When Besifloxacin Isn't Available, You Still Have Options

Bacterial conjunctivitis — pinkeye — needs treatment, and it needs it soon. If your doctor prescribed Besifloxacin (brand name Besivance) and you can't find it at any pharmacy near you, don't panic. There are several effective alternatives that can treat your infection just as well.

Besifloxacin is a brand-name-only medication with known availability challenges. The good news is that other fluoroquinolone eye drops — many available as affordable generics — work through similar mechanisms and are widely stocked at pharmacies nationwide.

Here's everything you need to know about your options.

What Is Besifloxacin and How Does It Work?

Besifloxacin is a fourth-generation fluoroquinolone antibiotic eye drop prescribed for bacterial conjunctivitis. It's available only as the brand-name product Besivance, manufactured by Bausch + Lomb, in a 0.6% ophthalmic suspension.

The medication works by targeting two essential bacterial enzymes — DNA gyrase and topoisomerase IV — which bacteria need to copy and repair their DNA. By blocking both enzymes simultaneously, Besifloxacin kills a broad range of bacteria that cause eye infections. For a deeper dive, read our article on how Besifloxacin works.

The standard treatment is one drop in the affected eye three times daily for seven days. It's effective, but it's not the only fluoroquinolone eye drop that works for pinkeye.

Why You Might Need an Alternative

There are several common reasons patients end up needing a Besifloxacin substitute:

• Availability: As a brand-name-only drug, Besivance isn't stocked at every pharmacy. Learn more about how to find it in stock.
• Cost: Without insurance, Besivance costs $130 to $300 per bottle. Generic alternatives can cost as little as $10.
• Insurance requirements: Many plans require step therapy — trying a generic fluoroquinolone before covering Besivance.
• Allergy or intolerance: Some patients experience irritation or other side effects with Besifloxacin specifically.

Best Alternatives to Besifloxacin for Bacterial Conjunctivitis

The following medications are commonly prescribed as alternatives to Besifloxacin. All are fluoroquinolone antibiotics that treat bacterial conjunctivitis, but they differ in generation, cost, availability, and dosing.

1. Moxifloxacin Eye Drops (Vigamox)

Moxifloxacin is the closest alternative to Besifloxacin. Like Besifloxacin, it's a fourth-generation fluoroquinolone that targets both DNA gyrase and topoisomerase IV, giving it broad-spectrum activity against common conjunctivitis-causing bacteria.

• Dosing: One drop three times daily for seven days
• Generic available: Yes — generic Moxifloxacin eye drops are widely available
• Cost: $15 to $50 for generic; $150+ for brand-name Vigamox
• Availability: Excellent — stocked at most pharmacies
• Key difference: Moxifloxacin does not contain a preservative in some formulations, making it a good option for patients sensitive to benzalkonium chloride (which Besivance contains)

Moxifloxacin is often the first choice when Besifloxacin isn't available because it shares the same generation and similar spectrum of activity.

2. Ofloxacin Eye Drops (Ocuflox)

Ofloxacin is a second-generation fluoroquinolone that has been used for decades to treat bacterial eye infections. While it targets primarily DNA gyrase (rather than both enzymes), it remains effective against many common conjunctivitis pathogens.

• Dosing: One to two drops every two to four hours for two days, then four times daily for five additional days
• Generic available: Yes — widely available and affordable
• Cost: $10 to $30 for generic
• Availability: Excellent
• Key difference: More frequent dosing schedule than Besifloxacin; narrower spectrum but still effective for most bacterial conjunctivitis cases

3. Ciprofloxacin Eye Drops (Ciloxan)

Ciprofloxacin is another well-established second-generation fluoroquinolone available in both eye drop and ointment forms. The ointment option can be particularly useful for young children or patients who have difficulty with eye drops.

• Dosing: One to two drops every two hours while awake for two days, then every four hours for five days
• Generic available: Yes
• Cost: $10 to $25 for generic drops; ointment may be slightly more
• Availability: Excellent
• Key difference: Available as both drops and ointment; more frequent initial dosing but very affordable

4. Gatifloxacin Eye Drops (Zymaxid)

Gatifloxacin is a fourth-generation fluoroquinolone like Besifloxacin, offering dual-enzyme targeting and broad-spectrum coverage. It's available as the brand-name product Zymaxid.

• Dosing: One drop every two hours while awake (up to eight times daily) for one day, then two to four times daily for six days
• Generic available: Limited generic availability
• Cost: $150 to $250 for brand-name Zymaxid
• Availability: Moderate — may require ordering
• Key difference: Same generation as Besifloxacin with similar broad-spectrum activity, but higher initial dosing frequency and similar cost challenges

How to Switch: What to Tell Your Doctor

If you can't find Besifloxacin, contact your prescriber's office and let them know. Here's what to say:

1. "My pharmacy can't get Besivance in stock. Can you prescribe an alternative fluoroquinolone eye drop?"
2. Mention if cost is a concern — your doctor can factor that into their recommendation.
3. Ask about any differences in how to use the new medication, since dosing schedules vary between products.

Most doctors can call in or e-prescribe an alternative within the same day, so you won't need another office visit.

Final Thoughts

Besifloxacin is an effective medication, but it's far from the only option for treating bacterial conjunctivitis. If you're struggling with availability or cost, generic Moxifloxacin is usually the closest substitute in terms of effectiveness, while Ofloxacin and Ciprofloxacin offer the most affordable options.

Before switching, always consult your doctor — they know your specific infection and medical history. And if you'd still prefer to fill your original Besifloxacin prescription, try using Medfinder to check which pharmacies near you have it in stock.