Adult Bacterial Sinusitis Treatment (Acute Bacterial Rhinosinusitis)

MD-only sinus infection care by secure online video visit, $49 flat-fee, no insurance required.

Acute bacterial rhinosinusitis is a bacterial infection of the sinuses that can develop after an upper respiratory infection. Many sinus symptoms are viral and improve without antibiotics. Our MDs use guideline-based criteria from the Infectious Diseases Society of America (IDSA) to distinguish viral rhinosinusitis from bacterial sinusitis, recommend evidence-based symptom relief, and prescribe antibiotics only when clinically appropriate.

  • $49 flat-fee adult visit
  • MD-only care (no mid-levels)
  • No insurance required
  • Secure video visits in 27 states
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Last reviewed on January 21, 2026 by Parth Bhavsar, MD

Online MD-Only Bacterial Sinusitis Care

  • Adult 18+ evaluation using bacterial vs viral criteria
  • Symptom relief plans for congestion, pressure, and cough
  • Antibiotics only when indicated, with stewardship focus
  • Clear triage for eye swelling, severe headache, or neurologic symptoms

Adults 18+ only. No controlled substances are prescribed through TeleDirectMD. Eye swelling, vision changes, severe headache with neck stiffness, confusion, or persistent high fever requires urgent in-person evaluation.

Bacterial Sinusitis Telehealth Eligibility Checklist

You are likely eligible for a TeleDirectMD video visit if ALL of these are true:

✓ You ARE Eligible If:

  • You are 18 years old or older
  • You are located in one of our 27 service states during the visit
  • You have sinus congestion, facial pressure, thick nasal discharge, or cough after a cold
  • Your symptoms have lasted 10+ days without improvement, OR you have severe onset with high fever and purulent discharge, OR symptoms worsened after initial improvement
  • You do NOT have eye swelling, vision changes, or painful eye movement
  • You do NOT have severe headache with neck stiffness, confusion, or neurologic symptoms
  • You are able to pay $49 by credit card (no insurance billing available)

✗ You Are NOT Eligible If:

  • You are under 18 years old (pediatric care required)
  • You have swelling or redness around the eye, proptosis, or painful eye movement
  • You have vision changes or double vision
  • You have severe headache with neck stiffness, confusion, focal weakness, or seizures
  • You have persistent high fever with severe illness appearance or signs of dehydration
  • You are severely immunocompromised with moderate to severe symptoms
  • You need controlled substances (narcotics) for pain management

If you have any red-flag symptoms, seek emergency care immediately. TeleDirectMD is not an emergency service.

TeleDirectMD vs Other Care Options for Adult Bacterial Sinusitis

Understanding your options helps you choose the right level of care. Here's how TeleDirectMD compares to other treatment settings for adult bacterial sinusitis:

Care option Typical cost Wait time Provider type Best for
TeleDirectMD $49 flat fee Same day, often within hours Board-certified MD only (no mid-levels) Adults 18+ with sinus symptoms meeting bacterial criteria, no red flags, want convenience and transparent pricing
Urgent Care Center $150-$300+ (before insurance) 1-3 hours average wait time MD, DO, PA, or NP (provider type varies) Same clinical scenarios as telehealth, but requires in-person visit and longer wait times
Emergency Room $500-$3,000+ (before insurance) 2-6 hours average Emergency medicine MD or DO Eye swelling, vision changes, severe headache with neck stiffness, confusion, focal weakness, severe illness appearance
Primary Care Office $100-$250+ (varies by insurance) 3-14 days for appointment availability Family medicine or internal medicine MD or DO (your established physician) Established relationship, complex medical history, chronic sinusitis requiring ENT referral, follow-up care
ENT Specialist $200-$400+ (specialist visit, before insurance) 1-4 weeks for appointment Otolaryngology MD (ENT surgeon) Recurrent bacterial sinusitis (4+ episodes per year), chronic sinusitis lasting 12+ weeks, need for sinus imaging or surgery evaluation

Bottom line: For straightforward adult bacterial sinusitis without complications, TeleDirectMD offers the same MD-level evaluation and evidence-based treatment as urgent care or primary care, but with faster access, lower cost, and no surprise bills.

