Adult Sinus Infection Treatment (Acute Rhinosinusitis)
Fast MD-only sinus infection care for adults in California by secure online video visit, $49 flat-fee, no insurance required.
Facial pressure, sinus congestion, post-nasal drip, and thick nasal discharge are common symptoms of a sinus infection. Most episodes are viral and improve without antibiotics, but some meet strict criteria for acute bacterial rhinosinusitis. Our board-certified MDs use IDSA guideline-based criteria to distinguish viral from bacterial sinusitis by video and prescribe safe, evidence-based treatment when appropriate for adults located in California.
- $49 flat-fee visit, no hidden costs
- MD-only care, no mid-level providers
- No insurance required or accepted
- Available for adults in California (and 25+ states)
- Secure, encrypted video visits from home
Online Sinus Care by California-Licensed MDs
- Typical visit length: 10–15 minutes
- IDSA criteria for bacterial sinusitis
- Targeted antibiotics only when indicated
- Strong antibiotic stewardship (no fluoroquinolones)
For adults only (18+). You must be physically located in California at the time of your video visit. We do not prescribe controlled substances or fluoroquinolones for sinus infections.
What Is a Sinus Infection (Acute Rhinosinusitis)?
Acute rhinosinusitis is inflammation of the nasal passages and sinus cavities, usually following an upper respiratory viral infection. Symptoms include nasal congestion, facial pressure, nasal discharge, decreased sense of smell, and sometimes cough from post-nasal drip.
The majority of sinus infections in adults are caused by viruses and improve with supportive care alone in about 7–10 days. Acute bacterial rhinosinusitis is less common and usually follows one of three classic patterns:
- Persistent symptoms lasting 10 or more days without improvement.
- Severe symptoms for at least 3 consecutive days, such as fever ≥ 102°F and significant facial pain or purulent nasal discharge.
- “Double worsening” where symptoms initially improve, then suddenly worsen again after a few days.
TeleDirectMD uses these guideline-based patterns to decide whether antibiotics are indicated or whether viral sinusitis can be safely managed with home care and monitoring.
Common Sinus Infection Symptoms and Red Flags
During your visit, the MD will review your symptom severity, duration, and overall health to determine whether you have likely viral or bacterial sinusitis and whether video-based care is appropriate.
| Symptom | What It Suggests | Telehealth appropriate? | Red flag requiring urgent in-person care |
|---|---|---|---|
| Nasal congestion and stuffiness | Seen in viral and bacterial sinusitis, as well as allergies | Yes, if breathing comfortably | Severe obstruction with trouble breathing or suspected foreign body |
| Thick yellow or green nasal discharge | Common in both viral and bacterial infections | Yes | Severe discharge with high fever and systemic illness |
| Facial pressure or pain over cheeks or forehead | Typical of sinus mucosal inflammation | Yes, if mild to moderate | Severe unilateral facial pain, especially with eye symptoms |
| Symptoms lasting 10 or more days without improvement | Meets “persistent” pattern for possible bacterial sinusitis | Yes | Persistent plus severe headache, high fever, or neurologic signs |
| Sudden worsening after initial improvement (“double worsening”) | Classic pattern for bacterial superinfection | Yes | Worsening accompanied by eye swelling, vision changes, or confusion |
| Fever ≥ 102°F (38.9°C) with facial pain | “Severe” criteria for bacterial sinusitis | Maybe; telehealth triage appropriate if otherwise stable | High fever with severe pain, neck stiffness, or systemic toxicity |
| Post-nasal drip and cough | Common with sinus inflammation and viral upper respiratory infections | Yes | Associated shortness of breath, chest pain, or low oxygen |
| Swelling around the eye or change in vision | Possible orbital complication of sinus infection | No | Requires immediate in-person or emergency eye/ENT evaluation |
| Severe headache, neck stiffness, or confusion | Possible spread beyond sinuses (e.g., meningitis) | No | Emergency evaluation required |
| Immunosuppression or uncontrolled diabetes | Higher risk for complicated sinus infections | Often no; depends on specific scenario | Low threshold for in-person evaluation and imaging |
Conditions That Can Mimic a Sinus Infection
Several conditions can present with similar symptoms to a sinus infection. Part of your TeleDirectMD visit is screening for these conditions and recommending the safest next step.
- Allergic rhinitis: Clear watery discharge, itchy eyes and nose, and sneezing, often seasonal or triggered by exposures.
- Common cold: Viral upper respiratory infection with congestion and sore throat that improves within about 7–10 days.
- COVID-19: Can cause congestion, loss of smell, and facial pressure; testing may be recommended.
