Besifloxacin provides broad coverage

Loma Linda, CA-Besifloxacin ophthalmic suspension 0.6% (Besivance, Bausch + Lomb) provides potent broad-spectrum anti-bacterial coverage coupled with favorable safety, tolerability, and dosing convenience.

Based on this profile, John C. Affeldt, MD, said he considers besifloxacin his fourth-generation fluoroquinolone of choice. Dr. Affeldt is a fellowship-trained cornea specialist, a member of the full-time faculty at Loma Linda University Medical Center, Loma Linda, CA, and assistant clinical professor, Doheny Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles.

Treatment of corneal infections is an important segment of his practice, and he also uses topical anti-microbial agents frequently as prophylaxis against infection when performing corneal surgery procedures.

"According to their prescribing information, three of the four currently available ophthalmic fourth-generation fluoroquinolones are indicated specifically for the treatment of bacterial conjunctivitis caused by susceptible organisms, although in ophthalmic practice, they are widely used off-label to treat and prevent other infections," he said. "The fourth-generation fluoroquinolones represent our current best choice for a monotherapeutic antibacterial agent because of their broad-spectrum activity and gentleness to the ocular surface."

"Relative to gatifloxacin and moxifloxacin, besifloxacin offers broader and more potent anti-infective coverage, especially against gram-positive bacteria, which account for the vast majority of ocular surface infections, and besifloxacin is formulated in a preparation that is particularly well-tolerated and enables a more convenient, less frequent dosing schedule," Dr. Affeldt said.

Concerns about resistance of some important ocular pathogens to the previously available fluoroquinolones are highlighted by data from the Ocular Tracking Resistance in the United States Today (TRUST) [Am J Ophthalmol. 2008;145:951-958].

Even at that time, high-level in vitro methicilllin-resistant Staphylococcus aureus (MRSA) resistance was found to the tested fluoroquinolones, which included ciprofloxacin, gatifloxacin, levofloxacin, and moxifloxacin. Based on the minimal inhibitory concentration (MIC) data, the authors of that publication concluded there was a need to consider other therapy when MRSA is the likely infectious organism.