Should I Use TeleDirectMD for My Sinus Symptoms? Decision Guide

Follow this step-by-step guide to determine the right level of care for your sinus symptoms:

1

Do you have ANY of these emergency symptoms?

  • Swelling or redness around the eye
  • Vision changes, double vision, or painful eye movement
  • Severe headache with neck stiffness
  • Confusion, altered mental status, or focal weakness
  • Seizures or signs of meningitis
  • Persistent high fever (103°F+) with toxic appearance

→ If YES: Go to the Emergency Room immediately

→ If NO: Continue to Step 2

2

Are you 18 years old or older?

→ If YES: Continue to Step 3

→ If NO (under 18): See a pediatrician or pediatric urgent care

3

Do you have sinus symptoms that meet any of these patterns?

  • Symptoms lasting 10 days or more without improvement (persistent symptoms)
  • Severe onset with fever 102.2°F (39°C) or higher AND purulent nasal discharge for at least 3-4 consecutive days
  • Double worsening: symptoms got better initially, then worsened again around day 5-7

→ If YES to any pattern: Continue to Step 4

→ If NO (symptoms less than 10 days, improving): Likely viral - consider supportive care first, or book visit for guidance

4

You are likely appropriate for a TeleDirectMD video visit

Our board-certified MDs can evaluate your symptoms, recommend evidence-based symptom relief, and prescribe antibiotics when clinically appropriate.

→ Book a $49 video visit now

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What Does Bacterial Sinusitis Treatment Cost with TeleDirectMD?

Transparent, flat-fee pricing with no surprise bills:

Video Visit Fee

$49

Flat fee, no hidden charges

What's Included:

  • Complete evaluation by board-certified MD
  • Diagnosis and treatment plan
  • Prescription sent to your pharmacy (if appropriate)
  • Follow-up instructions and guidance

Compare consultation fees:

  • TeleDirectMD: $49 flat fee
  • Urgent care visit: $150-$300+ (before insurance)
  • Emergency room visit: $500-$3,000+ (before insurance)
  • Primary care visit: $100-$250+ (varies by insurance)

No hidden fees. You pay $49 for the video visit regardless of diagnosis or treatment. If antibiotics are not clinically appropriate, you still receive a comprehensive evaluation, symptom management plan, and clear follow-up instructions for the same $49 fee. Prescription costs at your pharmacy are separate and vary by medication and pharmacy.

What Is Adult Bacterial Sinusitis (Acute Bacterial Rhinosinusitis)?

Rhinosinusitis means inflammation of the nasal passages and sinuses. Most acute cases are viral and improve with time and supportive care. Acute bacterial rhinosinusitis (ABRS) is suspected when symptoms follow specific patterns that suggest bacterial overgrowth rather than viral infection.

According to the Infectious Diseases Society of America (IDSA) 2012 clinical practice guidelines, bacterial sinusitis should be suspected when any of these criteria are met:

  • Persistent symptoms: Nasal discharge (of any quality) or daytime cough lasting 10 days or more without evidence of improvement
  • Severe onset: Fever 102.2°F (39°C) or higher with purulent nasal discharge or facial pain lasting at least 3-4 consecutive days at the beginning of illness
  • Worsening symptoms (double sickening): Symptoms initially improved, then worsened again, typically around day 5-7 of illness

TeleDirectMD focuses on confirming whether your symptoms fit bacterial criteria using these evidence-based patterns, checking for complications that require in-person evaluation, and building a treatment plan that balances symptom relief with antibiotic stewardship.

Symptoms and Red Flags in Adult Bacterial Sinusitis

Many adults with sinus symptoms can be managed via telehealth. Certain symptoms suggest complications such as orbital cellulitis, intracranial spread, severe dehydration, or another diagnosis that needs urgent in-person evaluation.