- Influenza: Prominent fever, body aches, and fatigue with overlapping respiratory symptoms.
- Migraine or tension headaches: Head pain sometimes misinterpreted as “sinus” headaches, especially without significant nasal symptoms.
When a Video Visit Is Appropriate vs. When to Go In-Person
When a Video Visit Is Appropriate
- Adult 18–64 with sinus congestion, facial pressure, and nasal discharge
- Symptoms consistent with viral illness improving or stable
- Symptoms meeting IDSA patterns for possible bacterial sinusitis but without red flags
- Able to drink fluids and take oral medications
- No significant eye swelling, vision change, or neurologic symptoms
- No recent facial trauma or sinus surgery requiring immediate in-person care
- Physically located in California at the time of the video visit
Red Flags Requiring In-Person or ER Care
- Eye swelling, double vision, or vision loss
- Severe headache, neck stiffness, or confusion
- High fever with shaking chills or signs of sepsis
- Severe unilateral facial pain or swelling
- Immunosuppression, uncontrolled diabetes, or history of invasive sinus disease
- Recent facial trauma, orbital surgery, or neurosurgery
Treatment Options for Adult Sinus Infections
Most sinus infections in adults are viral and improve with supportive care, including nasal rinses, hydration, and symptom relief medications. Antibiotics are reserved for cases that meet criteria for acute bacterial rhinosinusitis. TeleDirectMD follows IDSA-aligned antibiotic stewardship and does not use fluoroquinolones for routine sinus infections.
Supportive Care
- Saline nasal rinses or sprays to thin mucus and improve drainage.
- Humidifier or steam inhalation to ease congestion and dryness.
- Warm compresses over the cheeks and forehead for facial discomfort.
- Acetaminophen or ibuprofen (if safe for you) for pain and fever.
- Intranasal corticosteroid sprays (such as fluticasone) to reduce inflammation.
- Short-term use of oral or topical decongestants when medically appropriate.
Evidence-Based Antibiotic Options (When Indicated)
When bacterial sinusitis is suspected based on persistent, severe, or double-worsening patterns, antibiotics may be prescribed. The regimen is tailored to your allergy history, prior antibiotic exposure, and risk factors.
| Medication | Dose | Duration | When used |
|---|---|---|---|
| Amoxicillin-clavulanate | 875 mg by mouth twice daily | 5–7 days | First-line antibiotic for uncomplicated acute bacterial sinusitis in most non-allergic adults. |
| Doxycycline | 100 mg by mouth twice daily | 5–7 days | Alternative regimen for adults with penicillin allergy or when amoxicillin-clavulanate is not appropriate. |
| Intranasal corticosteroid (fluticasone) | 2 sprays in each nostril once daily | Variable | Adjunct to reduce mucosal inflammation and improve symptom control. |
| Saline irrigation | As directed, usually once or twice daily | Short term | Nonpharmacologic adjunct for congestion and mucus clearance. |
| Acetaminophen or ibuprofen | Acetaminophen 500–1,000 mg every 6 hours (max 3,000 mg/day); Ibuprofen 200–400 mg every 6 hours as needed | As needed | For pain and fever relief when no contraindications exist. |
TeleDirectMD does not prescribe fluoroquinolones for routine sinus infections due to safety concerns and antibiotic stewardship principles. If your symptoms or history suggest complicated sinusitis or orbital/intracranial involvement, we will recommend in-person evaluation instead of managing solely by telehealth.
Home Care, Recovery, and Return to Work
Viral sinus infections usually improve over 7–10 days, while bacterial sinusitis may begin to improve within several days of starting effective antibiotics. Cough and post-nasal drip can linger even after the main infection resolves.
- Stay well hydrated and use saline rinses regularly if tolerated.
- Use pain relievers and intranasal corticosteroids as directed for comfort.
- Sleep with your head elevated to promote sinus drainage.
- Avoid cigarette smoke and other irritants that can worsen symptoms.
Many adults can continue working or return to work once fever is controlled and symptoms are manageable. TeleDirectMD can provide a brief work note when medically appropriate as part of your $49 visit. We do not complete long-term disability, FMLA, or complex occupational forms for sinusitis.
Seek in-person care or emergency evaluation if your symptoms worsen significantly, you develop new eye swelling or vision changes, severe headache, neck stiffness, confusion, or if you do not improve as expected after appropriate treatment.
What to Expect From Your TeleDirectMD Visit
TeleDirectMD provides adult-only, MD-only virtual urgent care for sinus infections and other common respiratory conditions. Visits are conducted by secure video, last about 10–15 minutes, and cost $49 as a flat cash fee with no insurance involvement. During your sinus visit, the MD will review your symptoms, illness timeline, medical history, and red flags to determine whether you have viral or bacterial sinusitis and whether telehealth treatment is appropriate.
