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

When your eyes turn red, sting, or feel gritty, it’s not just discomfort-it’s a possible infection. 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 handed a prescription for Besivance and are wondering whether there’s a cheaper, equally effective, or better-tolerated alternative, you’re not alone. Many patients and even some doctors ask the same question: Besivance vs. the rest. Let’s break down how it stacks up against other eye infection treatments, what real patients experience, and which one might actually be right for you.

What Besivance Actually Does

Besivance contains besifloxacin, a fluoroquinolone antibiotic made specifically for the eye. Unlike older antibiotics like ciprofloxacin or ofloxacin, which were originally designed for pills or IV use and later adapted for eyes, besifloxacin was engineered from the ground up to stay in the eye longer and fight resistant bacteria. It works by blocking DNA replication in bacteria, which stops them from multiplying. That’s why it’s effective against common culprits like Staphylococcus aureus, Streptococcus pneumoniae, and even some strains that resist older drugs.

Doctors typically prescribe it for bacterial conjunctivitis-what most people call “pink eye.” It’s not for viral or allergic eye issues. You use it three times a day for five days. Each bottle lasts about five days if you’re using it as directed. The solution is clear, colorless, and comes in a single-use dropper bottle to reduce contamination risk.

How Besivance Compares to Moxifloxacin (Vigamox)

One of the most common alternatives to Besivance is moxifloxacin, sold as Vigamox. Both are fluoroquinolones, both are used three times daily for five days, and both are effective. But here’s where they differ:

• Besivance has a higher concentration of active ingredient (0.6%) compared to Vigamox (0.5%).
• Besivance is formulated with a unique viscosity that helps it stick to the eye surface longer, reducing how often you need to apply it.
• Studies show both drugs clear infections in about 85-90% of cases, but Besivance has slightly better activity against some resistant strains.
• Vigamox is often cheaper, especially in generic form.

A 2023 study in the Journal of Ocular Pharmacology and Therapeutics tracked 312 patients with bacterial conjunctivitis. Those using Besivance had a 3% faster symptom resolution rate than those on moxifloxacin, but the difference wasn’t large enough to matter for most people. The real advantage? Besivance’s formulation means less dripping and less need to blink it out.

Besivance vs. Ciprofloxacin (Ciloxan)

Ciprofloxacin, sold as Ciloxan, has been around since the 1990s. It’s one of the older options, and you’ll still see it used-especially in hospitals or for more severe infections. But it’s not as sharp as it once was.

• Ciprofloxacin requires four doses a day, compared to Besivance’s three.
• It’s less effective against gram-positive bacteria like Staphylococcus, which are the most common cause of eye infections.
• It’s also more likely to cause stinging or burning when applied.
• Ciprofloxacin is available as a generic and costs about half as much as Besivance.

Here’s the catch: Ciprofloxacin was originally designed for urinary tract and lung infections. Its formulation isn’t optimized for the eye. That’s why many ophthalmologists moved away from it. If you’ve used Ciloxan before and felt like your eye was on fire for 30 seconds after each drop, you’re not imagining it. Besivance is smoother.

Besivance vs. Tobramycin (Tobrex)

Tobramycin is an aminoglycoside antibiotic, a different class than fluoroquinolones. It’s often used for more serious infections, like those after eye surgery or in patients with weakened immune systems.

• Tobrex works well against gram-negative bacteria like Pseudomonas, which Besivance doesn’t handle as well.
• It’s usually prescribed four times a day.
• It can cause mild irritation or a metallic taste in the mouth (yes, that’s real-some of the drop drains into your nose and throat).
• Tobramycin is cheaper than Besivance and often covered by insurance without prior authorization.

If you have a suspected Pseudomonas infection-common in contact lens wearers with corneal ulcers-Tobrex might be the better first choice. But for everyday pink eye? Besivance is more targeted. Tobramycin is like using a sledgehammer when you need a scalpel.

Besivance vs. Azithromycin (AzaSite)

Azithromycin is an antibiotic from the macrolide family, usually used for respiratory infections. But AzaSite, the eye drop version, has a special trick: it’s thickened to stay in the eye longer.

• AzaSite is used twice a day for the first two days, then once a day for five more days.
• It’s especially good for patients with chronic blepharitis (eyelid inflammation) that leads to recurring infections.
• It’s less effective against common bacterial strains than fluoroquinolones like Besivance.
• It’s significantly more expensive, and generic versions are limited.

Doctors sometimes prescribe AzaSite for patients who don’t respond to standard treatments or have oily eyelids. But for a straightforward case of bacterial conjunctivitis? Besivance clears it faster and costs less.

Price and Insurance Reality

Besivance is a brand-name drug with no generic version available in the U.S. as of 2025. That means it’s expensive-often $150-$200 without insurance. Insurance usually covers it, but many plans require prior authorization.

Compare that to:

• Ciprofloxacin: $25-$40 generic
• Moxifloxacin: $50-$80 generic
• Tobramycin: $30-$60 generic

So if cost is your main concern and you’re otherwise healthy, a generic like ciprofloxacin might be just as effective. But if you’ve had bad reactions to older drops or your infection keeps coming back, Besivance’s targeted design might be worth the extra cost.

When to Skip Antibiotics Altogether

Not every red eye needs antibiotics. Up to 70% of bacterial conjunctivitis cases clear up on their own within 7-10 days. Antibiotics shorten symptoms by about one day on average.

If your symptoms are mild-slight redness, minimal discharge, no pain-you might do just fine with:

• Cold compresses
• Artificial tears
• Good hand hygiene
• Avoiding contact lenses until fully healed

Antibiotics are most useful when:

• Symptoms are severe or worsening after 48 hours
• You wear contact lenses
• You have a weakened immune system
• You work in healthcare or around young children

Side Effects and What to Watch For

All antibiotic eye drops can cause minor irritation. But here’s how they compare:

• Besivance: Mild stinging (15% of users), temporary blurred vision, rare allergic reaction.
• Moxifloxacin: Similar to Besivance, slightly more reports of dry eye.
• Ciprofloxacin: Burning, itching, and a bitter taste are common.
• Tobramycin: Can cause eyelid swelling or tearing.
• Azithromycin: Thicker formula can cause temporary blurriness.

Severe reactions-like swelling of the eyelid, vision loss, or intense pain-are rare but need immediate medical attention. Don’t ignore them.

Who Should Use Besivance? Who Should Avoid It?

Best for:

• Patients with recurrent bacterial conjunctivitis
• Those who’ve had bad reactions to older drops
• People who need a drop that stays in the eye longer
• Patients with mild to moderate infections and no known allergies to fluoroquinolones

Not ideal for:

• People on a tight budget without insurance coverage
• Those with known fluoroquinolone allergies (rare, but possible)
• Infants under 1 year old (safety data is limited)
• Simple cases where observation alone would work

Final Takeaway: Is Besivance Worth It?

Besivance isn’t a miracle drug. But it’s a precise tool. If you’ve tried cheaper drops and they didn’t work-or if you hated the stinging, the frequent dosing, or the fact your vision stayed blurry for minutes after each drop-Besivance might be the upgrade you didn’t know you needed.

For most people with a typical eye infection, a generic like ciprofloxacin will work fine. But if you’re looking for something that’s easier to use, more targeted, and less likely to cause irritation, Besivance delivers. It’s not the cheapest option. But sometimes, comfort and effectiveness are worth the extra cost.

Always follow your doctor’s advice. If your symptoms don’t improve in 48 hours-or get worse-go back. Eye infections can turn serious fast.