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. TeleDirectMD physicians 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 is 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) Similar clinical scenarios as telehealth, but requires in-person visit
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 Established relationship, complex medical history, chronic sinusitis requiring ENT referral
ENT Specialist $200-$400+ (specialist visit, before insurance) 1-4 weeks for appointment Otolaryngology MD (ENT surgeon) Recurrent episodes (4+ per year), chronic symptoms lasting 12+ weeks, need for imaging or endoscopy

Bottom line: For straightforward adult bacterial sinusitis without complications, TeleDirectMD offers MD-level evaluation and evidence-based treatment without urgent care wait times and without surprise bills.

Should I Use TeleDirectMD for My Sinus Symptoms? Decision Guide

Use 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, see a pediatrician or pediatric urgent care

3

Do your symptoms fit 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 improved initially, then worsened again around day 5-7

If YES to any pattern, continue to Step 4

If NO and symptoms are improving within 7-10 days, a viral cause is more likely and supportive care is often best

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 is 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.

Per IDSA guideline criteria, bacterial sinusitis is suspected when any of these patterns are present:

  • Persistent symptoms: nasal discharge (any quality) or daytime cough lasting 10 days or more without 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 improved, then worsened again, often around day 5-7

TeleDirectMD focuses on confirming whether 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 No red flag unless severe or atypical
Symptoms at least 10 days without improvement Possible bacterial sinusitis (persistent criteria) Yes No
Severe onset with fever 39°C (102.2°F) or higher plus purulent discharge or facial pain Higher likelihood bacterial sinusitis (severe criteria) Yes, if stable Urgent in-person care if toxic appearance or dehydration
Worsening after initial improvement around day 5 to 7 Double worsening pattern 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 with severe illness appearance Complication or alternate diagnosis No as sole management Urgent in-person evaluation
Immunosuppression with moderate to severe symptoms Higher risk and narrower safety margin Telehealth may triage In-person evaluation recommended

Differential Diagnosis: Bacterial Sinusitis vs Other Conditions

During your TeleDirectMD visit, the MD uses 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 worse when bending forward

Other Conditions Considered

  • Viral upper respiratory infection: most common cause, improves gradually within 7-10 days
  • Allergic rhinitis: itching, sneezing, watery drainage, seasonal triggers, no fever
  • Dental source pain: upper tooth infection can mimic sinus pressure, often unilateral
  • Primary headache disorders: migraine or tension headache can be mistaken for sinus pain
  • Chronic rhinosinusitis: symptoms lasting 12+ weeks, 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 symptoms that meet 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 bacterial 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. Unnecessary antibiotics can add side effects and contribute to antibiotic resistance.

Supportive Care (Recommended for All Patients)

  • Saline irrigation or saline spray: helps reduce congestion and mucus. Use 1-2 times daily.
  • 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.
  • Hydration: helps thin secretions.
  • Sleep and rest: supports recovery.
  • Humidified air: can ease congestion.
  • Avoid irritants: cigarette smoke and strong fragrances can worsen symptoms.

Antibiotics When Clinically Appropriate

Per IDSA guidance, 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.
  • Penicillin allergy alternatives: doxycycline is often appropriate. Respiratory fluoroquinolones (such as levofloxacin) may be considered in select cases. TeleDirectMD limits fluoroquinolone use due to FDA safety warnings.
  • Duration: often 5-7 days for uncomplicated adult bacterial sinusitis, based on evidence supporting shorter courses for many patients.
  • Antibiotic stewardship: TeleDirectMD avoids antibiotics when a viral illness is more likely.