Symptom or situation What it suggests Telehealth appropriate? Red flag requiring urgent in-person care
Nasal congestion, facial pressure, cough after a cold Often viral rhinosinusitis Yes, common telehealth scenario No red flag unless severe or atypical
Symptoms at least 10 days without improvement Possible bacterial sinusitis (IDSA persistent criteria) Yes, often appropriate No
Severe onset with fever 39°C (102.2°F) or higher plus purulent nasal discharge or facial pain Higher likelihood bacterial sinusitis (IDSA severe criteria) Yes, if stable and no red flags Urgent in-person care if toxic appearance or dehydration
Worsening after initial improvement around day 5 to 7 Double worsening, possible bacterial sinusitis (IDSA worsening criteria) Yes No
Swelling or redness around the eye, painful eye movement, vision changes, proptosis Possible orbital cellulitis or abscess No Emergency care immediately
Severe headache, neck stiffness, confusion, focal weakness, seizures Possible intracranial complication or meningitis No Emergency care immediately
Persistent high fever, severe facial swelling, severe unilateral pain out of proportion Complication or alternate diagnosis No as sole management Urgent in-person evaluation
Immunosuppression or major comorbidities with severe symptoms Higher risk and narrower safety margin Telehealth may triage In-person evaluation recommended if moderate to severe symptoms

Differential Diagnosis: Bacterial Sinusitis vs Other Conditions

During your TeleDirectMD visit, the MD will use symptom timing, fever pattern, facial pain distribution, and risk factors to distinguish bacterial sinusitis from other causes of congestion and headache.

Findings Consistent With Bacterial Sinusitis

  • Symptoms at least 10 days without improvement
  • Severe onset with high fever (≥39°C/102.2°F) and purulent discharge for 3-4 days
  • Double worsening after initial improvement
  • Localized facial pain or pressure, often unilateral
  • Maxillary tooth pain (especially upper molars)
  • Pain worsens when bending forward

Other Conditions Considered

  • Viral upper respiratory infection: Most common cause, improves gradually within 7-10 days. No severe onset, no double worsening pattern.
  • Allergic rhinitis: Itching, sneezing, watery drainage, seasonal pattern. Often bilateral symptoms with eye itching. No fever.
  • Dental source pain: Upper tooth pain from dental abscess or infection can mimic sinus pressure. Typically unilateral, worsens with chewing, no nasal discharge.
  • Primary headache disorders: Migraine or tension headache can be mistaken for sinus pain. Migraine often has light/sound sensitivity and nausea.
  • Chronic rhinosinusitis: Symptoms lasting 12+ weeks. Requires different management approach, often needs ENT evaluation.

If symptoms suggest orbital involvement, neurologic complications, or another high-risk diagnosis, our MDs will direct you to urgent in-person evaluation.

When Is a Video Visit Appropriate for Adult Bacterial Sinusitis?

When a Video Visit Is Appropriate

  • Adult 18+ with sinus symptoms that meet IDSA bacterial criteria or need triage
  • No eye swelling, vision changes, or painful eye movement
  • No confusion, neck stiffness, focal weakness, or severe headache pattern change
  • Able to hydrate and not vomiting persistently
  • Willing to use supportive care and follow antibiotic guidance when indicated
  • Located in one of TeleDirectMD's 27 service states at time of visit

Red Flags Requiring In-Person or ER Care

  • Swollen or red eyelid, vision changes, proptosis, or painful eye movement
  • Severe headache with neck stiffness, confusion, weakness, or seizures
  • Persistent high fever with toxic appearance or dehydration
  • Severe facial swelling or severe unilateral pain out of proportion
  • Significant immunosuppression with moderate to severe symptoms

If any red-flag symptoms are present, seek urgent in-person or emergency care. TeleDirectMD is not an emergency service.

Treatment Options for Adult Bacterial Sinusitis

Treatment focuses on symptom relief and selective antibiotic use when IDSA criteria are met. Many adults improve with supportive care alone. When bacterial sinusitis is likely, antibiotics can shorten illness duration and reduce risk of complications, but unnecessary antibiotics add side effects and contribute to antibiotic resistance.

