Besivance (Besifloxacin)

Besivance is an eye medicine used to treat certain bacterial eye infections. The medicine was originally developed by a Japanese pharmaceutical company, which later sold the rights to InSite Vision Incorporated. InSite Vision refined the original formulation for use as eye drops. In 2003, distribution rights were sold to Bausch + Lomb, a major eye-care company in the UK and a global leader in ophthalmic medicines and eye-care products.

Six years later, in 2009, the medicine was authorised in the UK for the treatment of bacterial conjunctivitis.

How Does Besivance Work?

The active ingredient in Besivance eye drops is besifloxacin. This medicine belongs to the fourth-generation fluoroquinolone antibiotics. It is highly effective against Gram-positive, Gram-negative and anaerobic bacteria. Because of this, Besivance has a broad spectrum of activity and can be used for eye conditions caused by different types of staphylococci, streptococci and other bacteria that are susceptible to besifloxacin.

It works by blocking bacterial DNA gyrase and topoisomerase IV, enzymes that are responsible for bacterial DNA synthesis and replication. By inhibiting these enzymes, Besivance stops bacteria from growing and leads to their death.

Why Is Besivance Better Than Other Generations of Quinolones?

One of the main advantages of Besivance is that it was designed specifically for use in the eyes. This helps reduce the body's overall exposure to the antibiotic and may help limit the development of resistance, which is an important concern when treating bacterial infections.

What Are Besivance Eye Drops Used For?

Besivance works against a wide range of bacterial infections that cause inflammation of the eye. It does not work against viral or fungal infections. That is why it is important to have a medical assessment to identify the organism causing the inflammation.

In UK clinical practice, Besivance may be used to treat or help prevent the following eye conditions:

• bacterial conjunctivitis;
• bacterial inflammation of the cornea;
• bacterial keratitis;
• prevention of eye infection in patients undergoing laser treatment for cataracts;
• prevention of eye infection after eye surgery.

Although bacterial infections can also cause other eye conditions, Besivance should not be used for a stye or blepharitis, as its effectiveness for these conditions has not been shown in clinical studies. In addition, post-marketing reports list blepharitis as a possible side effect of Besivance.

These conditions may require combination treatment with antimicrobial medicines and corticosteroids to reduce inflammation while treating the infection. One such combination is Tobradex (tobramycin/dexamethasone). Unlike Besivance, Tobradex is used to treat blepharitis.

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

Pink eye is another name for conjunctivitis. In the UK, it is a common condition. Pink eye is inflammation of the conjunctiva, a transparent membrane that covers the whites of the eyes and the inner surface of the eyelids. When this membrane becomes inflamed, the small blood vessels in the conjunctiva become more visible, which makes the eyes look pink.

Besivance can help reduce inflammation and clear the bacterial cause 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 it to be used topically. A common question is: "Does Besivance contain aspirin?" This is a misconception; acetylsalicylic acid is not one of the active or inactive ingredients.

The dosing schedule and length of treatment depend on the organism causing the infection, the reason for use (treatment or prevention), the severity of the condition and the patient's response.

To treat bacterial conjunctivitis with Besivance, put 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 around 70% of cases), but this does not mean treatment should be stopped early. By day 5 of treatment, bacterial eradication may reach about 90%. Stopping early can increase the risk of the infection coming back.

In children, the dose 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 eye infections do not respond to other antibiotics (for example, ciprofloxacin).

How to Use the Drops

An important recommendation is to keep the dropper tip sterile. Each time you open the bottle, take care not to let the dropper tip touch any surface, including your hands or eyes.

After putting in the drops, try to keep your eye closed for 1-2 minutes with your head tilted back to help the medicine absorb.

Missing a Dose: Is It a Problem?

Try not to miss doses, as this helps you get the most benefit from treatment. If you miss a dose of Besivance, use it as soon as you remember. If it is nearly time for your 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 medicine does not work against these organisms.

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 people.

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

Precautions for Therapy with Besivance

In the United Kingdom, Besivance is available on prescription only, so you need to see a doctor before starting treatment. To reduce the risk of side effects, tell your healthcare provider about all prescription medicines and medicines you take without a prescription.

Besivance may cause side effects that can temporarily affect your vision, such as blurred vision. Do not drive or operate machinery until your vision returns to normal.

During pregnancy, Besivance may be used when the potential benefit to the mother outweighs the potential risk 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 needed while breastfeeding, breastfeeding may need to be stopped for at least the duration of treatment.

Avoid wearing contact lenses during treatment with Besivance, at least until the signs of infection have cleared. Contact lenses may be put back in at least 15 minutes after using the drops.

Possible Adverse Reactions to Besivance

Topical use generally results in fewer whole-body side effects. The most common side effects occur in 1% to 10% of people. If they happen, they usually affect the treated eye, or both eyes if both are being treated:

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

These reactions usually do not need medical treatment, but you should tell your doctor if they occur, continue or get worse.

Besivance eye drops are not expected to cause side effects affecting the cardiovascular system, liver or kidneys.

Can Besivance upset your stomach?

No. Besivance is not meant to be taken by mouth, so it does not affect the digestive system and should not cause gastrointestinal symptoms when used as directed.