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 improved the original formulation by developing it as eye drops. In 2003, distribution rights were sold to Bausch + Lomb, a company well known in eye care, and in Australian clinical practice these antibiotic eye drops are typically prescribed and used under the guidance of a GP or eye specialist.

Six years later, in 2009, the medicine was approved in Australia 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 active 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 besifloxacin-susceptible bacteria.

It works by inhibiting bacterial DNA gyrase and topoisomerase IV, enzymes responsible for bacterial DNA synthesis and replication. By blocking these enzymes, Besivance stops 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 use in the eyes. This helps reduce systemic exposure to the antibiotic and may help limit the development of resistance, which is an important concern in the treatment of 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 cause of the inflammation.

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

• bacterial conjunctivitis;
• bacterial inflammation of the cornea;
• bacterial keratitis;
• prevention of eye infection in patients undergoing laser therapy 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 in the treatment of blepharitis.

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

Pink eye is another name for conjunctivitis. In Australia, this condition is common, particularly among children and in places where infections can spread easily. Pink eye is inflammation of the conjunctiva, a transparent membrane that covers the white of the eye and the inner surface of the eyelids. Because of this inflammation, small blood vessels in the conjunctiva become more visible, making the eyes look pink.

Besivance can help reduce inflammation and clear the bacterial infection 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 dose and length of treatment depend on the pathogen causing the infection, the purpose of use (treatment or prevention), the severity of the condition and the patient's response.

To treat bacterial conjunctivitis with Besivance, instil 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 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 tip touch any surface, including your hands or eyes.

After using the drops, 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 so you get the full benefit. 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 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 people.

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, so you will need to speak with a doctor before starting treatment. To help reduce the risk of side effects, tell your Australian healthcare provider about all prescription and over-the-counter medicines you are taking.

Besivance may cause side effects that can temporarily affect vision, such as blurred vision. Avoid driving or using machinery until your vision returns to normal.

In pregnancy, Besivance may be used when the potential benefits to the mother outweigh the 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 needed while breastfeeding, breastfeeding may need to be stopped at least for the duration of treatment.

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

Possible Adverse Reactions to Besivance

Topical use generally results in fewer systemic side 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 being 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 tell your doctor if they occur, persist or get worse.

Besivance eye drops are not expected to cause side effects 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.