Supportive Care (Recommended for All Patients)

  • Saline irrigation or saline spray: Reduces congestion and mucus. Use 1-2 times daily. Studies show irrigation can reduce symptom duration.
  • Intranasal corticosteroid spray: Reduces inflammation, especially helpful with allergy overlap. Examples: fluticasone, mometasone. Use daily for 10-14 days.
  • Acetaminophen or NSAIDs: For pain or fever when safe. Follow dosing instructions, consider contraindications.
  • Hydration: 8+ glasses of water daily helps thin secretions.
  • Sleep and rest: Supports immune function.
  • Humidified air: Cool mist humidifier can ease congestion.
  • Avoid irritants: Cigarette smoke, strong perfumes, chlorine can worsen symptoms.

Antibiotics When Clinically Appropriate

Per IDSA guidelines, antibiotics are generally considered when symptoms meet bacterial criteria (persistent ≥10 days, severe onset, or double worsening) and there are no signs of complications requiring in-person care.

  • First-line choice: Amoxicillin-clavulanate is preferred for most adults due to coverage of common bacterial pathogens including beta-lactamase producing strains.
  • Penicillin allergy alternatives: Doxycycline or respiratory fluoroquinolones (levofloxacin) when appropriate. TeleDirectMD limits fluoroquinolone use due to FDA safety warnings.
  • Duration: Typically 5-7 days for uncomplicated bacterial sinusitis in adults (per recent evidence supporting shorter courses).
  • Antibiotic stewardship: TeleDirectMD follows IDSA guidance to avoid antibiotics when viral infection is more likely.

Watchful Waiting Approach

For mild symptoms early in the bacterial criteria window (day 10-12 of persistent symptoms), a watchful waiting approach with strong symptom relief may be recommended. You'll receive clear instructions on when to start antibiotics or seek follow-up based on symptom progression.

Common Medications Used for Adult Bacterial Sinusitis

The best regimen depends on symptom pattern, allergy history, recent antibiotics, and kidney function. The table below shows typical examples an MD may consider for adults appropriate for telehealth.

Medication Dose Duration When it is used
Amoxicillin-clavulanate 875-125mg tablet 875-125mg by mouth twice daily with food 5-7 days IDSA first-line antibiotic when bacterial criteria are met and no penicillin allergy. Covers S. pneumoniae, H. influenzae, M. catarrhalis including beta-lactamase producers.
Doxycycline 100mg capsule 100mg by mouth twice daily 5-7 days Alternative for adults with penicillin allergy when appropriate. Good tissue penetration. Avoid in pregnancy.
Levofloxacin 500mg tablet 500mg by mouth once daily 5 days Reserved for beta-lactam allergic patients when doxycycline not suitable. TeleDirectMD uses sparingly due to FDA boxed warnings (tendon rupture, peripheral neuropathy, CNS effects).
Fluticasone nasal spray 50mcg per spray 2 sprays per nostril once daily 10-14 days or longer if chronic rhinitis overlap Inflammation control and congestion relief. Safe for prolonged use. Works best with consistent daily dosing.
Saline nasal irrigation (e.g., NeilMed) Use as directed 1-2 times daily As needed, can continue long-term Mucus clearance and symptom relief. Evidence supports effectiveness. Safe for all patients.
Acetaminophen 500mg 500-1000mg every 6 hours as needed (max 3000mg/day) As needed for symptoms Pain and fever relief. Safe in most patients. Lower max dose if liver disease or alcohol use.
Ibuprofen 200mg 400-600mg every 6-8 hours as needed with food (max 2400mg/day) As needed for symptoms Pain, fever, and inflammation relief. Avoid if kidney disease, heart failure, or GI bleeding history.

Important: These are example regimens only. Actual medications, strengths, and durations are determined by the MD after reviewing your complete medical history, allergies, contraindications, kidney function, liver function, and other medications. Never take antibiotics prescribed for someone else or saved from a previous illness.

Home Care, Expectations, and Return to Work

Viral sinus symptoms often improve within 7-10 days. When bacterial sinusitis is present and treated appropriately with antibiotics, many adults begin to improve within 48-72 hours after starting treatment, though congestion and cough can linger longer.

