Sinus infection (Acute Rhinosinusitis): Symptoms, When Antibiotics Help, and Fast Relief
What is a “sinus infection”—and is it usually viral or bacterial?
“Sinus infection” means inflammation of the sinus and nasal lining (rhinosinusitis). Most cases begin as a cold and are viral; only a subset become bacterial and benefit from antibiotics.
How do doctors tell viral from bacterial?
According to the American Academy of Otolaryngology–Head & Neck Surgery (AAO-HNS) guideline, we look for three patterns that suggest bacterial infection:
Persistent: symptoms last ≥10 days without improvement.
Severe: high fever with purulent discharge or facial pain for 3–4+ days at the start.
Double-worsening: you start to improve, then clearly get worse within 10 days.
Meeting one of these makes bacterial infection more likely and is when antibiotics may be considered.
Do I always need antibiotics?
No. For uncomplicated cases that meet criteria, either watchful waiting (with reliable follow-up) or starting antibiotics is reasonable. It’s a shared decision based on your symptoms and preferences.
If antibiotics are needed, what does TeleDirectMD usually prescribe?
According to the Infectious Diseases Society of America (IDSA), amoxicillin-clavulanate is typical first-line for adults; doxycycline is a common alternative if you can’t take penicillins. Typical adult courses are 5–10 days, tailored to severity and response. We avoid routine fluoroquinolones for sinus infections given safety concerns and comparable alternatives.
What non-antibiotic treatments actually help?
Saline nasal irrigation using distilled, previously boiled (then cooled), or filtered water can relieve congestion and reduce medication use.
Intranasal corticosteroid sprays offer modest benefit, especially if you have allergies.
Pain/fever control with over-the-counter options can improve comfort.
What should I skip?
Routine oral/topical decongestants and antihistamines are not recommended for acute bacterial sinusitis because benefits are limited and side effects are common. Avoid topical decongestant sprays for more than 3 days to prevent rebound congestion.
Are oral steroids a good idea?
Not routinely. For uncomplicated cases, systemic steroids provide little patient-oriented benefit and come with side effects. Intranasal steroid sprays are preferred if you need anti-inflammatory help.
When is imaging (CT) needed?
Not for routine, uncomplicated cases. Consider imaging if symptoms don’t improve with appropriate care, an alternate diagnosis is suspected, or you have complications (e.g., around the eyes or involving the brain).
What are the danger signs that mean in-person care right away?
Go in person urgently for any of the following: eye swelling/redness, vision changes, severe or persistent fever, severe headache, neck stiffness, confusion, facial swelling, or signs of meningitis.
How long should I expect to feel sick?
Even with bacterial cases, many people improve within 7–15 days whether or not antibiotics are used. Antibiotics can shorten illness modestly for a minority of patients. We’ll discuss whether watchful waiting or immediate antibiotics fits your situation.
Can TeleDirectMD treat me by video?
Yes—adults (18+), video-only, cash-pay. We will:
Screen for red flags and complications.
Use the criteria above to decide if antibiotics are appropriate.
Send e-prescriptions and provide precise home-care instructions.
No controlled substances are prescribed for sinusitis.
Practical self-care (what we’ll likely recommend)
Saline rinses once or twice daily (distilled/boiled/filtered water only).
Intranasal steroid spray once daily for 1–2 weeks if congestion is significant, especially with allergies.
Analgesics/antipyretics for pain or fever.
Avoid routine oral decongestants/antihistamines; avoid topical decongestants beyond 3 days.
Myth vs Reality
Myth: Green mucus = you need antibiotics. → Reality: Color alone doesn’t prove bacterial infection.
Myth: A CT scan is needed to diagnose sinusitis. → Reality: Routine imaging isn’t needed for uncomplicated cases.
Myth: Oral steroids speed recovery for most sinus infections. → Reality: Not recommended routinely; intranasal steroids are preferred.
Myth: Antibiotics always make you better faster. → Reality: Many cases are viral; antibiotics offer only modest benefit when truly bacterial.
Myth: Fluoroquinolones are the strongest and therefore best. → Reality: We avoid them routinely due to safety risks when safer alternatives exist.
Evidence & Further Reading (Last verified: Aug 22, 2025)
AAO-HNS — Adult Sinusitis Clinical Practice Guideline (Update)
FDA — Fluoroquinolone Safety Warnings
