Usage
- Besifloxacin is prescribed for the treatment of bacterial conjunctivitis (pink eye).
- Pharmacological classification: Fluoroquinolone antibiotic.
- Mechanism of action: Besifloxacin inhibits bacterial DNA gyrase and topoisomerase IV, enzymes essential for bacterial DNA replication, transcription, repair, and cell division. This inhibition leads to bacterial cell death.
Alternate Names
- Besifloxacin hydrochloride
- Brand name: Besivance
How It Works
- Pharmacodynamics: Besifloxacin exerts a bactericidal effect by inhibiting the bacterial enzymes DNA gyrase and topoisomerase IV. These enzymes are crucial for bacterial DNA replication, transcription, repair, and the separation of replicated DNA during cell division. By inhibiting these enzymes, besifloxacin effectively stops bacterial growth and leads to cell death.
- Pharmacokinetics: Following topical ophthalmic administration, besifloxacin demonstrates minimal systemic absorption. The small amount absorbed is metabolized in the liver and eliminated through renal and hepatic pathways. Its elimination half-life is approximately 7 hours.
- Mode of action: Besifloxacin’s mechanism of action involves binding to and inhibiting DNA gyrase and topoisomerase IV. This binding disrupts the essential functions of these enzymes, which prevents normal bacterial DNA function and causes bacterial death.
- Elimination pathways: Besifloxacin is metabolized in the liver and excreted through renal and hepatic routes.
Dosage
Standard Dosage
Adults:
- One drop in the affected eye(s) three times a day (approximately every 4-12 hours) for 7 days.
Children:
- 1 year and older: One drop in the affected eye(s) three times a day (approximately every 4-12 hours) for 7 days.
- Younger than 1 year: Safety and efficacy have not been established.
Special Cases:
- Elderly Patients: No dosage adjustment is typically required.
- Patients with Renal Impairment: No dosage adjustment is typically necessary due to low systemic absorption.
- Patients with Hepatic Dysfunction: No dosage adjustment is typically necessary due to low systemic absorption.
- Patients with Comorbid Conditions: No specific dosage adjustments are indicated, but exercise caution in patients with a history of hypersensitivity to quinolones.
Clinical Use Cases
Besifloxacin is specifically indicated for bacterial conjunctivitis. Its use in other clinical settings like intubation, surgical procedures, mechanical ventilation, ICU use, or emergency situations is not established and is not recommended.
Dosage Adjustments
Dosage adjustments are typically not necessary for elderly patients or those with renal or hepatic impairment due to minimal systemic absorption.
Side Effects
Common Side Effects
- Blurred vision
- Eye redness, itching, irritation, pain
- Headache
Rare but Serious Side Effects
- Severe eye irritation, swelling, discharge, or crusting
- Signs of a new infection (fever, worsening symptoms)
- Allergic reactions (rash, hives, swelling, difficulty breathing)
Long-Term Effects
Prolonged use may lead to fungal overgrowth or the development of resistant bacteria.
Adverse Drug Reactions (ADR)
- Severe allergic reactions (anaphylaxis)
Contraindications
- Known hypersensitivity to besifloxacin, other quinolones, or any component of the formulation.
Drug Interactions
No clinically significant drug interactions have been identified due to the minimal systemic absorption of besifloxacin ophthalmic solution.
Pregnancy and Breastfeeding
- Pregnancy Safety Category: No data available on use during pregnancy to determine drug-associated risk, although systemic exposure following topical ocular administration is low. Animal data suggest no adverse developmental effects at clinically relevant exposures. However, besifloxacin should be used during pregnancy only if the potential benefit outweighs the potential risk to the fetus.
- Breastfeeding: It is unknown if besifloxacin is excreted in human milk. Caution should be exercised when administering to a nursing mother.
Drug Profile Summary
- Mechanism of Action: Inhibits bacterial DNA gyrase and topoisomerase IV.
- Side Effects: Blurred vision, eye irritation, headache. Rarely, severe allergic reactions.
- Contraindications: Hypersensitivity to besifloxacin or other quinolones.
- Drug Interactions: No clinically significant interactions identified.
- Pregnancy & Breastfeeding: Use with caution; weigh benefits against potential risks.
- Dosage: One drop in affected eye(s) three times daily for 7 days.
- Monitoring Parameters: Resolution of conjunctivitis symptoms (redness, discharge, itching, pain).
Popular Combinations
Besifloxacin is typically used as a monotherapy for bacterial conjunctivitis. There are no commonly recommended drug combinations.
Precautions
- General Precautions: Avoid contact lens wear during treatment. Shake bottle well before use. Avoid contaminating the dropper tip.
- Specific Populations: See Pregnancy and Breastfeeding section.
- Children & Elderly: No specific precautions beyond the standard dosing guidelines.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Besifloxacin?
A: One drop in the affected eye(s) three times daily for 7 days for adults and children 1 year and older.
Q2: Can I use Besifloxacin if I am allergic to other antibiotics?
A: If you have a known allergy to quinolone antibiotics, you should not use Besifloxacin.
A: No, you should not wear contact lenses during treatment for bacterial conjunctivitis or while using Besifloxacin.
Q4: What should I do if I miss a dose?
A: Instill the missed dose as soon as you remember. If it is almost time for the next dose, skip the missed dose and resume your regular dosing schedule. Do not double the dose.
Q5: How long does it take for Besifloxacin to work?
A: You should start to feel better within a few days. However, it’s important to complete the full 7-day course of treatment even if your symptoms improve earlier to ensure complete eradication of the infection.
Q6: Can Besifloxacin be used for other types of eye infections?
A: No, Besifloxacin is only effective against bacterial infections. It will not treat viral, fungal, or other types of eye infections.
Q7: Is it safe to use Besifloxacin during pregnancy or while breastfeeding?
A: The safety of besifloxacin during pregnancy and breastfeeding has not been fully established. Consult with your doctor to weigh the potential benefits against possible risks.
Q8: What are the potential long-term effects of Besifloxacin use?
A: Prolonged or repeated use of Besifloxacin, like other antibiotics, may lead to the development of resistant bacteria or secondary fungal infections.
Q9: What are the signs of an allergic reaction to Besifloxacin?
A: Signs of an allergic reaction include rash, hives, itching, swelling (especially of the face, tongue, or throat), and difficulty breathing. Seek immediate medical attention if you experience any of these symptoms.