What to Expect During Recovery

  • First 24-48 hours: Continue supportive care (saline, fluids, rest). Fever should start improving if antibiotics are prescribed.
  • Days 3-5: Noticeable reduction in facial pain, pressure, and purulent discharge for most patients on appropriate antibiotics.
  • Days 5-10: Congestion and postnasal drip gradually improve. Some mild cough may persist.
  • After 10 days: Most patients back to baseline. Lingering mild congestion can take 2-3 weeks to fully resolve.

Home Care Instructions

  • Use supportive care consistently for symptom relief (saline irrigation, nasal steroid spray, hydration).
  • If antibiotics are prescribed, take them exactly as directed. Complete the full course even if feeling better. Do not save doses for later use.
  • Continue intranasal corticosteroid spray for the full 10-14 days even if symptoms improve earlier.
  • Avoid overuse of over-the-counter decongestant nasal sprays (Afrin, oxymetazoline) - maximum 3 days to prevent rebound congestion.
  • Monitor for worsening symptoms or development of red flags.

Return to Work and Activities

  • Most adults can return to work when fever has resolved for 24 hours without fever-reducing medications and symptoms are manageable.
  • Office/sedentary work: Often reasonable to return within 2-3 days of starting treatment if feeling well enough.
  • Physical labor: May need an additional 2-3 days if experiencing significant fatigue or congestion.
  • Bacterial sinusitis is not highly contagious once on antibiotics for 24 hours, though common cold viruses that often precede it may still be transmissible.
  • Exercise: Light activity is generally safe when fever-free. Avoid strenuous exercise until feeling close to baseline to avoid prolonging recovery.

When to Seek Follow-up Care

Contact a healthcare provider or seek urgent care if:

  • Symptoms worsen or do not improve after 3-5 days of antibiotics
  • Development of any red-flag symptoms (eye swelling, vision changes, severe headache, confusion)
  • New high fever after initial improvement
  • Severe side effects from antibiotics (rash, severe diarrhea, difficulty breathing)

When NOT to Use TeleDirectMD for Sinus Symptoms

TeleDirectMD is designed for straightforward adult bacterial sinusitis without complications. We believe in transparent communication about when our service is not the right fit for your care needs.

You Should NOT Use TeleDirectMD If:

  • You are under 18 years old: We only treat adults 18 and older. Pediatric sinusitis requires pediatrician evaluation due to different bacterial pathogens, dosing considerations, and development factors.
  • You have eye involvement: Swelling around the eye, redness of the eyelid, vision changes, double vision, painful eye movement, or bulging eye (proptosis) suggest orbital cellulitis or abscess. This requires emergency imaging (CT scan) and possible IV antibiotics or surgery. Go to the ER immediately.
  • You have neurologic symptoms: Confusion, altered mental status, severe headache with neck stiffness, focal weakness, numbness, seizures, or signs of meningitis require emergency evaluation for possible intracranial complications. Go to the ER immediately.
  • You likely need imaging: If your symptoms suggest complicated sinusitis requiring CT sinus imaging (recurrent episodes, chronic symptoms, failed multiple antibiotic courses), start with in-person urgent care, ENT specialist, or your primary care doctor who can order imaging.
  • You need controlled substances: TeleDirectMD does not prescribe controlled medications including narcotic pain relievers. If you have severe pain requiring opioids, seek in-person evaluation.
  • You have severe immunosuppression with moderate to severe symptoms: Active chemotherapy, HIV with low CD4 count, chronic high-dose steroids, or organ transplant patients with significant symptoms have higher complication risk and may benefit from in-person evaluation with possible imaging.
  • You have recurrent bacterial sinusitis: If you have 4+ episodes per year, you may have chronic rhinosinusitis, anatomic issues (deviated septum, polyps), or immune deficiency. ENT specialist evaluation is more appropriate for comprehensive workup.
  • You have chronic sinusitis (12+ weeks of symptoms): Chronic rhinosinusitis requires different management approach, often including nasal endoscopy, CT imaging, prolonged steroid sprays, and sometimes surgery consultation. See an ENT specialist.
  • You are located outside our service states: Telemedicine visits require medical licensure in your state. If you're not in one of our 27 service states at the time of your visit, we cannot provide care.

