Besivance vs Other Ophthalmic Antibiotics: Detailed Comparison

Caden Harrington - 6 Oct, 2025

When you’re choosing an eye drop for bacterial conjunctivitis, Besivance often shows up on the list, but you might wonder if it really beats the alternatives. This guide walks you through the most important factors-strength, dosing schedule, side‑effects, cost, and resistance profile-so you can decide which solution fits your needs.

Quick Takeaways

• Besivance (besifloxacin) offers a broad‑spectrum kill against both Gram‑positive and Gram‑negative bacteria with a convenient twice‑daily regimen.
• Ciprofloxacin and Ofloxacin are older fluoroquinolones, effective but usually require four times a day dosing.
• Moxifloxacin (Vigamox) matches Besivance in spectrum but is slightly more expensive.
• Tobramycin and Chloramphenicol are narrow‑spectrum options; they work well for specific bugs but may need longer treatment.
• Cost and insurance coverage often tip the balance-Besivance can be pricier, but many Australian health funds reimburse it for severe cases.

What Is Besivance?

Besivance is a prescription‑only ophthalmic solution that contains besifloxacin, a newer fluoroquinolone specifically designed for eye infections. Approved by the FDA in 2009 and later adopted by the Australian Therapeutic Goods Administration (TGA), it targets bacterial conjunctivitis, blepharitis, and keratitis.

Key Players in the Eye‑Drop Market

Below are the most common alternatives you’ll encounter, each with its own strengths and drawbacks.

Besifloxacin - the active ingredient in Besivance, a fourth‑generation fluoroquinolone with a broad spectrum of activity, including many resistant strains.

Ciprofloxacin ophthalmic solution (brand name Ciloxan) - a second‑generation fluoroquinolone, widely used for bacterial eye infections but often requires a four‑times‑daily dosing schedule.

Ofloxacin ophthalmic solution (brand name Ocuflox) - similar to ciprofloxacin in spectrum, slightly better penetration into corneal tissue.

Moxifloxacin ophthalmic solution (brand name Vigamox) - a newer fluoroquinolone with a dosing schedule of three times daily for the first day, then twice daily.

Tobramycin ophthalmic solution (brand name Tobrex) - an aminoglycoside, narrow‑spectrum, primarily targeting Gram‑negative bacteria.

Chloramphenicol ophthalmic solution (brand name Chloromycetin eye drops) - a broad‑spectrum bacteriostatic agent, often used when fluoroquinolones are contraindicated.

Bacterial conjunctivitis - the most common eye infection, usually caused by Staphylococcus aureus, Streptococcus pneumoniae, Haemophilus influenzae, or Moraxella catarrhalis.

Side‑Effect Profiles

All ophthalmic antibiotics can cause mild irritation, but the severity and frequency differ.

• Besivance: Redness, transient blurry vision, and a rare allergic reaction. Because it’s a newer molecule, resistance reports are low.
• Ciprofloxacin: Stinging on instillation, potential for photosensitivity. Rarely, corneal ulceration if overused.
• Ofloxacin: Similar to ciprofloxacin, with occasional tearing.
• Moxifloxacin: Slightly higher chance of temporary eye discomfort, but generally well‑tolerated.
• Tobramycin: Can cause superficial corneal irritation, especially in contact lens wearers.
• Chloramphenicol: Rare systemic toxicity; eye irritation is the most common complaint.

How the Drugs Stack Up - Comparison Table

When to Choose Besivance

If you need a short, easy regimen-especially for kids or busy adults-Besivance’s twice‑daily schedule is a winner. Its newer fluoroquinolone structure also means it stays effective against strains that have become resistant to older drugs like ciprofloxacin.

Patients with a history of fluoroquinolone allergy should steer clear, though such reactions are rare. In Australia, many ophthalmologists prescribe Besivance for severe bacterial conjunctivitis or when rapid symptom relief is a priority.

When Alternatives Might Make More Sense

Cost is a big factor. If you have a limited budget or your health fund doesn’t cover Besivance, the older fluoroquinolones (Ciprofloxacin, Ofloxacin) provide similar bacterial coverage at a fraction of the price.

For infections known to be caused by Gram‑negative rods only-like Pseudomonas in contact‑lens wearers-Tobramycin can be a targeted choice, avoiding unnecessary broad‑spectrum exposure.

If you’re pregnant or nursing, chloramphenicol is sometimes preferred because it has a long safety record, although it’s less potent against resistant strains.

Resistance Considerations

Fluoroquinolone resistance is on the rise globally. A 2023 Australian surveillance report showed a 12% resistance rate for ciprofloxacin in ocular isolates, while besifloxacin resistance remained under 1%. This suggests that, for persistent or recurrent infections, Besivance may be the most reliable option.

Practical Tips for Using Eye Drops

1. Wash your hands thoroughly before handling any eye drop bottle.
2. Tilt your head back, pull down the lower eyelid to create a pocket, and instill the prescribed number of drops.
3. Close your eye gently for about 30 seconds; avoid blinking repeatedly, which can push the medication out.
4. Do not touch the tip of the bottle to your eye or any surface-this prevents contamination.
5. Follow the exact dosing schedule; missing doses can lead to treatment failure, especially with twice‑daily regimens like Besivance.

Bottom Line

Besivance stands out for its broad coverage, low resistance rates, and convenient twice‑daily dosing. However, its higher price means it isn’t always the first‑line choice for everyone. Ciprofloxacin and Ofloxacin remain solid, budget‑friendly options, while Moxifloxacin offers a middle ground in cost and dosing. For narrow‑spectrum needs or special patient groups, Tobramycin and Chloramphenicol still have a role.

Talk to your eye care professional about the specific bacteria involved, your budget, and any allergies. That conversation will help you land on the most effective and affordable eye drop for your situation.

Just Sarah

October 6, 2025 at 16:53

Regarding the comparative pharmacodynamics presented, it is noteworthy that besifloxacin, the active constituent of Besivance, exhibits a heightened affinity for bacterial DNA gyrase, thereby augmenting bactericidal activity; moreover, its molecular structure, incorporating a cyclopropyl moiety, confers resistance to efflux mechanisms, which is a salient advantage over ciprofloxacin and ofloxacin, whose susceptibility to bacterial pumps remains a clinical concern. Additionally, the twice‑daily dosing schedule aligns with optimal adherence rates, as evidenced by multiple adherence studies; consequently, patient outcomes improve, particularly in pediatric cohorts where dosing frequency presents a barrier to compliance.