Can't Fill Your Besifloxacin Prescription? Here Are Your Options

If your doctor prescribed Besifloxacin (Besivance) for a bacterial eye infection but you can't find it at your pharmacy — or the cost is too high — you're not stuck. There are several effective alternative antibiotics that can treat bacterial conjunctivitis. The key is working with your doctor to find the right one for your situation.

Besifloxacin is an excellent medication, but it's not always easy to find due to its brand-only status and high cost. Before we dive into alternatives, let's quickly cover what makes Besifloxacin unique and how it works.

What Is Besifloxacin and How Does It Work?

Besifloxacin is a fourth-generation fluoroquinolone antibiotic available as an ophthalmic suspension (eye drops) at a concentration of 0.6%. It was FDA-approved in May 2009 and is sold exclusively under the brand name Besivance by Bausch + Lomb.

What sets Besifloxacin apart from other fluoroquinolone eye drops is that it was developed exclusively for topical ophthalmic use. It was never marketed as an oral or systemic antibiotic, which means bacteria have had less exposure to it and are less likely to have developed resistance. It works by inhibiting two critical bacterial enzymes — DNA gyrase and topoisomerase IV — effectively blocking bacterial DNA replication.

The typical regimen is one drop in the affected eye(s) three times daily for 7 days. For more details, see our complete guide on what Besifloxacin is and how to use it.

Effective Alternatives to Besifloxacin

All of the alternatives below are prescription medications. Talk to your doctor before switching — they'll consider your specific infection, any allergies, and your medical history.

1. Moxifloxacin Ophthalmic (Vigamox / Generic)

Moxifloxacin is another fourth-generation fluoroquinolone and is the most commonly prescribed alternative to Besifloxacin. Like Besifloxacin, it targets both DNA gyrase and topoisomerase IV.

• Dosing: One drop in the affected eye(s) three times a day for 7 days
• Availability: Available as a generic, making it much easier to find and significantly cheaper
• Cost: Generic moxifloxacin eye drops typically cost $15-$40 — a fraction of Besivance's $230-$350 price tag
• Key difference: Moxifloxacin has been used systemically (as oral Avelox), so bacteria may have had more exposure to it compared to Besifloxacin

2. Ofloxacin Ophthalmic (Ocuflox / Generic)

Ofloxacin is a second-generation fluoroquinolone that has been used for decades to treat bacterial eye infections.

• Dosing: One to two drops in the affected eye(s) every 2-4 hours for the first two days, then four times daily for up to 5 additional days
• Availability: Widely available as a generic at virtually every pharmacy
• Cost: Typically $10-$25 for a bottle
• Key difference: Slightly less broad-spectrum than fourth-generation fluoroquinolones, but highly effective for common conjunctivitis pathogens

3. Ciprofloxacin Ophthalmic (Ciloxan / Generic)

Ciprofloxacin is another second-generation fluoroquinolone available as both eye drops and an ophthalmic ointment.

• Dosing: One to two drops in the affected eye(s) every 2 hours while awake for the first two days, then every 4 hours for 5 more days
• Availability: Generic widely available in both drop and ointment forms
• Cost: Approximately $10-$30
• Key difference: The ointment form can be helpful for patients who have difficulty instilling eye drops, or for nighttime use. May cause white crystalline deposits on the cornea that are usually harmless and temporary

4. Erythromycin Ophthalmic Ointment

For patients who are allergic to fluoroquinolones or prefer an ointment, erythromycin is a solid alternative. It's a macrolide antibiotic with a completely different mechanism of action.

• Dosing: Apply a small ribbon of ointment to the affected eye(s) up to 6 times daily, depending on infection severity
• Availability: Very widely available as a generic
• Cost: Typically $10-$20
• Key difference: Not a fluoroquinolone, so it's appropriate for patients with fluoroquinolone allergies. Ointment causes temporary blurring of vision after application

5. Trimethoprim/Polymyxin B Ophthalmic (Polytrim / Generic)

This combination antibiotic eye drop is commonly used, especially in pediatric patients.

• Dosing: One drop in the affected eye(s) every 3 hours for 7-10 days (up to 6 drops per day)
• Availability: Generic widely available
• Cost: Approximately $10-$25
• Key difference: A non-fluoroquinolone option that combines two antibiotics for broader coverage. Very commonly used in children

How to Choose the Right Alternative

The best alternative depends on several factors:

• Your allergy history: If you're allergic to fluoroquinolones, erythromycin or trimethoprim/polymyxin B are your best options
• Infection severity: More severe infections may benefit from fourth-generation fluoroquinolones like moxifloxacin
• Cost concerns: All of the alternatives above are available as generics and cost a fraction of Besifloxacin's price
• Contact lens use: You should not wear contacts while being treated for conjunctivitis regardless of which antibiotic you use
• Preference for drops vs. ointment: If you dislike drops, erythromycin ointment or ciprofloxacin ointment may be more comfortable

Always consult your doctor before switching medications. They may have prescribed Besifloxacin for a specific clinical reason.

Before Switching: Try to Find Besifloxacin First

If your doctor specifically prescribed Besifloxacin, it's worth trying to fill it before switching. Use Medfinder to check which pharmacies near you have it in stock. You might also look into the Bausch + Lomb savings programs to make it more affordable.

Final Thoughts

While Besifloxacin is an excellent antibiotic with unique advantages — particularly its low resistance profile — it's not the only option for treating bacterial conjunctivitis. Generic fluoroquinolones like moxifloxacin, ofloxacin, and ciprofloxacin are effective, widely available, and far more affordable. Non-fluoroquinolone options like erythromycin and trimethoprim/polymyxin B provide alternatives for patients with fluoroquinolone allergies.

Work with your doctor to find the right fit, and don't delay treatment. Bacterial conjunctivitis typically responds well to prompt antibiotic therapy, regardless of which medication you use.