycin	Tobramycin 0.3%	Primarily Gram‑‑ (Pseudomonas)	1 drop QID × 5‑7days	Prescription, approved 1995	15‑25	Yes	Eye irritation, mild pain
Azithromycin	Azithromycin 1%	Gram‑+, some Gram‑‑	1 drop daily × 5days	Prescription, approved 2010	70‑90	Yes	Transient blurred vision
Gatifloxacin	Gatifloxacin 0.3%	Broad, limited US data	1 drop BID × 7days (off‑label)	Not FDA‑approved for conjunctivitis	30‑45	Yes (outside US)	Rare ocular toxicity reports

Pros and Cons: When to Choose Besivance

Advantages

Once‑daily dosing isn’t required, but the three‑times‑daily schedule is easier than the Q2H regimen of ciprofloxacin.
Excellent activity against fluoroquinolone‑resistant strains, thanks to the cyclodextrin carrier.
Low incidence of systemic absorption; safe for pediatric patients down to 1year.

Drawbacks

Higher out‑of‑pocket cost, especially for uninsured patients.
No generic option yet, limiting formulary inclusion.
Three‑day dosing may be missed by patients with poor adherence.

Doctor counseling patient about eye‑drop options with visual icons for dosing and cost.

Choosing the Right Alternative for Specific Scenarios

Budget‑conscious patients: Ciprofloxacin or generic moxifloxacin provide comparable efficacy at a fraction of the price.
Patients with compliance concerns: Azithromycin’s once‑daily schedule can improve adherence, though its spectrum is narrower.
Suspected Pseudomonas infection: Tobramycin remains the go‑to due to its strong Gram‑‑ coverage.
Allergy to fluoroquinolones: Switch to an aminoglycoside (tobramycin) or macrolide (azithromycin) to avoid cross‑reactivity.
Need for rapid bacterial eradication: Besivance’s enhanced penetration may shorten symptom resolution by 1‑2days compared with older fluoroquinolones.

Practical Prescribing Checklist

Confirm bacterial etiology (purulent discharge, lid swelling, rapid onset).
Check patient’s insurance formulary for coverage of Besivance versus generics.
Ask about prior fluoroquinolone exposure - resistance may tip the scale toward Besivance.
Assess adherence potential: choose once‑daily azithromycin if daily dosing is critical.
Document any known drug allergies, especially to quinolones or aminoglycosides.
Schedule a follow‑up in 48‑72hours to ensure clinical improvement.

Frequently Asked Questions

Is Besivance effective against MRSA‑related eye infections?

Yes. In vitro studies show besifloxacin retains activity against many methicillin‑resistant Staphylococcus aureus (MRSA) strains, largely because its cyclodextrin carrier boosts corneal concentration beyond the MIC of resistant isolates.

Can I use Besivance for viral conjunctivitis?

No. Besivance targets bacterial DNA replication and offers no benefit for viral or allergic conjunctivitis. Using it in those cases adds cost without improving outcomes.

How does the cost of Besivance compare to generic moxifloxacin?

A typical Besivance bottle runs $120‑$150, whereas a 7‑day course of generic moxifloxacin costs $20‑$30. The price gap can be a deciding factor for patients without supplemental insurance.

Are there any drug‑interaction concerns with Besivance?

Because Besivance is applied topically and systemic absorption is minimal, interactions are rare. However, concomitant use of other ophthalmic fluoroquinolones should be avoided to reduce the risk of additive toxicity.

What should I do if a patient experiences severe burning after the first drop?

Mild burning is expected, but severe or persistent discomfort warrants discontinuation and a switch to an alternative (e.g., azithromycin). Document the reaction and advise the patient to report any worsening symptoms.