Alternatives to Besivance If You Can't Fill Your Prescription

Besivance (besifloxacin 0.6% ophthalmic suspension) is a highly effective antibiotic for bacterial conjunctivitis. But because it's brand-name only with no generic available, it can be hard to find and expensive. If your pharmacy is out of stock, your insurance won't cover it, or the cost is prohibitive, several alternatives can treat bacterial pink eye effectively.

Important: Always Talk to Your Doctor Before Switching

Antibiotic eye drops vary in their spectrum of bacterial coverage. Your prescriber chose Besivance for a reason — possibly because you've had prior treatment failures, because the bacteria identified is known to respond to besifloxacin, or because of your specific medical history. Before switching to an alternative, call your doctor's office to discuss your situation.

Best Alternatives to Besivance for Bacterial Conjunctivitis

1. Moxifloxacin Eye Drops (Generic Vigamox) — Best Overall Alternative

Moxifloxacin ophthalmic solution 0.5% is the closest therapeutic equivalent to Besivance. Both are fourth-generation fluoroquinolones that work by inhibiting bacterial DNA gyrase and topoisomerase IV. Moxifloxacin is approved for patients of all ages (including infants), while Besivance is approved for patients 1 year and older.

The major advantage: generic moxifloxacin is widely available at virtually every pharmacy and costs $15–$40 for a full treatment course. It covers a broad range of Gram-positive and Gram-negative bacteria and is clinically proven to be effective for most bacterial conjunctivitis cases.

Dosage: 1 drop 3 times daily for 7 days

Cost: $15–$40 for generic; widely covered by insurance

Availability: Widely stocked at nearly every pharmacy

2. Ciprofloxacin Ophthalmic (Generic Ciloxan) — Widely Available and Inexpensive

Ciprofloxacin 0.3% ophthalmic solution is a second-generation fluoroquinolone eye drop that has been used for decades to treat bacterial conjunctivitis and corneal ulcers. It is one of the most widely stocked ophthalmic antibiotics at pharmacies nationwide.

It covers many of the same bacteria as Besivance, though it has less activity against certain resistant Gram-positive organisms. For uncomplicated community-acquired bacterial conjunctivitis, ciprofloxacin ophthalmic is often sufficient.

Cost: Under $10 generic at most pharmacies

Availability: Universally stocked

3. Tobramycin Eye Drops (Generic Tobrex) — Good for Resistant Cases

Tobramycin 0.3% ophthalmic solution is an aminoglycoside antibiotic with strong activity against Gram-negative bacteria including Pseudomonas aeruginosa. It's often used when fluoroquinolone resistance is suspected or when a patient has a fluoroquinolone allergy. Generic tobramycin is inexpensive and widely available.

Cost: Under $20 generic at most pharmacies

Best for: Patients with fluoroquinolone allergy or Pseudomonas coverage needs

4. Gatifloxacin Ophthalmic (Zymaxid) — Another Fourth-Generation Option

Gatifloxacin 0.5% ophthalmic solution (Zymaxid) is another fourth-generation fluoroquinolone similar to Besivance. Like Besivance, it offers broad-spectrum activity and is effective for most bacterial conjunctivitis. A generic version is available, which helps with cost. It may be easier to find in stock than Besivance at some pharmacies.

5. Ofloxacin Ophthalmic (Generic Ocuflox) — Budget-Friendly Third-Generation Option

Ofloxacin 0.3% ophthalmic solution is a third-generation fluoroquinolone that treats bacterial conjunctivitis. It's one of the most affordable options, with generics available for under $10. While it has less activity against resistant organisms than fourth-generation fluoroquinolones, it remains effective for most community-acquired pink eye infections.

Alternatives Comparison at a Glance

Here's a quick comparison of Besivance alternatives:

Moxifloxacin: Best equivalent; 4th-gen fluoroquinolone; generic $15–$40; all ages

Ciprofloxacin: 2nd-gen fluoroquinolone; generic under $10; very widely stocked

Tobramycin: Aminoglycoside; generic under $20; good for Pseudomonas/fluoroquinolone allergy

Gatifloxacin: 4th-gen fluoroquinolone; generic available; broad coverage

Ofloxacin: 3rd-gen fluoroquinolone; generic under $10; very affordable

The Bottom Line

If you're unable to fill your Besivance prescription today, generic moxifloxacin eye drops are your closest equivalent. They're inexpensive, widely stocked, and clinically proven effective for bacterial conjunctivitis. Always check with your doctor before substituting. If you want to keep trying to locate Besivance, check out our guide on how to find Besivance in stock near you.