Watchful Waiting Approach

For mild symptoms near the beginning of the persistent symptom window, watchful waiting with strong symptom relief may be reasonable. You will 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 875-125 mg tablet 875-125 mg by mouth twice daily with food 5-7 days First-line antibiotic when bacterial criteria are met and there is no penicillin allergy.
Doxycycline 100 mg capsule 100 mg by mouth twice daily 5-7 days Alternative for adults with penicillin allergy when appropriate. Avoid in pregnancy.
Levofloxacin 500 mg tablet 500 mg by mouth once daily 5 days Reserved for select cases when other options are not suitable. Used sparingly due to FDA safety warnings.
Fluticasone nasal spray 50 mcg per spray 2 sprays per nostril once daily 10-14 days Inflammation control and congestion relief, especially with allergic overlap.
Saline nasal irrigation Use as directed 1-2 times daily As needed Mucus clearance and symptom relief.
Acetaminophen 500 mg 500-1000 mg every 6 hours as needed (max 3000 mg/day) As needed Pain and fever relief. Lower max dose if liver disease or heavy alcohol use.
Ibuprofen 200 mg 400-600 mg every 6-8 hours as needed with food (max 2400 mg/day) As needed Pain, fever, and inflammation relief. Avoid with kidney disease, heart failure, or GI bleeding history.

Important: These are example regimens. Actual medications, strengths, and durations are determined by the MD after reviewing medical history, allergies, contraindications, kidney function, liver function, and current medications. Do not take antibiotics prescribed for someone else.

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).
  • Days 3-5: facial pain, pressure, and discharge often improve if antibiotics are appropriate.
  • Days 5-10: congestion and postnasal drip gradually improve.
  • After 10 days: most patients are close to baseline. Mild congestion can persist longer.

Home Care Instructions

  • Use supportive care consistently (saline irrigation, nasal steroid spray, hydration).
  • If antibiotics are prescribed, take them exactly as directed and complete the course.
  • Avoid overuse of OTC decongestant nasal sprays (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.
  • Light activity is generally safe when fever-free. Avoid strenuous exercise until close to baseline.

When to Seek Follow-up Care

  • Symptoms worsen or do not improve after 3-5 days of antibiotics
  • Any red-flag symptoms develop (eye swelling, vision changes, severe headache, confusion)
  • Severe side effects from antibiotics (rash, severe diarrhea, trouble breathing)

When NOT to Use TeleDirectMD for Sinus Symptoms

TeleDirectMD is designed for straightforward adult bacterial sinusitis without complications. We are direct about when our service is not the right fit.

You Should NOT Use TeleDirectMD If:

  • You are under 18 years old: we treat adults only.
  • You have eye involvement: swelling around the eye, redness, vision changes, double vision, painful eye movement, or proptosis. Go to the ER immediately.
  • You have neurologic symptoms: confusion, severe headache with neck stiffness, focal weakness, numbness, seizures, or meningitis concerns. Go to the ER immediately.
  • You likely need imaging: recurrent episodes, chronic symptoms, or failure of multiple antibiotic courses often require in-person evaluation and possible CT imaging.
  • You need controlled substances: TeleDirectMD does not prescribe controlled medications.
  • You have severe immunosuppression with moderate to severe symptoms: in-person evaluation is often safer.
  • You have recurrent bacterial sinusitis: 4+ episodes per year suggests a need for broader evaluation.
  • You have chronic sinusitis: symptoms lasting 12+ weeks often require ENT evaluation.
  • You are outside our service states: you must be located in one of our 27 states at the time of the visit.

Alternative Care Options:

  • Emergency room: eye or neurologic red flags, severe illness appearance
  • Urgent care: same-day in-person evaluation when imaging might be needed
  • ENT specialist: recurrent or chronic symptoms, need for endoscopy or imaging
  • Primary care: follow-up care and longer-term management

Adult Bacterial Sinusitis Treatment FAQs

Can I get antibiotics online for a sinus infection?

Yes, if you are an adult 18+ with symptoms that meet bacterial criteria (persistent symptoms 10+ days without improvement, severe onset with high fever and purulent discharge, or double worsening) and you do not have red-flag symptoms. TeleDirectMD MDs prescribe antibiotics only when clinically appropriate.

How much does online sinus infection treatment cost?

