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Besifloxacin (Monograph)

Brand name: Besivance
Drug class: Antibacterials
VA class: OP210
Chemical name: (+)-7-[(3R)-3-aminohexahydro-1H-azepin-1-yl]-8-chloro-1-cyclopropyl-6-fluoro-4-oxo-1,4-dihydroquinoline-3-carboxylic acid hydrochloride
Molecular formula: C19H21ClFN3O3•HCl
CAS number: 405165-61-9

Medically reviewed by on May 13, 2024. Written by ASHP.


Antibacterial; 8-chloro fluoroquinolone.

Uses for Besifloxacin

Bacterial Ophthalmic Infections

Topical treatment of conjunctivitis caused by Aerococcus viridans, CDC coryneform group G, Corynebacterium pseudodiphtheriticum, C. striatum, Haemophilus influenzae, Moraxella catarrhalis, M. lacunata, Pseudomonas aeruginosa, Staphylococcus aureus, S. epidermidis, S. hominis, S. lugdunensis, S. warneri, Streptococcus mitis group, S. oralis, S. pneumoniae, or S. salivarius.

Many cases of mild, acute bacterial conjunctivitis resolve spontaneously without anti-infective therapy. Although topical ophthalmic anti-infectives may shorten time to resolution and reduce severity and risk of complications, avoid indiscriminate use of topical anti-infectives.

Treatment of acute bacterial conjunctivitis generally is empiric; use of a broad-spectrum topical ophthalmic antibacterial usually recommended. In vitro staining and/or cultures of conjunctival material may be indicated in diagnosis and management of recurrent, severe, or chronic purulent conjunctivitis or when acute conjunctivitis does not respond to initial empiric topical treatment.

Besifloxacin Dosage and Administration


Ophthalmic Administration

Apply 0.6% ophthalmic suspension topically to the eye.

For topical ophthalmic use only; do not inject subconjunctivally and do not introduce directly into anterior chamber of the eye.

Wash hands prior to administration.

Invert the closed bottle containing besifloxacin ophthalmic suspension and shake once prior to each use.

Avoid contaminating applicator tip with material from eye, fingers, or other source.


Available as besifloxacin hydrochloride; dosage expressed in terms of besifloxacin.

Pediatric Patients

Bacterial Ophthalmic Infections

Children ≥1 year of age: Instill 1 drop of 0.6% suspension in the affected eye(s) 3 times daily (give doses 4–12 hours apart) for 7 days.


Bacterial Ophthalmic Infections

Instill 1 drop of 0.6% suspension in the affected eye(s) 3 times daily (give doses 4–12 hours apart) for 7 days.

Cautions for Besifloxacin



Sensitivity Reactions


Although besifloxacin is not used systemically, consider that hypersensitivity reactions have been reported with systemic quinolones, even following a single dose.

Immediately discontinue at first sign of rash or hypersensitivity reaction.

Administration Precautions

For topical ophthalmic use only; not for injection into the eye.


Prolonged use may result in overgrowth of nonsusceptible organisms (e.g., fungi).

If superinfection occurs, discontinue besifloxacin ophthalmic suspension and institute appropriate therapy.

Patient Monitoring

Whenever clinical judgment dictates, examine patient with the aid of magnification (e.g., slit lamp biomicroscopy) and, if appropriate, fluorescein staining.

Contact Lenses

Do not wear contact lenses during treatment with besifloxacin ophthalmic suspension or if any signs or symptoms of bacterial conjunctivitis are present.

Specific Populations


Category C.

Data not available regarding use of besifloxacin 0.6% ophthalmic suspension in pregnant women.


Although not measured in human milk, presumed to be distributed into human milk.

Use with caution in nursing women.

Pediatric Use

Safety and efficacy not established in children <1 year of age.

Geriatric Use

No overall differences in safety and efficacy relative to younger adults.

Common Adverse Effects

Conjunctival redness.

Drug Interactions

No formal drug interaction studies using besifloxacin 0.6% ophthalmic suspension.

Besifloxacin Pharmacokinetics



After topical application of besifloxacin 0.6% ophthalmic suspension to each eye 3 times daily for 16 doses, maximum plasma concentrations of the drug were <1.3 ng/mL.



Penetrates into conjunctiva and aqueous humor; maximum concentrations reported are 62.8 and 1.7 mcg/mL, respectively.



Average elimination half-life of systemically absorbed drug estimated to be 7 hours.





15–25°C. Protect from light.

Contains benzalkonium chloride as a preservative.

Actions and Spectrum

Advice to Patients


Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

Please refer to the ASHP Drug Shortages Resource Center for information on shortages of one or more of these preparations.

Besifloxacin Hydrochloride


Dosage Forms


Brand Names




0.6% (of besifloxacin)


Bausch & Lomb

AHFS DI Essentials™. © Copyright 2024, Selected Revisions May 22, 2017. American Society of Health-System Pharmacists, Inc., 4500 East-West Highway, Suite 900, Bethesda, Maryland 20814.

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