Alternative Care Options:

  • Emergency room: For red-flag symptoms (eye/vision changes, severe headache, confusion, neurologic symptoms)
  • Urgent care center: For same-day in-person evaluation when imaging might be needed
  • ENT specialist: For recurrent sinusitis (4+ episodes/year), chronic sinusitis (12+ weeks), or need for nasal endoscopy
  • Primary care physician: For established relationship, complex medical history, or chronic sinusitis requiring ongoing management
  • Pediatrician or pediatric urgent care: For patients under 18

Common Questions About Online Bacterial Sinusitis Treatment

These are the most common questions patients ask when researching online treatment for sinus infections. Here are straightforward answers:

Can I get antibiotics online for a sinus infection?

Yes, if you are an adult 18+ with symptoms that meet IDSA bacterial criteria (persistent ≥10 days, severe onset with high fever, or double worsening) and no red-flag complications. TeleDirectMD board-certified MDs can prescribe amoxicillin-clavulanate, doxycycline, and other appropriate antibiotics during a $49 video visit when clinically indicated. Antibiotics are not prescribed for viral sinus symptoms.

How much does online sinus infection treatment cost?

TeleDirectMD charges a $49 flat fee per adult video visit. No insurance is required or accepted. This includes your complete evaluation, diagnosis, treatment plan, and prescription sent to your pharmacy when appropriate. Prescription costs at your pharmacy are separate and vary by medication, pharmacy, and whether you use insurance or discount programs.

Can a virtual doctor diagnose a sinus infection?

Yes. Board-certified MDs can evaluate bacterial sinusitis using evidence-based criteria including symptom timeline (duration ≥10 days without improvement), severity of onset (high fever ≥102.2°F with purulent discharge), pattern of illness (worsening after initial improvement), fever pattern, and facial pain distribution. Red flags like eye swelling, vision changes, severe headache with neurologic symptoms, or signs of complications require in-person or emergency care.

What states does TeleDirectMD treat sinus infections in?

TeleDirectMD provides adult bacterial sinusitis treatment via video visit in 27 states including Alabama, Arizona, California, Colorado, Florida, Georgia, Illinois, Indiana, Iowa, Kentucky, Louisiana, Michigan, Minnesota, Mississippi, Missouri, Nevada, New Jersey, North Carolina, Ohio, Oklahoma, Pennsylvania, South Carolina, Tennessee, Texas, Utah, Washington, and Wisconsin. You must be physically located in one of these states at the time of your video visit. See full state list with condition-specific pages.

How do I know if I have bacterial sinusitis vs a viral cold?

Bacterial sinusitis is more likely when: (1) symptoms last 10+ days without improvement, (2) severe onset with fever ≥102.2°F and purulent nasal discharge for 3-4 days, or (3) symptoms worsen after initially improving around day 5-7. Viral colds typically improve within 7-10 days. A TeleDirectMD MD can help determine if your symptom pattern suggests bacterial infection warranting antibiotics or viral illness best treated with supportive care.

Can I use TeleDirectMD if I have a fever and sinus pain?

Yes, if you are 18+ and have no red flags. Fever with sinus pain can suggest bacterial sinusitis, especially if fever is ≥102.2°F (39°C) with purulent nasal discharge. However, if you have severe headache with neck stiffness, confusion, eye swelling, vision changes, or appear severely ill, you need emergency in-person evaluation, not telehealth.

Will I get antibiotics every time I have a sinus infection?

No. TeleDirectMD follows antibiotic stewardship guidelines. Most sinus symptoms are viral and improve without antibiotics within 7-10 days. Our MDs prescribe antibiotics only when your symptoms meet IDSA criteria for bacterial sinusitis. If your symptoms appear viral, you'll receive evidence-based symptom management recommendations (saline irrigation, nasal steroid spray, pain relief) without antibiotics. This approach reduces unnecessary antibiotic side effects and helps combat antibiotic resistance.

What if I have a penicillin allergy?