TeleDirectMD charges a $49 flat fee per adult video visit. No insurance is required or accepted. Prescription costs at your pharmacy are separate and vary by medication and pharmacy.

Can a virtual doctor diagnose a sinus infection?

Yes. A physician can evaluate the symptom timeline, severity, fever pattern, facial pain distribution, and the presence of bacterial criteria. Red flags like eye swelling, vision changes, severe headache with neurologic symptoms, or signs of complications require in-person or emergency care.

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 (39°C/102.2°F) and purulent discharge for 3-4 days, or when symptoms worsen after initial improvement (double worsening). These criteria help distinguish bacterial from viral illness.

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

Viral colds typically improve within 7-10 days. Bacterial sinusitis is more likely if symptoms persist 10+ days without improvement, start severely with high fever and purulent discharge, or worsen again after initial improvement around day 5-7.

Do I always need antibiotics for sinus symptoms?

No. Many sinus symptoms are viral and improve with supportive care. Antibiotics are used when bacterial criteria are met and benefits outweigh risks. This approach reduces avoidable side effects and supports antibiotic stewardship.

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

No. TeleDirectMD prescribes antibiotics only when symptoms fit bacterial criteria and there are no red flags. If symptoms appear viral, you will receive an evidence-based symptom relief plan without antibiotics.

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

Amoxicillin-clavulanate is commonly used as a first-line option when bacterial criteria are met and there is no penicillin allergy. The exact choice depends on allergy history, recent antibiotic use, comorbidities, and risk factors.

What if I have a penicillin allergy?

Doxycycline is often an appropriate alternative for adults with penicillin allergy. In select cases, other options may be considered. Be prepared to describe the reaction you had to penicillin so the MD can choose the safest alternative.

What supportive treatments help the most?

Saline nasal irrigation 1-2 times daily, intranasal corticosteroid spray used consistently, hydration, humidified air, and pain relievers when safe are common high-yield options. Avoid using topical decongestant sprays for more than 3 days to prevent rebound congestion.

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

If antibiotics are clinically appropriate, the prescription is typically sent electronically to your chosen pharmacy soon after the visit. Fill times vary by pharmacy.

When is sinusitis dangerous?

Sinusitis is dangerous when it spreads beyond the sinuses. Red flags include eye swelling or redness, vision changes, painful eye movement, proptosis, severe headache with neck stiffness, confusion, focal neurologic weakness, seizures, or persistent high fever with severe illness appearance. These require urgent in-person evaluation.

What if I need imaging like a CT scan?

If symptoms suggest you may need imaging (recurrent episodes, chronic symptoms lasting 12+ weeks, failure of multiple courses, or concern for complications), you should be evaluated in person by urgent care, primary care, or an ENT specialist who can order appropriate imaging.

What states does TeleDirectMD treat sinus infections in?

TeleDirectMD provides adult bacterial sinusitis care via video visit in 27 states: 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.

Can TeleDirectMD treat children with sinus infections?

No. TeleDirectMD treats adults 18+ only. Children with sinus symptoms should be evaluated by a pediatrician or pediatric urgent care provider.

Can I use my insurance for a TeleDirectMD visit?

No. TeleDirectMD does not accept insurance. Visits are $49 flat-fee paid at booking. Your prescription can be filled using your pharmacy insurance or discount programs as usual.

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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References

  • Infectious Diseases Society of America (IDSA). Clinical Practice Guideline for Acute Bacterial Rhinosinusitis in Children and Adults. View guideline
  • CDC. Sinus Infection Basics (including watchful waiting and when antibiotics may be needed). View CDC page
  • CDC. Adult Outpatient Antibiotic Prescribing Guidance (acute rhinosinusitis section). View guidance
  • FDA. Drug Safety Communication on fluoroquinolone risks (boxed warnings and safety concerns). View FDA communication

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.

Physicians use evidence-based criteria from IDSA to distinguish viral rhinosinusitis from bacterial sinusitis, recommend symptom relief, and prescribe antibiotics only when clinically appropriate.

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.