If you meet criteria for acute bacterial sinusitis without red flags, we can send an electronic prescription for an appropriate antibiotic and adjunctive medications to your preferred local pharmacy in California. If viral sinusitis or another diagnosis is more likely, we will focus on high-yield supportive care and clear return precautions. When in-person or emergency care is safer, we will explain why and guide you to the best setting.
We do not prescribe controlled substances or fluoroquinolones for sinus infections by telehealth.
Sinus Infection Treatment FAQ
Can a sinus infection really be treated safely online?
Yes. Many sinus infections are viral and improve with supportive care alone. TeleDirectMD MDs use IDSA guideline criteria to determine whether you likely have viral or bacterial sinusitis. If your symptoms meet bacterial sinusitis patterns without red flags, we can prescribe antibiotics by telehealth. If there are warning signs for complications, we direct you to in-person or emergency care instead of managing solely online.
How do you tell the difference between viral and bacterial sinusitis?
We focus on symptom duration, severity, and pattern. Viral sinusitis usually improves within about 7–10 days. Bacterial sinusitis is more likely when symptoms persist for 10 or more days without improvement, are severe with high fever and facial pain for at least 3 days, or follow a “double worsening” pattern after initial improvement. These IDSA-based patterns guide whether antibiotics are recommended.
Do all sinus infections need antibiotics?
No. Most sinus infections are viral and do not require antibiotics. Using antibiotics when they are not needed can cause side effects and increase resistance. We only recommend antibiotics when your symptoms clearly meet bacterial sinusitis criteria or when your medical risk profile makes bacterial infection more likely and telehealth prescribing is safe.
Which antibiotics do you usually prescribe, and why not fluoroquinolones?
For uncomplicated bacterial sinusitis in adults, common options include amoxicillin-clavulanate or doxycycline, tailored to allergy history and other factors. TeleDirectMD does not use fluoroquinolones as first-line sinusitis treatment due to safety concerns (such as tendon and central nervous system effects) and antibiotic stewardship. We reserve in-person evaluation for cases where broader coverage may be considered.
How long will it take for my sinus infection to improve?
Viral sinus infections often start to improve within 7–10 days from symptom onset. For bacterial sinusitis treated with appropriate antibiotics, many adults notice improvement within a few days, though full resolution can take a week or more. Persistent or worsening symptoms despite treatment warrant in-person re-evaluation.
Do I need a CT scan or X-ray for a sinus infection?
In most uncomplicated acute sinus infections, imaging is not necessary. Diagnosis is based on history and symptoms. CT scans or other imaging studies are generally reserved for complicated, recurrent, or chronic cases, or when there is concern for orbital or intracranial complications. If we suspect a complicated course, we will recommend in-person evaluation with your primary care clinician or ENT specialist.
Can allergy medications or nasal sprays help my sinus symptoms?
Yes. Intranasal corticosteroid sprays and saline rinses can significantly improve congestion, drainage, and facial pressure. For patients with underlying allergic rhinitis, antihistamines and allergy management may reduce the frequency and severity of sinus symptoms. During your visit, we will discuss whether allergy-focused treatment should be part of your plan.
When should I worry about serious sinus infection complications?
Warning signs include swelling or redness around the eyes, double vision or vision loss, severe unilateral facial pain, severe headache with neck stiffness, confusion, or high fever with systemic illness. These symptoms can indicate orbital or intracranial spread and require urgent in-person or emergency evaluation. Telehealth is not appropriate for these situations, and we will direct you accordingly.
Can you give me a work note for a sinus infection?
Yes. If your sinus infection significantly affects your ability to work safely or comfortably, TeleDirectMD can provide a brief work note as part of your $49 visit, typically covering a short period aligned with your symptoms. We do not complete long-term disability, FMLA, or complex occupational paperwork for sinusitis.
What if my sinus symptoms keep coming back?
Recurrent or chronic sinus symptoms may require in-person evaluation, nasal endoscopy, imaging, or allergy testing. TeleDirectMD can help with acute episodes and provide guidance on when to seek ENT or primary care follow-up for persistent or recurrent problems, but long-term management of chronic sinusitis is best handled with an in-person clinician.
Are you available for sinus infection care outside California?
TeleDirectMD currently serves adults located in California and in more than 25 additional states, offering MD-only video visits for sinus infections, allergies, respiratory illnesses, and other urgent-care conditions. During booking, you will confirm that you are physically located in a licensed state at the time of your visit so that our physicians can safely and legally provide care.