TeleDirectMD MDs can prescribe alternative antibiotics for penicillin-allergic patients. Doxycycline is commonly used for adults with penicillin allergy. In select cases, respiratory fluoroquinolones (like levofloxacin) may be considered, though TeleDirectMD uses these sparingly due to FDA safety warnings. Be prepared to describe your penicillin allergy reaction (rash, hives, anaphylaxis, etc.) as this helps determine the safest alternative.

How quickly will I get my prescription after the video visit?

If antibiotics are clinically appropriate, your prescription is typically sent electronically to your chosen pharmacy within 15-30 minutes after your video visit ends. Most pharmacies can fill the prescription within 1-2 hours. We recommend calling your pharmacy to confirm they have the medication in stock, especially for less common antibiotics or if using a small independent pharmacy.

Can TeleDirectMD treat children with sinus infections?

No. TeleDirectMD only treats adults 18 years and older. Pediatric sinusitis requires different evaluation, involves different bacterial pathogens, uses different antibiotic dosing based on weight, and has different safety considerations. Children with sinus symptoms should see a pediatrician or pediatric urgent care provider.

TeleDirectMD Telehealth Disclaimer

TeleDirectMD provides MD-only virtual urgent care for adults using secure video visits to evaluate sinus symptoms and bacterial sinusitis. Visits are $49 flat-fee with no insurance required and are available in 27 states including Alabama, Arizona, California, Colorado, Florida, Georgia, Illinois, Indiana, Iowa, Kentucky, Louisiana, Michigan, Minnesota, Mississippi, Missouri, Nevada, New Jersey, North Carolina, Ohio, Oklahoma, Pennsylvania, South Carolina, Tennessee, Texas, Utah, Washington, and Wisconsin.

Our physicians use evidence-based criteria from the Infectious Diseases Society of America (IDSA) to distinguish viral rhinosinusitis from bacterial sinusitis, recommend symptom relief, and prescribe antibiotics only when clinically appropriate. Treatment decisions are based on the 2012 IDSA Clinical Practice Guideline for Acute Bacterial Rhinosinusitis in Children and Adults.

TeleDirectMD is not an emergency service and is not a replacement for comprehensive in-person care. Patients with red-flag symptoms including eye swelling, vision changes, severe headache with neurologic symptoms, or signs of complications require urgent in-person or emergency evaluation.

Adult Bacterial Sinusitis Treatment FAQs

How do you tell viral sinusitis from bacterial sinusitis?

Bacterial sinusitis is more likely when symptoms last at least 10 days without improvement, when there is severe onset with high fever (≥102.2°F/39°C) and purulent discharge for 3-4 days, or when symptoms worsen after initial improvement (double worsening). These are the IDSA evidence-based criteria that distinguish bacterial from viral rhinosinusitis.

Do I always need antibiotics for sinus symptoms?

No. Most sinus symptoms are viral and improve without antibiotics within 7-10 days using supportive care (saline irrigation, nasal steroid spray, hydration, rest). When bacterial criteria are met, antibiotics may help shorten illness duration and reduce complications, but unnecessary antibiotics add side effects (diarrhea, yeast infections, allergic reactions) and contribute to antibiotic resistance. TeleDirectMD follows antibiotic stewardship principles.

Can TeleDirectMD treat bacterial sinusitis through an online visit for adults?

Yes, for many adults 18+ without red flags. Our board-certified MDs can evaluate your symptom timeline, fever pattern, facial pain distribution, and apply IDSA criteria to determine if antibiotics are appropriate. We provide symptom management recommendations and prescribe antibiotics when clinically indicated. Patients with eye symptoms, vision changes, severe headache with neurologic signs, or complications require in-person or emergency evaluation.

What is the first-line antibiotic for adult bacterial sinusitis?

Amoxicillin-clavulanate 875-125mg twice daily for 5-7 days is the IDSA-recommended first-line antibiotic when bacterial criteria are met and there is no penicillin allergy. This combination covers the most common bacterial pathogens including Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis, including beta-lactamase producing strains. The exact choice depends on allergies, recent antibiotic use, and other risk factors.

How quickly should I feel better after starting antibiotics?

