Besivance vs. Other Eye Infection Drops: What Works Best?

When your eyes are red, swollen, or burning, you don’t have time to guess which eye drop will work. Besivance (besifloxacin) is one of the most prescribed antibiotic eye drops for bacterial conjunctivitis, but it’s not the only option. If you’ve been prescribed Besivance and are wondering if there’s a cheaper, equally effective alternative, you’re not alone. Many patients and even some doctors question whether Besivance is worth the cost compared to other options. Let’s cut through the noise and compare Besivance to the most common alternatives-what they do, how they stack up, and who really benefits from each one.

What is Besivance (besifloxacin)?

Besivance is a brand-name ophthalmic solution containing besifloxacin is a fourth-generation fluoroquinolone antibiotic specifically designed for eye use. It kills bacteria that cause conjunctivitis-commonly called pink eye-by blocking DNA replication. Unlike older antibiotics, besifloxacin stays active in the eye longer, which is why it’s dosed only three times a day. It’s FDA-approved for adults and children over one year old. The solution comes in a 5 mL single-use vial, and a typical course lasts five to seven days. It’s not used for viral or fungal infections, only bacterial ones.

Why Besivance costs more than other eye drops

Besivance is significantly more expensive than generic alternatives. A single bottle can cost $150-$250 without insurance. Compare that to moxifloxacin (Vigamox) or ciprofloxacin (Ciloxan), which can cost under $30 as generics. Why the gap? Besivance was developed as a topical-only fluoroquinolone, meaning it’s formulated to stay in the eye and not absorb into the bloodstream. This reduces systemic side effects, but the manufacturing process is more complex. It also has a patented delivery system that helps it stick to the eye surface longer. While that sounds good, clinical studies show its effectiveness is very similar to other fluoroquinolones.

Besivance vs. Vigamox (moxifloxacin)

Vigamox is the brand name for moxifloxacin, another fourth-generation fluoroquinolone. It’s also FDA-approved for bacterial conjunctivitis and dosed three times daily. In head-to-head trials, both Besivance and Vigamox cleared infections in over 90% of cases within 5 days. The real difference? Cost and availability. Vigamox has been available as a generic since 2015, and the generic version works just as well. Many ophthalmologists now switch patients to generic moxifloxacin after the first prescription, especially if cost is a concern. Neither drug works better for resistant strains, and both carry the same warning: avoid prolonged use to prevent fungal overgrowth or antibiotic resistance.

Besivance vs. Ciloxan (ciprofloxacin)

Ciloxan contains ciprofloxacin, a second-generation fluoroquinolone. It’s been around since the 1990s and is one of the cheapest options-often under $20 with insurance. Ciprofloxacin is dosed four to five times a day, which can be harder to stick to. But for simple bacterial infections, it’s just as effective as Besivance in most cases. A 2022 study in the Journal of Ocular Pharmacology and Therapeutics found no significant difference in cure rates between ciprofloxacin and besifloxacin in patients with mild to moderate conjunctivitis. The downside? Ciprofloxacin doesn’t stay on the eye as long, so you need more doses. If you’re a busy parent or shift worker, that extra dosing can be a real burden.

Besivance vs. Zymaxid (gatifloxacin)

Zymaxid (gatifloxacin) is another fourth-generation fluoroquinolone, though it’s less commonly used today. It was pulled from the U.S. market in 2013 for systemic use due to blood sugar issues, but the eye drop version remains approved. It’s dosed four times daily and costs about the same as Vigamox. While it’s effective, it hasn’t replaced Besivance or moxifloxacin in most clinics. Why? No clear advantage in cure rates, and it’s not as widely stocked. Most pharmacies keep Besivance, Vigamox, and ciprofloxacin on hand-but not Zymaxid.

When Besivance might be the best choice

Besivance isn’t always overkill. There are cases where it makes sense:

• You’ve tried generic ciprofloxacin or moxifloxacin and the infection came back
• You’re allergic to preservatives in other drops (Besivance is preservative-free)
• You have a history of antibiotic-resistant eye infections
• You’re a contact lens wearer with recurrent bacterial conjunctivitis

For most people, though, these situations are rare. If your doctor prescribes Besivance without discussing alternatives, ask why. You might be paying extra for a brand name when a generic works just as well.

What about non-fluoroquinolone options?

Not all antibiotic eye drops are fluoroquinolones. Some doctors still prescribe:

• Tobramycin (Tobrex)-a gentamicin-type antibiotic, used for more severe infections
• Sulfacetamide (Bleph-10)-an older, cheaper option, often used in children
• Erythromycin ointment-used at night, especially for babies

These aren’t direct substitutes for Besivance. Tobramycin is stronger and used for corneal ulcers. Sulfacetamide is milder and less effective against resistant strains. Erythromycin is slow-acting and messy. They’re used in specific cases, not as routine replacements. If your doctor suggests one of these, it’s usually because they suspect a different type of infection or you’re a child or pregnant.

How to decide what’s right for you

Here’s a simple decision guide:

1. Is your infection mild? (Redness, itching, minor discharge) → Try generic ciprofloxacin or moxifloxacin
2. Did a previous antibiotic fail? → Ask about Besivance or consider a culture test
3. Do you have trouble remembering doses? → Besivance or Vigamox (3x/day) are easier than ciprofloxacin (4-5x/day)
4. Are you on a tight budget? → Generic ciprofloxacin is the clear winner
5. Are you using contacts? → Besivance’s preservative-free formula may reduce irritation

Don’t assume the most expensive option is the best. Most eye infections respond well to any fluoroquinolone. The goal is to clear the infection quickly and safely-not to spend more than needed.

Side effects and safety

All these drops are generally safe. Common side effects include:

• Temporary stinging or burning after application
• Blurred vision for a few minutes
• Mild eye irritation or dryness

More serious reactions-like allergic swelling, severe pain, or vision changes-are rare. If they happen, stop the drop and call your doctor immediately. None of these drugs should be used longer than 7-10 days unless directed. Overuse can lead to fungal infections or antibiotic resistance. Also, never share eye drops. Even if they look clean, they can carry bacteria from one person to another.

What to do if your infection doesn’t improve

If your symptoms don’t get better after 2-3 days of using any antibiotic drop, you might not have a bacterial infection. Viral conjunctivitis looks similar but doesn’t respond to antibiotics. Allergies, dry eye, or even contact lens overwear can mimic bacterial pink eye. If you’re still red, gritty, or watery after a few days, go back to your eye doctor. They may need to do a swab test to identify the exact cause. Don’t keep using the same drop hoping it’ll work-it could make things worse.

Final thoughts

Besivance is a good drug. It’s effective, well-tolerated, and preservative-free. But it’s not the only good option. For most people, generic moxifloxacin or ciprofloxacin work just as well, cost a fraction, and are just as safe. The key is matching the treatment to your situation-not your budget or your doctor’s habit. Ask questions. Compare options. And don’t be afraid to ask for the generic version. Your eyes-and your wallet-will thank you.