Besivance (Besifloxacin)

Besivance is a medication used in ophthalmology to treat certain types of bacterial eye infections. The drug was originally developed by a Japanese pharmaceutical company, which later sold the rights to InSite Vision Incorporated. InSite Vision improved the original formulation by developing it as eye drops. In 2003, distribution rights were sold to the American company Bausch + Lomb, one of the world’s leaders in ophthalmic medicines and eye-care products.

Six years later, in 2009, the medication received approval from the US Food and Drug Administration (FDA) for the treatment of bacterial conjunctivitis.

How Does Besivance Work?

The active component of Besivance eye drops is besifloxacin. This drug belongs to the fourth-generation fluoroquinolone antibiotics. It is highly effective against Gram-positive, Gram-negative, and anaerobic bacteria. Therefore, Besivance has a broad spectrum of activity and can be used for eye diseases caused by different types of staphylococci, streptococci, and other besifloxacin-susceptible bacteria.

The mechanism of action is based on inhibition of bacterial DNA gyrase and topoisomerase IV—enzymes responsible for bacterial DNA synthesis and replication. By inhibiting these enzymes, Besivance prevents bacterial growth and leads to bacterial death.

Why Is Besivance Better Than Other Generations of Quinolones?

A major benefit of Besivance is that it is specifically designed for ocular use. This helps reduce systemic exposure to the antibiotic and may help limit the development of resistance, which is a key concern in the treatment of bacterial infections.

What Are Besivance Eye Drops Used For?

Besivance is effective against a wide range of bacterial infections that cause inflammation of the eye. It is not effective for infections of viral or fungal origin. Therefore, it’s important to have a medical evaluation to identify the pathogen causing the inflammation.

In clinical practice, Besivance may be used in the treatment and prevention of the following ophthalmic diseases and conditions:

• bacterial conjunctivitis;
• bacterial inflammation of the cornea;
• bacterial keratitis;
• prophylaxis of ocular infection in patients undergoing laser therapy for cataracts;
• prophylaxis of ocular infection following ocular surgery.

Although bacterial infections may also cause other eye diseases, Besivance should not be used for a stye or blepharitis, as its effectiveness for these conditions has not been demonstrated in clinical studies. Moreover, post-marketing reports list blepharitis as a possible adverse effect of Besivance.

These conditions may require combination therapy with antimicrobial agents and corticosteroids to reduce inflammation while targeting the pathogen. One such combination is Tobradex (tobramycin/dexamethasone). Unlike Besivance, Tobradex is used in the treatment of blepharitis.

What Is Pink Eye? Can Besivance Be Used for Pink Eye?

Pink eye is another name for conjunctivitis. In the United States, this condition affects about 6 million people each year. Pink eye is inflammation of the conjunctiva—a transparent membrane that covers the whites of the eyes and the inner surface of the eyelids. Because of this inflammation, small blood vessels in the conjunctiva become more visible, making the eyes appear pink.

Besivance can help reduce inflammation and eradicate the bacterial pathogen when conjunctivitis is bacterial.

Dosage and General Recommendations

Besivance is supplied as an ophthalmic suspension containing 0.6% besifloxacin. This low concentration of the active ingredient allows topical use. A common question is: “Does Besivance contain aspirin?” This is a misconception; acetylsalicylic acid is not among the active ingredients or excipients.

The dosing regimen and duration of therapy depend on the pathogen causing the infection, the goal of use (treatment or prophylaxis), the severity of the condition, and the patient’s response.

To treat bacterial conjunctivitis with Besivance, instill one drop into the affected eye every 6 to 12 hours. There is no need to treat both eyes if only one is infected. Treatment usually lasts 5–8 days. Symptoms may improve sooner (reported in approximately 70% of cases), but this does not mean therapy should be stopped early. By day 5 of treatment, bacterial eradication may reach about 90%. Stopping early can increase the risk of relapse.

In pediatric patients, the dosage generally does not need to be adjusted.

Because the risk of bacterial resistance to Besivance is considered low, it may be used in patients whose ocular infections do not respond to other antibiotics (e.g., ciprofloxacin).

How to Use the Drops

A key recommendation is to maintain sterility of the dropper tip. Be careful each time you open the bottle to avoid contact of the dropper tip with any surface, including your hands and eyes.

After instillation, try to keep your eye closed for 1–2 minutes (with your head tilted back) to allow absorption.

Missing a Dose: Is It a Problem?

Try not to miss doses to maximize benefit. If you miss a dose of Besivance, instill it as soon as you remember. If it’s almost time for the next dose, skip the missed dose.

Who Should Avoid Using Besivance?

Because Besivance is used topically, it has few contraindications. One is eye infections caused by viruses or fungi, since the drug is not active against these pathogens.

Besivance should not be used in patients with known hypersensitivity to besifloxacin or other quinolone antibiotics. The product also contains inactive ingredients that may cause allergic reactions in susceptible individuals.

The safety of Besivance in infants younger than 1 year of age has not been established; therefore, it is contraindicated in this age group.

Precautions for Therapy with Besivance

Besivance is available by prescription only; therefore, a doctor’s consultation is necessary before starting treatment. To reduce the risk of adverse effects, inform your healthcare provider about all prescription and over-the-counter medicines you are taking.

Besivance may cause adverse reactions that can temporarily affect vision (e.g., blurred vision). Avoid driving or operating machinery until your vision returns to normal.

In pregnancy, Besivance may be used when the potential benefits to the mother outweigh potential risks to the fetus. This caution is based on animal studies in which besifloxacin caused maternal toxicity.

It is not known whether besifloxacin passes into breast milk. If Besivance is necessary during lactation, breastfeeding may need to be discontinued at least for the duration of treatment.

Avoid wearing contact lenses during treatment with Besivance, at least until clinical signs of infection have resolved. Contact lenses may be inserted at least 15 minutes after instilling the drops.

Possible Adverse Reactions to Besivance

Topical administration generally results in fewer systemic adverse effects. The incidence of the most common side effects ranges from 1% to 10%. If they occur, they usually involve the treated eye (or both eyes, if both are treated):

• eye redness;
• itching;
• sore eyes;
• blurred vision;
• swelling of the eyelids;
• eye pain;
• headache.

These reactions usually do not require medical treatment, but you should inform your doctor if they occur, persist, or worsen.

Besivance eye drops are not expected to cause adverse reactions involving the cardiovascular system, liver, or kidneys.

Can Besivance upset your stomach?

No. Besivance is not intended for oral use, so it does not affect the gastrointestinal tract and should not cause gastrointestinal symptoms when used as directed.