Many adults start noticing improvement within 48-72 hours of starting appropriate antibiotics. Fever should resolve, facial pain and pressure should decrease, and purulent nasal discharge should improve. However, congestion and postnasal drip can take 7-10 days to fully resolve, and mild cough may persist for 2-3 weeks. If you are worsening, develop red flags (eye symptoms, severe headache, confusion), or have no improvement after 3-5 days of antibiotics, you should seek follow-up care.

What supportive treatments help the most?

Saline nasal irrigation (1-2 times daily), intranasal corticosteroid spray (fluticasone or mometasone once daily), adequate hydration (8+ glasses water daily), humidified air (cool mist humidifier), and pain relievers when safe (acetaminophen or ibuprofen) provide the most symptom relief. Evidence supports saline irrigation for reducing symptom severity and duration. Avoid overusing topical decongestant sprays like Afrin (maximum 3 days) as they cause rebound congestion with prolonged use.

When is sinusitis dangerous?

Sinusitis is dangerous when it spreads beyond the sinuses to surrounding structures. Red flags include: eye swelling or redness, vision changes or double vision, painful eye movement, bulging eye (proptosis), severe headache with neck stiffness, confusion or altered mental status, focal neurologic weakness, seizures, or persistent high fever with toxic appearance. These symptoms suggest orbital cellulitis, orbital abscess, intracranial extension, meningitis, or brain abscess. All require emergency in-person evaluation with imaging (CT scan) and possible IV antibiotics or surgery.

Can allergies cause sinus pressure that feels like an infection?

Yes. Allergic rhinitis can cause nasal congestion, facial pressure, postnasal drip, and headache that mimic bacterial sinus infection. Key differences: allergies typically cause itching (nose, eyes, throat), sneezing, watery (not purulent) nasal drainage, bilateral symptoms, and seasonal or trigger-based patterns. Allergies do not cause fever. Allergy-focused treatment (antihistamines, nasal steroid spray, allergen avoidance) is more appropriate when symptoms fit allergic rhinitis pattern rather than bacterial criteria.

Why does TeleDirectMD focus on antibiotic stewardship?

Antibiotics help when bacterial sinusitis is likely, but most sinus symptoms (estimated 90-98%) are viral and do not benefit from antibiotics. Unnecessary antibiotics cause avoidable side effects (diarrhea, yeast infections, allergic reactions, C. difficile colitis), contribute to antibiotic resistance (a major public health threat), and add cost without benefit. Stewardship means using antibiotics appropriately when they help while avoiding them when they don't. This approach follows IDSA guidelines and protects both individual patients and public health.

What makes TeleDirectMD different for adult bacterial sinusitis care?

TeleDirectMD provides MD-only (no physician assistants or nurse practitioners), guideline-based evaluation by secure video visit with transparent $49 flat-fee pricing (no insurance required or accepted) in 27 states. We use IDSA evidence-based viral versus bacterial criteria, emphasize symptom relief with saline irrigation and nasal steroid sprays, prescribe antibiotics only when clinically appropriate, provide clear red flag triage for complications, and follow antibiotic stewardship principles. Same-day appointments are typically available with prescription sent to your pharmacy within 15-30 minutes when appropriate.

Can I use my insurance for a TeleDirectMD visit?

No. TeleDirectMD does not accept insurance or provide documentation for insurance reimbursement. All visits are $49 flat-fee paid by credit card at time of booking. This allows us to offer transparent pricing with no surprise bills, copays, deductibles, or claim denials. Your prescription can be filled using your pharmacy insurance or discount programs (GoodRx, pharmacy savings cards) as usual.

What if I need imaging like a CT scan?

TeleDirectMD cannot order imaging studies like CT scans through video visits. If your symptoms suggest you may need imaging (recurrent sinusitis, chronic symptoms lasting 12+ weeks, failed multiple antibiotic courses, concern for complications, severe symptoms), we will direct you to in-person urgent care, your primary care physician, or an ENT specialist who can order appropriate imaging and provide comprehensive in-person evaluation.

Not sure if this is viral or bacterial?

$49 flat fee. Adult-only video visits. MD-only care. Evidence-based criteria, symptom relief, and antibiotics only when appropriate.

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